Assessing the Inner Setting among Massachusetts Community Health Centers: Opportunities for Multilevel Investigation and Expansion of Influences on Health Equity.

BACKGROUND

Implementation science increasingly aims to improve equity in delivery of evidence-based interventions. It is important to expand the conceptualization of the inner setting, organizations like community health centers where interventions are put into place, accordingly. Taking a comprehensive, partnered approach to measuring the inner setting among a network of community health centers engaged in implementation research ensures assessment of the variability among sites and generates centralized contextual data that can be applied across studies.

METHODS

We conducted a cross-sectional survey among staff (n = 63) from 12 community health centers in Massachusetts engaged in research at the Implementation Science Center for Cancer Control Equity. The survey assessed inner setting constructs from the Consolidated Framework for Implementation Research, including learning climate, leadership engagement, available resources, and implementation demands/stress using validated measures. Additional equity-focused inner setting items included structural characteristics of the work infrastructure and language access services. Descriptive statistics examined differences by staff role and health center.

RESULTS

Staff rated learning climate (mean = 3.98) and leadership engagement (mean = 3.67) positively, while available resources (mean = 2.78) had the lowest rating, particularly staffing resources. Clinical staff rated the inner context lowest compared to other roles. Most centers provided tuition assistance and all reported supportive human resources benefits for caregiving, while fewer offered formal mentorship or affinity groups. Most community health centers reported written materials are routinely provided to patients in languages other than English and interpreter services were most common in Spanish, Vietnamese, and Portuguese.

CONCLUSIONS

This study provides a baseline assessment of the inner setting within Massachusetts community health centers. Periodic follow-up surveys will monitor changes over time. Data can be used in future analyses to explore how inner setting characteristics influence implementation outcomes and impact equitable translation of evidence-based interventions into practice.