使用认知访谈来改进实施准备度的衡量。
Using cognitive interviews to improve a measure of organizational readiness for implementation.
机构信息
Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
出版信息
BMC Health Serv Res. 2023 Jan 27;23(1):93. doi: 10.1186/s12913-022-09005-y.
BACKGROUND
Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.
METHODS
We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.
RESULTS
Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means).
CONCLUSION
Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.
背景
组织准备度是成功实施基于证据的干预措施（EBIs）的关键因素，但需要一种有效的、可靠的衡量标准来评估不同背景和环境下的准备情况。R = MC 启发式理论认为，组织准备度源于组织实施特定创新的动机、能力及其总体能力。本文描述了一种用于检验基于 R = MC 开发的用于评估实施结直肠癌筛查（CRCS）EBI 的联邦合格健康中心（FQHC）的组织准备度（基于 R = MC）的准备情况调查中项目的表面有效性和内容有效性的过程。
方法
我们在南卡罗来纳州和德克萨斯州对 FQHC 工作人员（临床和非临床）进行了 20 次认知访谈。参与者收到了准备情况调查的一部分项目进行审查。制定了一个半结构化访谈指南，通过“大声思考”和探究技术从参与者那里获得反馈。参与者采用目的性抽样方法招募，并使用 Zoom 和 WebEx 进行虚拟访谈。参与者被问到 1）项目的相关性，2）他们如何解释项目或特定术语的含义，3）识别难以理解的项目，以及 4）如何改进项目。访谈逐字转录并在 ATLAS.ti 中进行编码。研究结果用于修改准备情况调查。
结果
主要建议包括缩短调查长度和删除冗余或难以理解的项目。此外，参与者建议在整个调查中使用一致的术语（例如，其他单位/团队与部门）并更改代词（例如，人们，我们）以使其更加具体（例如，领导层，员工）。此外，参与者建议明确模糊的术语（例如，定义“更好”的含义）。
结论
使用认知访谈可以进行一项参与式的过程来改进现有的准备情况衡量标准。改进和最终确定的准备情况调查可用于支持和改善结直肠癌筛查 EBI 在诊所环境中的实施，从而降低癌症负担和与癌症相关的健康差距。
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