Fernandez et al. 2018. Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research

Maria Fernandez and colleagues developed quantitative measures for 7 constructs within the Inner Setting. Five exist within CFIR: Culture Overall (9 items), Implementation Climate (4 items), Learning Climate (4 items), Leadership Engagement (4 items), and Available Resources (7 items). Items were drawn from the Practice Adaptive Reserve instrument (Jaen et al, 2010), The Organizational Readiness for Change Assessment (Helfrich et al, 2009), Clinical Oncology Program Survey (Weiner et al, 2011), and a single item from the Implementation Climate Assessment (Konn et al, 2001). Two constructs are not included in CFIR but included in measure development: Culture Stress (4 items) and Culture Effort (5 items). These latter two constructs are conceptualized as distinct from general Culture. Culture Effort is based on the work of Patterson et al and measures how hard people work toward achieving goals and includes items like, “People in this clinic always want to perform to the best of their abilities.” Culture Stress, based on the work of Lehman et al, measures perceived strain, stress, and role overload and includes items like, “Staff frustration is common here.” They chose to focus on these 7 constructs based on the degree to which they fit CFIR definitions, salience for health-related settings, achieved survey goals for FQHCs within a cancer control network, and had some evidence of reliability and validity.

All scales exhibited acceptable/good scale reliability, model fit, discriminant validity and interrater reliability. Analyses revealed that individual responses to survey items can be aggregated to the clinic level, which is great news. In separate analyses (not included in this article), they found that rolling up the 38 items into a single measure did exhibit properties supporting the notion of a latent class related to Inner Setting. These measures are available for use. We have posted the instrument under our Quantitative Measures page and included links from the individual construct pages. To compute each subscale, compute the mean response by unit (e.g., clinic) and average the items for each subscale (construct). They were not able to provide recommendations on minimum number of individuals needed to reliably assess organization-level constructs.

For a copy of the instrument and permission to use, please email Dr. Fernandez at: Maria.E.Fernandez at uth-dot-tmc-dot-edu