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Evidence-based interventions (EBIs) exist to increase colorectal cancer (CRC) screening, but implementation remains slow in federally qualified health centers (FQHCs). Assessing organizational readiness can improve EBI implementation outcomes, but no studies have quantitatively examined the relation between organizational readiness subcomponents and implementation outcomes. This study examines associations between readiness subcomponents and CRC screening EBI implementation outcomes in FQHCs.
Methods:
We used data from an ongoing parent study to develop an organizational readiness measure using the R = MC2 heuristic. We conducted descriptive and cross-sectional analyses using FQHC clinic (n = 57) data across three states. A clinic contact completed a survey about clinic characteristics and then distributed an EBI-specific survey to clinic staff containing readiness and implementation questions about Community Guide EBIs (e.g., patient reminders). Pearson correlations assessed bivariate associations between readiness variables and implementation outcomes. We then computed multivariable linear associations between readiness variables and implementation outcomes while controlling for clinic-level variables. One-way analysis of variance tested group differences in readiness subcomponent mean scores using EBI implementation responses.
Results:
Respondents’ most common job type was medical assistant, and the most frequently implemented EBIs were provider or patient reminders. Organizational structure was associated with implementing patient reminders. Clinics reporting inconsistent implementation had lower organizational structure scores than clinics planning or fully implementing patient reminders.
Conclusion:
This study guides researchers in prioritizing organizational structure and selecting specific implementation strategies to improve this construct to implement CRC screening-related EBIs. Future research should examine these associations using a larger sample size to explore additional relations between organizational readiness and implementation outcomes.
Attitudes toward innovation can be a facilitating or limiting factor in the dissemination and implementation of new technologies. Several demographic and professional characteristics of providers have been found to be related to attitudes toward evidence-based practice, as measured by the evidence-based practice attitude scale (EBPAS). Organizational culture and climate both have been found to be related to providers' attitudes toward evidence-based practice. Positive climate measured by the organizational readiness for change scale was negatively related to divergence scores on the EBPAS and demoralizing or negative organizational climate has been found to be positively related to divergence scores. Leadership behaviors in an organization, specifically transformational and transactional leadership, have been related to attitudes toward evidence-based practice. Transactional leadership was positively associated with the openness subscale and marginally positively associated with the requirements subscale.
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