Assessing the inner setting among Massachusetts community health centers: opportunities for multilevel investigation and expansion of influences on health equity.

Rebekka M Lee, James G Daly, Daniel A Gundersen, Ruth I Lederman, Susan Dargon-Hart, Jonathan P Winickoff, Karen M Emmons
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Abstract

Background: Implementation science increasingly aims to improve health outcomes in delivery of evidence-based interventions. It is important to understand the inner setting of organizations where interventions are put into place, as setting characteristics can have significant impact on implementation outcomes. Community health centers are increasingly engaged in efforts to improve use of evidence-based cancer control interventions. Taking a comprehensive, partnered approach to measuring the inner setting among a network of community health centers engaged in implementation research ensures assessment of the variability among sites.

Methods: We conducted a cross-sectional survey among staff (n = 63) purposively sampled from 12 community health centers in Massachusetts engaged in research at the Implementation Science Center for Cancer Control Equity. The survey assessed inner setting constructs from the Consolidated Framework for Implementation Research, including learning climate, leadership engagement, available resources, and implementation demands/stress using validated measures (Likert scale range: 1 "strongly disagree" to 5 "strongly agree"). Additional equity-focused inner setting items included structural characteristics of the work infrastructure and language access services. Descriptive statistics examined differences by staff role and health center.

Results: Staff rated learning climate (mean = 3.98) and leadership engagement (mean = 3.67) positively, while available resources (mean = 2.78) had the lowest rating, particularly staffing resources. Clinical staff rated the inner context lowest compared to other roles. All centers reported supportive human resource benefits for caregiving and 92% provided tuition assistance, while fewer offered formal mentorship (50%) or affinity groups (33%). Community health centers reported written materials are routinely provided to patients in languages other than English and interpreter services were most common in Spanish, Vietnamese, and Portuguese.

Conclusions: This study provides an assessment of the inner setting within Massachusetts community health centers at the start of a new research collaboration. Periodic follow-up surveys will monitor changes over time. Data can be used in future analyses to explore how inner setting characteristics influence implementation outcomes and impact equitable translation of evidence-based interventions into practice.

评估马萨诸塞州社区卫生中心的内部环境:多层次调查的机会和扩大对卫生公平的影响。
背景:实施科学越来越多地旨在改善以证据为基础的干预措施的健康结果。了解实施干预措施的组织的内部环境非常重要,因为环境特征会对实施结果产生重大影响。社区卫生中心越来越多地致力于改善循证癌症控制干预措施的使用。采用一种全面的、合作的方法来测量从事实施研究的社区卫生中心网络的内部环境,确保对站点之间的可变性进行评估。方法:我们对马萨诸塞州12个社区卫生中心从事癌症控制公平实施科学中心研究的工作人员(n = 63)进行了横断面调查。该调查评估了实施研究统一框架中的内部设置结构,包括学习氛围、领导参与、可用资源和实施需求/压力,使用了有效的测量方法(李克特量表范围:1“非常不同意”到5“非常同意”)。其他注重公平的内部设置项目包括工作基础设施的结构特征和语言获取服务。描述性统计检查了工作人员角色和保健中心的差异。结果:员工对学习氛围(平均= 3.98)和领导敬业度(平均= 3.67)的评价为积极的,而可用资源(平均= 2.78)的评价最低,特别是人力资源。与其他角色相比,临床工作人员对内部环境的评价最低。所有中心都报告了支持性的人力资源福利,92%的中心提供学费资助,而提供正式指导(50%)或亲和小组(33%)的中心较少。社区卫生中心报告说,通常向病人提供英语以外的书面材料,西班牙语、越南语和葡萄牙语的口译服务最为常见。结论:本研究在一项新的研究合作开始时,对马萨诸塞州社区卫生中心的内部环境进行了评估。定期的后续调查将监测随着时间的变化。数据可用于未来的分析,以探索内部环境特征如何影响实施结果,以及如何影响以证据为基础的干预措施公平转化为实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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