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Table 1 List of CFIR constructs included in Think Aloud survey development

From: A pragmatic context assessment tool (pCAT): using a Think Aloud method to develop an assessment of contextual barriers to change

Survey introduction

Pilot version

Version used in initial Think Aloud interviewsa

Final version of pCAT

Question Stem (open-text response):

Please enter your problem area (area for improvement). This should reflect whatever topic you and your team are currently considering. It does not have to be final (e.g., The majority of patients fail to show up for scheduled orientation)

Please enter your problem area (area for improvement). This should reflect whatever topic you and your team are currently considering. It does not have to be final (e.g., The majority of patients fail to show up for scheduled orientation)

We’ve found that it’s best to think concretely about a planned or on-going implementation (as opposed to the more general implementation environment). Include the specifics of the implementation/improvement project here

Identifying Barriers vs. Facilitators (item responses):

Overall, we are most likely to encounter more (check only one):

1 = Facilitating forces related to [construct]

2 = Hindering forces related to [construct]

3 = We cannot think of any facilitating or hindering forces related to [construct]

1 = Disagree

2 = Neutral

3 = Agree

1 = Disagree: This means the item is a potential barrier

2 = Neutral

3 = Agree: This means the item is a potential facilitator

Effect on implementation (item responses):

1 = Weak

2 = Moderate

3 = High

1 = Low impact

2 = Moderate impact

3 = High impact

0 = Weak/no effect

1 = Strong effect

CFIR-based survey items

CFIR domain

CFIR construct

Short definition

Survey version 1.0

Survey version 2.0

Final survey

Program Characteristics

Relative Advantage

Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution

The extent to which leaders and staff recognize the potential benefit of implementing a change to address your problem area, especially compared to other alternatives, may influence your success

Key people will see the advantage of implementing the change versus an alternative

People here see the advantage of implementing the change versus an alternative

Outer Setting

Patient Needs & 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

The extent people are aware of Veteran needs and preferences and use that information to improve programs may influence your success

People here regularly seek to understand the needs of patients and make changes to better meet those needs

[NO CHANGE from version used in Think Aloud interviews]

People here regularly seek to understand the needs of patients and make changes to better meet those needs

Inner Setting

Structural Characteristics

The social architecture, age, maturity, and size of an organization

The structural characteristics, including the age, size, how people and processes are organized, hierarchical structure, policies and procedures may influence your success

The structures and policies in place here will enable us to make the change

[NO CHANGE from version used in Think Aloud interviews]

The structures and policies in place here enable us to make the change

 

Networks & Communications

The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization

Quality and type of working relationships between people and the quality of communications may influence your success

I have open lines of communication with everyone needed to make the change

[NO CHANGE from version used in Think Aloud interviews]

I have open lines of communication with everyone needed to make the change

 

Tension for Change

The degree to which stakeholders perceive the current situation as intolerable or needing change

The degree to which stakeholders perceive the current situation as intolerable or needing change may influence your success

Key people will see the current situation as intolerable and that the change is needed

People here see the current situation as intolerable and that the change is needed

 

Compatibility

The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems

The level of compatibility between the change you might implement and (1) existing workflows and systems; and (2) norms, values, and perceived risks and needs in your facility, may influence your success

The change is compatible with existing clinical processes

[NO CHANGE from version used in Think Aloud interviews]

The change is compatible with existing clinical processes

    

The change is aligned with clinician values related to weight loss among Veterans

[NO CHANGE from version used in Think Aloud interviews]

The change is aligned with clinician values related to weight loss among Veterans

 

Goals & Feedback

The degree to which goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals

The extent leaders clearly communicate goals and provide helpful feedback, as well as the extent feedback aligns with organizational and clinical goals, may influence your success

The change is aligned with leadership goals

[NO CHANGE from version used in Think Aloud interviews]

The change is aligned with leadership goals

 

Learning Climate

A climate in which: (a) leaders express their own fallibility and need for team members’ assistance and input; (b) team members feel that they are essential, valued, and knowledgeable partners in the change process; (c) individuals feel psychologically safe to try new methods; and (d) there is sufficient time and space for reflective thinking and evaluation

The extent to which people feel encouraged to experiment, look for ways to improve current processes and programs, and learn from mistakes may influence your success

Not assessed

Not assessed

 

Leadership Engagement

Commitment, involvement, and accountability of leaders and managers with the implementation

The level of commitment and involvement of leaders in your charter aim may influence your success

Leaders here will be committed, involved, and accountable for the planned improvement

Higher level leaders are committed, involved, and accountable for the planned improvement

Leaders I work with most closely are committed, involved, and accountable for the planned improvement

 

Available Resources

The level of resources dedicated for implementation and on-going operations including money, training, education, physical space, and time

The level of resources available to support your charter aim, including money, physical space, and time, may influence your success

We will have sufficient time dedicated to make the change

We have sufficient time dedicated to make the change

    

We will have sufficient space to accommodate the change

We have sufficient space to accommodate the change

    

We will have other needed resources to make the change

We have other needed resources to make the change

Process

Reflecting & Evaluating

Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience

Not assessed

I have access to data to help track changes in outcomes

[NO CHANGE from version used in Think Aloud interviews]

I have access to data to help track changes in outcomes

  1. aThe pCAT was iteratively updated based on input from interviewees as interviews were completed