Challenges in measuring acceptability, appropriateness, and feasibility: a case study in the pediatric intensive care...

Rigorous development and evaluation of implementation outcome measures is needed to advance the field of implementation science. The Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), and the Intervention Appropriateness Measure (IAM) are commonly used, psychometrically validated measures. The objective of the current analysis was to analyze use of the AIM, FIM, and IAM in a single-center pediatric intensive care (PICU) unit study.

This was a secondary analysis of a mixed-methods interventional study. The initial project studied development of a novel cardiac arrest ventilation rate metronome to improve adherence to guideline-recommended ventilation rates during CPR; study components included contextual inquiry, participatory intervention design, and simulation usability testing. Using a purposive sampling strategy for pre-implementation contextual inquiry, eligible participants included multidisciplinary PICU clinicians. The pre-implementation questionnaire asked about current cardiac arrest ventilation practices and perceived acceptability, appropriateness, and feasibility of our proposed intervention (AIM, FIM, and IAM). Five-point scale Likert data were summarized using descriptive statistics (medians and interquartile ranges). A score of > 3 was considered favorable.

Of 133 started instances of the pre-implementation survey, 107 were completed (80.5%). The response rate was 30.6% (107/350). Respondents included 34 nurses (31.8%), 18 respiratory therapists (16.8%), and 55 ordering providers (physicians and nurse practitioners; 51.4%). Most respondents (79/107; 73.8%) had previously participated in > 10 PICU cardiac arrests. Appropriateness, acceptability, and feasibility of the ventilation metronome were favorable (appropriateness median: 4 [IQR 4,5]; acceptability median: 4 [IQR 3,5]; feasibility median: 4 [IQR 4,4.5]). For each AIM, IAM, and FIM statement, ≥24.3% of all responses were the highest value on the 5-point scale. Of the 19.5% of survey instances with only partial responses, all but one (26/27; 96.3%) were stopped at the AIM, IAM, FIM matrix of statements.

In this single-center PICU study utilizing the previously validated Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure, there were several challenges associated with the use of these scales, including (1) survey responses that were terminated at the portion of the questionnaire presenting the AIM, IAM, and FIM and (2) ceiling effect.