Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for...

Area of Science:

• Implementation Science
• Health Services Research
• Psychometrics

Background:

• Reliable and valid measures of contextual factors influencing implementation are crucial but scarce.
• Existing measures often lack demonstrated reliability or validity.
• This study addresses this gap by developing and assessing psychometric properties of measures for the Consolidated Framework for Implementation Research (CFIR) Inner Setting domain.

Purpose of the Study:

• To develop and psychometrically evaluate measures for seven constructs within the CFIR Inner Setting domain.
• To assess the reliability and validity of these measures for use in healthcare settings, specifically Federally Qualified Health Centers (FQHCs).
• To determine if individual-level Inner Setting measures can be aggregated to represent clinic-level constructs.

Main Methods:

• Literature search for existing measures of CFIR Inner Setting constructs.
• Adaptation of items for the healthcare context and pilot testing in FQHCs.
• Confirmatory factor analysis (CFA), reliability assessments (inter-item consistency), discriminant validity checks (scale correlations), and inter-rater reliability/agreement analyses.

Main Results:

• CFAs generally showed good model fit, with high factor loadings.
• Scale reliabilities were good to excellent (Cronbach's alpha ≥ 0.70).
• Sufficient discriminant validity was demonstrated, and inter-rater reliability supported clinic-level measurement.

Conclusions:

• The developed CFIR Inner Setting measures demonstrate strong psychometric properties.
• Individual measures can be aggregated to represent clinic-level constructs.
• These validated measures can enhance understanding and prediction of implementation in FQHCs and guide targeted improvement strategies.