French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC)

Contextual characteristics are well-recognized for their potential to significantly influence the implementation of interventions [1‐3]. Among these characteristics, organizational readiness has been studied because of its critical impact on the subsequent stages of the change process [4‐7]. Some authors have identified organizational readiness as one of the strongest predictors/facilitators for the adoption of new practices, policies and programs [8, 9].

Armenakis et al. (1993) initially suggested that the assessment of individuals’ readiness to change in an organization is a good opportunity to gain insight into their beliefs and attitudes regarding the necessity (or not) of implementing a change, and into the organization’s capacity to implement it with success [10]. The concept of organizational readiness covers characteristics related to individuals (e.g., motivation, commitment, self-efficacy) that are well-recognized for their influence on implementation of a change [11‐13]. According to Weiner’s organizational theory, organizational readiness is defined as the extent to which members of an organization are psychologically and behaviorally prepared to implement a change in their setting [14]. These definitions highlight the overlap between the organizational and individual characteristics underlying the multilevel aspect of organizational readiness. An approach that considers both contextual- and individual-specific assessments of readiness is highly recommended when planning and conducting knowledge translation (KT) efforts aimed at optimizing the benefits of the applied change [11, 15‐17]. Organizational readiness can therefore allow to document the interplay of these characteristics in a KT process.

The study of organizational determinants related to the KT process and strategies used to enhance organizational readiness has been initiated in the scientific literature [17, 18]. However, faced with the paucity of validated tools to measure an organization’s readiness for change [9, 19], particularly within a KT perspective in healthcare contexts [4], Shea and colleagues (2014) developed and validated the “Organizational Readiness for Implementing Change” (ORIC) questionnaire [5]. The ORIC is based on Weiner’s organizational theory (2009), and describes two main facets of organizational readiness: (1) change commitment and (2) change efficacy [14]. The ORIC aims to document an organization’s level of readiness to implement change as perceived by its members, in order to guide them in the identification of strategies and resources relevant to the context [5]. The ORIC is comprised of 10 items divided into two main subscales: (1) five items on change commitment (i.e., do the intended members of the organization want the change?) and (2) five items on change efficacy (i.e., are the intended members of the organization able to change?). Each of these items is scored using a 5-point Likert scale ranging from “Disagree” to “Agree”. Studies of its psychometric properties support its content validity (i.e., content adequacy); construct validity (i.e., factor structure with exploratory and confirmatory factor analysis); and reliability (i.e., inter-rater reliability and inter-rater agreement) in both laboratory and organizational contexts. For example, the reliability of the original version of the ORIC has been documented to inform the variability of perception from an individual- and group-level perspective [5]. The initial 12-item version of the ORIC was revised following the psychometric research reported by Shea et al. (2014). Two items related to the Efficacy subscale were removed because of their interpretation about motivation, a concept related to the Commitment subscale according to the participants’ perspective. The 10-item version of the ORIC subsequently became the recommended English version, as it only contains the items that most strongly correspond to the two components initially defined for the measurement of organizational readiness [5].

Studies from different health sectors (e.g., pain management, pharmacological and dental care) have since used the 10-item version of the ORIC to document the perception of readiness among members of an organization [20‐22]. For example, Sanders et al. (2017) found it useful to use the ORIC to identify healthcare students’ perceptions and concerns about an immersion program in direct patient care and to guide qualitative data collection in mixed methods research that focuses on the underlying concepts of organizational readiness [22]. However, to our knowledge, the French tools documenting organizational characteristics are not based on the underlying conceptualization described above. Rapid and valid screening of organizational readiness should be extended to French organizations to support the identification of their members’ readiness regarding the implementation of a change, thus maximize their chances of success. As such, the aims of this study were to (1) translate and culturally adapt the ORIC questionnaire in French for Canadian organizations, and (2) initiate the study of its psychometric properties.

A cross-cultural adaptation process of the English version of the ORIC developed by Shea et al. (2014) [5] was conducted based on the six steps of Beaton’s methodology [24] and complemented by Vallerand procedures [25]. In addition, Massoubre et al.’s (2002) procedure was used following the expert committee review to help document the different types of equivalences (i.e., semantical, technical, idiomatic, related to experience, and conceptual) [26].

The purpose of this study was to conduct a French cross-cultural adaptation of the ORIC, a questionnaire which aims to document the organizational readiness of members to implement change within an organization. This cross-cultural adaptation process has resulted in a new French version of the ORIC, the ROIC. Preliminary psychometric testing suggests that the ROIC has the potential to contribute to the measurement of the construct of organizational readiness in the context of health services by documenting the perceptions of members in an organization about a KT process.

In the French scientific literature, although the importance of readiness among individuals of an organization is also recognized as a prerequisite to implementing change [33], concepts that address organizational readiness are defined differently (see for instance [34, 35]). It is therefore important to situate the construct of organizational readiness in KT studies according to the conceptualization used to illustrate the process. In this study, we mainly used the ROIC to document the perceptions of healthcare professionals about their working environment in homecare services, with regards to the component Recipients (i.e., individuals involved in the KT process) of the i-PARIHS operational model [11]. However, the questionnaire could also inform different levels of context (e.g., local, organizational, external), as suggested in the conceptual frameworks Promoting Action on Research Implementation in Health Sciences [36] and Consolidated Framework for Implementation Research [37]. To this end, with the use of the ORIC, Sharma et al. (2018) demonstrated that readiness levels varied according to the contextual level studied, which supports the conceptualization of organizational readiness as a multilevel construct [38].

Regarding the reliability of the ROIC, when the items were divided into their respective subscales, Cronbach’s alpha values (Commitment subscale: α = 0.84 and Efficacy subscale: α = 0.86) were slightly inferior to the coefficients obtained by Shea et al. (2014) in the English original version (Commitment subscale: α = 0.92 and Efficacy subscale: α = 0.88), but remained in the accepted range of homogeneity according to DeVellis (2003) [29]. In this study, the average inter-item correlation coefficients (0.50) and the range of inter-item correlation coefficients [0.21–0.73] were also acceptable (i.e., between 0.15 and 0.50).These results provide initial evidence that the ROIC’s items are related to each other and can be used to document the construct of organizational readiness. However, the high values of inter-item correlation coefficients (> 0.50) observed for items 5, 6 and 7 suggest possible redundancy of content. Considering that items 6 and 7 are related to the Efficacy subscale, the assumption that the content of these items could be in line with items 6 to 10 is plausible since it refers to the same subscale (see Table 3). Concerning the item-to-total scale correlations, Cronbach’s alpha coefficients (Commitment subscale: 0.78 to 0.84; Efficacy subscale: 0.82 to 0.84) were lower than the global internal consistency calculated for each subscale (i.e., Commitment subscale: α = 0.84; Efficacy subscale: α = 0.86). This highlights the importance of each item’s contribution in documenting the subscale to which they refer. While the two facets of the concept of organizational readiness are considered independent, they were still interrelated [5, 14]. This theoretical perspective about the overlap of concepts through the two subscales of the ROIC can also be illustrated with the item-to-total scale statistics of the 10-item version, with Cronbach’s alpha coefficients slightly varying between 0.89 and 0.91, which denotes the tool’s stable internal consistency.

Initial documentation of the ROIC’s model fit using confirmatory factor analysis suggests that the French version of the ORIC’s items can distinguish the two initial subscales of the ORIC’s original version, and provides initial evidence for the ROIC’s construct validity. However, this statement should be nuanced for certain items of the French version of the questionnaire and illustrates the challenge of operationalizing the initial conceptualization of organizational readiness’ components view theoretically as independent factors. Indeed, the factor loading of item 1 is slightly inferior to 0.60 - lower than that obtained in Shea et al.’s initial confirmatory factor analysis [5]. This observation can be triangulated with the lower squared multiple correlation noted for item 1, as it tends to explain a lower proportion of variance than the other items of the Commitment subscale (see Table 4). Although they are near the threshold initially established, the factor loadings of items 2, 3 and 9 are also lower than the ones obtained in the original version of the ORIC (see Table 6). Moreover, the values of the CFI (0.89) and the TLI (0.85) are slightly inferior to the pre-established threshold (≥ 0.95), and the value of the RMSEA (0.12) is slightly superior to the allowed error value (< 0.06) according to Hu & Bentler (1999) [32]. Although the sample size (n = 125) of this study could be considered sufficient according to the rule of thumb using the number of variables (N/p [number of variables] ≥ 10), it does not meet the two other rules usually used in confirmatory factor analysis (i.e., number of parameters [N/q ≥ 5] and sample size [n ≥ 200]) [39, 40]. While the CFI and TLI indexes are less sensitive to sample size than SRMR and RMSEA indexes, the TLI and RMSEA indexes tend to reject the true population model when the sample size is small [32, 41, 42]. Even though these adjustment measures are useful to indicate that equivalence between the ROIC’s and the ORIC’s models may not yet be satisfactory according to some items and the sample size, their original theory-testing purpose should be emphasized. In this perspective, results from the ROIC’s confirmatory factor analysis could also suggest that linguistic validation allowed for selecting the optimal French terms corresponding partly to the original item’s underlying concepts. Storkholm et al. (2018) experienced similar issues with vocabulary (e.g., signification of the term “investment”) when translating and testing the ORIC into a Danish version, and they elected to use an 11-item version presenting the optimal fit [43]. Seeing as several conceptual differences were identified during the cross-cultural adaptation process (see Table 1), it may be that the cultural equivalence between French and English concepts in the field of organizational change, as they appear in the ORIC, is imperfect. For instance, item 1, which shows a relatively weak association with its subscale (Commitment), includes the notion of “being committed”, which can be translated into either “s’engager” or “s’investir” depending on the context.

In a context where the importance of theory-based KT measures is increasingly being advocated for the development and validation of tools with known measurement properties, it is essential to put effort into making existing questionnaires available to researchers and clinicians involved in the planning and implementation of a change [16]. The ORIC, now culturally adapted to the French language (i.e., the ROIC), has the potential to support organizations in documenting their member’s readiness for the development of individual- and context-specific interventions. Considering the intra-organizational and dynamic nature of the concept of organizational readiness [44, 45], the use of questionnaires such as the ROIC should be contextualized to give a relevant and authentic picture of the organization and orientate its members in the identification of subsequent efforts for implementing a change.