Background
Methods
Overview and setting
PRECEDE Construct | Hypothetical Example |
---|---|
Predisposing Factors: the beliefs, knowledge, and attitudes of individuals that predispose them to certain aligned behaviors | Clinician knowledge of evidence in support of the CDSMP |
Reinforcing Factors: the community norms, incentives, and infrastructures that shape and reinforce the predisposing factors | Frequency with which clinicians’ peers and administrators discuss the CDSMP |
Enabling Factors: the immediate availability of individual and community resources required to carry out aligned behaviors | Availability of staff and technology to facilitate CDSMP referrals |
Administrative Issues: the culture and priorities of a community or organization that determine, prescribe and facilitate changes to other factors | Organizational culture and mission that desires to keep people healthy |
Policy Issues: the existing rules that require or prevent certain behaviors independent of motivations | Presence of organizational policies that limit external collaboration |
Measure development
Participants and recruitment
Primary care clinicians | Other Stakeholders (Constituency Represented) | ||
---|---|---|---|
C101 | Female, internal medicine physician who oversees nurse care coordinators for large system | S001 | Endocrinologist and researcher with expertise in patient self-management (healthcare system structure informant) |
C102 | Male, family medicine physician who is on clinical practice committee for large system | S002 | Health services researcher and patient familiar with CDSMP (healthcare system structure informant) |
C103 | Female, internal medicine physician at urban community practice of large system | S003 | Coordinator of EBPs for Area Agency on Aging and CDSMP leader (funded to implement EBPs) |
C104 | Female, internal medicine physician at urban community practice of large system | S004 | Executive Director of Area Agency on Aging (funded to implement EBPs) |
C105 | Male, internal medicine physician leader in population health of large system | S005 | Health services researcher with expertise in chronic care delivery (healthcare system structure informant) |
C106 | Female, family medicine physician leader in population health for smaller system | S006 | Director of community outreach for small rural hospital affiliated with large health system (healthcare system structure informant) |
C107 | Female, family medicine physician at urban community practice of large system | S007 | Public health employee tasked with facilitating clinic-community linkages in rural county (funded to implement EBPs) |
C108 | Male, family medicine physician at urban community practice of large system | S008 | Employee of state Department of Human Services with role in CDSMP implementation (funded to implement EBPs) |
C109 | Male, internal medicine physician at urban free clinic for underserved | S009 | Nurse care coordinator at rural site in large health system (healthcare system structure informant) |
C110 | Female, family medicine nurse practitioner at rural clinic in small health system | S010 | Director of community outreach for smaller health system and CDSMP leader (healthcare system structure informant) |
C111 | Male, family medicine physician assistant at rural clinic in small health system | S011 | Director of community organization and CDSMP leader (funded to implement EBPs) |
C112 | Male, family medicine physician at rural clinic for large health system | S012 | Nurse supervisor for nurse care coordinators in large health system (healthcare system structure informant) |
C113 | Female, family medicine physician and medical director of rural clinic for large system | S013 | CDSMP leader at rural rehabilitation center (funded to implement EBPs) |
C114 | Male, family medicine physician at rural community practice of large system | S014 | Employee of state Department of Health with role in EBP implementation and CDSMP leader (funded to implement EBPs) |
C115 | Male, family medicine physician at urban community clinic | S015 | Community leader working with healthcare and focused on health in urban development (healthcare system structure informant) |
Procedure
Analysis
Results
Qualitative component
Demographics
PRECEDE analysis
Emergent themes analysis
Quantitative component
Demographics
Participant Characteristic | N (%) |
---|---|
Primary Care Clinicians N = 190 | |
Type of Practice | |
Family Practice | 101 (53.2%) |
Internal Medicine | 50 (26.3%) |
Other (urgent care, ED) | 27 (14.2%) |
Degree | |
MD/DO | 107 (56.3%) |
PA | 11 (5.8%) |
NP | 49 (25.8%) |
Other | 9 (4.7%) |
Other Stakeholders N = 88 | |
Role/interest in improving health in SEMN | |
Health care employee that may refer patients to community resources | 19 (22%) |
Health care employee not likely to refer patients to community resources | 12 (14%) |
Public health | 14 (16%) |
Community-based agency or non-profit | 16 (18%) |
Patient | 8 (9%) |
Researcher | 7 (8%) |
Payer/Insurer | 1 (1%) |
Funder/Philanthropist | 1 (1%) |
Contractor | 1 (1%) |
Volunteer | 2 (2%) |
Other | 7 (8%) |
PRECEDE analysis
Survey Measure | Total (n = 278) | Clinicians (n = 190) | Stakeholders (n = 88) | P value |
---|---|---|---|---|
Predisposing Factors | ||||
Believe community resources are important parts of effective primary carea | 260 (95.9%) | 179 (95.2%) | 81 (97.6%) | 0.36 |
Believe community resources need to be reliable and trustworthyb | 153 (56.7%) | 125 (66.8%) | 28 (33.7%) | < 0.01 |
Believe lack of education and awareness about program is barrier to CDSMP referralc | 203 (73.0%) | 134 (73.2%) | 69 (86.3%) | 0.02 |
Reinforcing Factors | ||||
Believe community resources, if suggested, are not likely to be used by patientsa | 43 (15.9%) | 33 (17.6%) | 10 (12.0%) | 0.25 |
Believe community resources are not accessibleb | 193 (71.5%) | 111 (59.4%) | 82 (98.8%) | < 0.01 |
Enabling Factors | ||||
Believe easy to make referrals to community resources if desireda | 43 (15.9%) | 32 (17.0%) | 11 (13.3%) | 0.43 |
Administrative Issues | ||||
Believe community resources are emphasized and encouraged in my settingd | 114 (42.2%) | 76 (40.4%) | 38 (46.3%) | 0.37 |
Believe community resources are underutilized in my settingd | 180 (66.7%) | 119 (63.3%) | 61 (74.4%) | 0.08 |
Emergent themes analysis
Two Systems Two Worlds | ||||
Survey Item | Total (n = 278) | Healthcare system (n = 223) | Community system (n = 55) | P value |
Predisposing Factors | ||||
Believe community resources are important parts of effective primary carea | 260 (93.5%) | 209 (93.7%) | 51 (92.7%) | 0.39 |
Believe community resources need to be reliable and trustworthyb | 153 (55.0%) | 131 (58.7%) | 22 (40.0%) | 0.02 |
Believe community resources are something I am aware of and educated aboutb | 78 (28.1%) | 74 (33.2%) | 4 (7.3%) | < 0.01 |
Reinforcing Factors | ||||
Believe community resources, if suggested, are not likely to be used by patientsa | 43 (15.5%) | 39 (17.5%) | 4 (7.3%) | 0.07 |
Believe community resources are not accessibleb | 193 (69.4%) | 142 (63.7%) | 51 (92.7%) | < 0.01 |
Enabling Factors | ||||
Believe easy to make referrals to community resources if desireda | 43 (15.5%) | 36 (16.1%) | 7 (12.7%) | 0.60 |
Administrative Issues | ||||
Believe community resources are emphasized and encouraged in my settingc | 114 (41.0%) | 89 (39.9%) | 25 (45.5%) | 0.28 |
Believe community resources are underutilized in my settingc | 180 (64.7%) | 146 (65.5%) | 34 (61.8%) | 1.00 |
Not My Job | ||||
Survey Item | Total (n = 278) | Clinicians (n = 190) | Stakeholders (n = 88) | P Value |
Believe lack of feedback about patient participation is barrier to referrald | 62 (22.3%) | 26 (14.2%) | 36 (45.0%) | < 0.01 |
Believe lack of an electronic referral system is barrier to referrald | 105 (37.8%) | 62 (33.9%) | 43 (53.8%) | < 0.01 |
Believe referral process, if pursued, must be integrated into work flowe | 209 (75.2%) | 151 (84.4%) | 58 (69.9%) | < 0.01 |
Seeing is Believing | ||||
Survey Item | All clinicians (n = 186f) | Clinicians with CDSMP exposure (n = 38) | Clinicians w/out CDSMP exposure (n = 148) | P value |
Believe community resources are important part of primary care | 177 (95.2%) | 35 (92.1%) | 142 (96.0%) | 0.33 |
Believe community resources need to be reliable and trustworthyg | 123 (66.5%) | 23 (62.2%) | 100 (67.6%) | 0.53 |
Believe education and awareness about CDSMP is barrier to referralh | 134 (73.2%) | 7 (18.9%) | 127 (87.0%) | <.0001 |
Believe community resources are underutilized in their setting | 118 (63.4%) | 23 (60.5%) | 95 (64.2%) | 0.68 |