Table 2 Emergent themes and representative quotes from clinician interviews
Themes | CFIR Constructs | Representative Quotes |
|---|---|---|
Intervention characteristics | ||
Clinicians want evidence-based clinical decision support tools for screening and management that are actionable, integrate into their workflow, and do not detract from patient care or extend visit time. | Adaptability Complexity | “I think having the built-in processes will make it more seamless. It’s something that we can use to make sure that we’re not letting people fall through the cracks as easily, as it [might happen] if we had to remember each time ourselves.” “I think being sensitive to the potential impact of a new workflow on our existing workflow and patient experience would be nice.” |
Outer setting | ||
Family resources should be responsive to the needs of families by being concrete, culturally sensitive, available in multiple languages, and include local resources. | Patient needs and resources | “Our community health center families…have different primary languages and primary cultures. A lot of our pediatric parents speak English, but for a lot of them, English is not their first language. The foods that [Latino families are] likely to buy are very different than what a Caucasian family or an African-American family or Cambodian family would buy. I think…the resources need to fit the health literacy of the parents.” “I personally think that it would be really nice to have something that we can hand them at the [well-child] visit, some educational materials and information about local resources… I think all of it is going to be beneficial.” |
The delivery of these resources should be multimodal to suit the needs of families, clinicians, and staff. | Patient needs and resources | “I’m interested in the text messaging program. I feel like [parents] communicate that way the most. I don’t think an email would be effective… Handouts are easy for us, but not necessarily effective for the patient.” |
Inner setting | ||
Childhood obesity is an important issue and clinicians are open to implementing new programs, but they are aware that competing priorities may detract from this program. | Implementation climate Readiness for implementation | “I think every clinic is a little bit different. Some are more open to change than others, but I think in general, we’ve done tons of new programs and have no problem. and People are generally pretty [open] as long as it’s not too much extra time.” “I wouldn't say I've never deliberately not [discussed weight management], but there's certainly times when it hasn't happened due to competing priorities or complexity of visits or a variety of things.” |
For successful adoption, the program should highlight the importance of improving patient care rather than documentation, and sustainability plans should be addressed early as clinicians have seen other programs fade out. | Culture Implementation climate | “I think, for myself, and actually the other providers I work with, the practice, in general, is pretty open to new programs and changes, especially if it seems very patient-focused. I think the practice tends to drag our feet a lot on things that feel very administrative.” “I think we have a good culture of evaluation. I think people are very thoughtful about what could be better. Both, what could make the clinical practice better but also what we can do for families that is an improvement on what we're doing right now. I think that all of that is very much a part of the organization.” |
Process | ||
Clinicians preferred a combination of in-person, individual, and online trainings that are concise, interactive, and case-based that are offered throughout the program duration and provide feedback to clinicians and practices. | Engaging Champions Reflecting and evaluating | “I think the biggest thing is going to be teaching and training. Having everybody onboard and knowing what to do… All the pieces working together would probably be the biggest thing in making sure that everybody’s onboard.” “I think the biggest ones have been… deciding what we can measure, tracking the data, and giving the feedback back to providers in a pretty timely way. When we were rolling out a project to improve our measurements for children with asthma, the clinic started off by presenting the percentage of visits where this recommended thing was happening. Then, presented what our goal target was, and gave us monthly charts that were emailed out with a lot of cheerleading for the improvements. I think it was really helpful for folks.” |