Identifying factors influencing implementation of evidence-based practices for cancer prevention and control in community health centers (CHCs): Development of a multi-state CHC survey

Background: Community Health Centers (CHCs) provide primary care and preventive services for minority and underserved population. To improve cancer control efforts at Community Health Centers (CHCs), the Cancer Prevention and Control Research Network's (CPCRN) Federally Qualified Health Centers (FQHC) Workgroup, consisting of researchers from 8 CPCRN centers across the country, engaged national, state and local stakeholders to develop a comprehensive survey assessing factors associated with implementation of evidence-based practices (EBPs) for cancer control in CHCs. This presentation will describe the development process of the survey and its psychometric properties. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to guide survey development. Measures of implementation outcomes were developed based on Community Guide recommendations and the Patient-Centered Medical Home model of best practices. During an annual CPCRN face-to-face meeting, experts in Dissemination and Implementation Science selected a set of key constructs from the CFIR to be assessed through the CHC survey. We conducted an extensive literature review to identify published measures related to CFIR constructs and adapted them for the CHC survey. Consensus regarding the final items was reached through a series of workgroup discussions and consultations with stakeholders. Pilot-tests were performed with clinic staffs in 3 CHCs from 2 states to further refine the survey. Results: The final CHC survey includes items related to constructs in all five domains of the CFIR, including Complexity and Relative Advantage in the Intervention Characteristics domain; Outer Setting constructs such as Patient Needs and Resources and External Policies and Incentives; Structural Characteristics including organizational resources and existing electronic health records, Implementation Climate, Culture, Leadership Engagement and Networks and Communication. Also included were individual characteristics such as Knowledge and Belief of EBPs and Executing, Evaluating and Reflecting in the Process domain. The survey is being administered online for clinic staff of CHCs across 7 states and data collection will be completed in Apr 2013. Descriptions of these measures, their psychometric properties (Cronbach's alpha, inter-rater reliability, confirmatory and exploratory factor analysis) and their correlation with key implementation outcomes will be discussed. Conclusion: The CPCRN's Multi-state CHC Survey represents the first questionnaire developed based on the CFIR to assess the implementation of EBPs for cancer prevention and control in CHCs.