Skip to main content

Table 1 Respondents’ insights about the family engagement navigator model categorized by the CFIR domain and construct

From: A rapid pre-implementation evaluation to inform a family engagement navigator program during COVID-19

CFIR domain Construct/subconstruct Findings Example
Intervention Intervention source: Perception about whether the intervention is externally or internally developed Respondents recognized that the intervention was designed by frontline stakeholders. “It’s going to be well-received because the idea germinated from within, not from people who don’t know the details of day-to-day experience”
Evidence strength and quality: Perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes The program was likened to other successful communication facilitation programs. “Outside of COVID, there are studies that support using external team members to support family communication”
Adaptability: The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs The navigator program was perceived as adaptable to meet the individualized needs of families. “We may need to vary the frequency we check in with families”
“Some families may prefer certain technology than others”
Relative advantage: Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution The family engagement navigator program was preferred to RN or MD providing support because it offloads clinicians doing bedside care. “Family support was once incorporated into bedside rounding but now requires additional time commitment that could interfere with clinical responsibilities”
“It could offload some of the work for the bedside team”
Complexity: Perceived difficulty of the intervention, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement Respondents worried that identifying patients and exchanging information between navigators and the clinical team are not straightforward. “The logistics of coordinating between navigators and medical team… will be the major barrier”
“It could be productive, if structured correctly”
Outer setting Patient needs and resources: The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization Respondents were concerned that access to technology and language barriers could impede equitable implementation of the intervention. “There are a lot of factors we cannot control (language barriers, reliable phone connection/access)”
Some clinicians feared that families would be frustrated if navigators could not give clinical updates. “Families may not be sure what the aim is, since they can’t convey information about prognosis, status, or plan of care”
“Most families will just want to know about the medical updates”
Culture: Norms, values, and basic assumptions of a given organization Respondents perceived that family engagement was a priority for the organization and that new ideas are typically embraced by the organization. “We’re really focused on family engagement, and this will help to get back to that”
“New ideas are embraced, especially in the COVID era”
Implementation climate:
Tension for change: The degree to which stakeholders perceive the current situation as intolerable or needing change Most respondents strongly endorsed a need for solution to family engagement and support during restricted visitation. “Communication with families is necessary and creates a better experience for everyone”
“I would be terrified if I couldn’t visit my loved one in the ICU”
“It has been very difficult to communicate with families”
Compatibility: How the intervention fits with existing workflows and systems Clinicians felt the program could easily fit into the existing workflow but worried about role confusion and inconsistent information. “We must ensure that redundancies in communication are minimized”
“It will require collaboration so that information remains consistent”
Respondents expressed a strong opinion that this intervention be additive not substitutive for communication with clinical team. “It will be helpful but won’t replace the role of a team member actually caring for the patient calling”
Individuals Knowledge and beliefs: Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention Respondents placed a high value on family engagement and were enthusiastic about the family engagement navigator program’s success. “Communication with families is necessary and creates a better experience for everyone”
“I think this will improve communication between patients, families, and treatment teams”
“This will help families feel some sort of control by empowering them to ask questions”
Clinicians requested more information on the workflow and role definitions. “I would like to know more about how it will work, what the navigator will do versus what I will do”
Self-efficacy: Individual belief in their own capabilities to execute courses of action to achieve implementation goals Navigators felt confident in their ability to provide support to ICU families. Medical students felt that the training and available resources were effective. “I am very confident that we can successfully implement the program”
“The resources are helpful in building skills for communication, empathy, and team-based care”
Process Engagement: Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities Both navigators and clinicians could readily identify “champions” (people in the organization who are likely to go above and beyond what might be expected) for the intervention. “I could definitely see (Provider A or Provider B) taking this on!”
Reflecting/evaluation: feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience Navigators placed importance on receiving feedback from families and others about the impact of intervention. “I would like to get family feedback to see if it was helpful”
“I would like to know what the medical team thinks of the communication strategy”
  1. CFIR Consolidated Framework for Implementation Research [10]