Selby Homework 6

Selby Homework 6

by Kevin -

Project overview: Important gaps exist in the follow-up of positive fecal immunochemical tests (FIT), reducing the efficacy of this test in real-world settings. An analysis of variance between Kaiser Permanente Northern California service areas shows that direct, automated referral of patients to the gastroenterology (GI) office in their area, and coordination and navigation of these patients by GI is associated with more patients getting timely follow-up colonoscopy. The GIFFy study (Implementing GI-based FIT Follow-up) will spread and standardize this practice between KPNC GI facilities. I am using the CFIR framework to understand the implementation of this change. The following questions would be asked of GI leadership after attempting to roll out the GIFFy intervention.

Question 1: Do you think that there are significant advantages to having organization of and responsibility for the follow-up of positive FIT tests be by gastroenterology offices rather than primary care offices? (5-point Likert, Strongly disagree to strongly agree)

Rationale: Part of the CFIR framework asks about intervention characteristics. If local leadership does not see the relative advantage of GI-based over primary care-based FIT follow-up, they may be less likely to give it full support.

Question 2: Do you think that your facility sufficiently resembles the GI facilities on which this intervention was based to make the GIFFy intervention appropriate for your facility? Were you given enough flexibility to make needed changes to the intervention? (5-point Likert for each, Strong no to strong yes)

Rationale: Other important aspects of interventions that aid their spread are intervention source (perception that the intervention was internally developed) and Adaptability (degree to which intervention can be adapted)

Question 3: Did you feel that the GIFFy intervention came at an appropriate time for your facility? Was FIT positive follow-up an important priority at the time of implementation? (5-point Likert for each, Strong no to strong yes)

Rationale: These questions are exploring the implementation climate of the local facility and relative priority of FIT positive follow-up for the GI leadership. These are aspects of Inner Setting for the CFIR framework.

Re: Selby Homework 6

by Kadiatou -

Hi Kevin,

 

This week’s homework seems to be really confusing. I asked Elvin and Xiao responded that she had similar questions and forwarded me the following answer:

"Thanks, yes. I will clarify that.  Imagine you are doing a mixed methods project – the guide has to be assembled before the intervention has been implemented – so you have to say what you think will happen, how you will measure it, as well as a plan for measuring what you don’t know will happen! "

And Xioa added: “So, you are coming up with an interview guide apriori, to understand possible outcomes from implementation of your intervention. Hope this helps.”

To comment on your posting, I think in qualitative methods Likert scale might not give you enough information, unless you add a comment box maybe to further probe for explanation of their choice.  One respondent might check “agree” and might want to add: “however, Primary Care offices are better positioned to …..” it can be one explanation or another.

Like for questions 2 and 3, respondents might have explanations for their choices and arguments that can go both ways.

Asking open-ended questions will provide you more information than the Likert scale.

For example, with you question 1, you could reformulate:

What do you think are the advantages and/or challenges of having organization of and responsibility for the follow-up of positive FIT tests be by gastroenterology offices rather than primary care offices?

With this question, you will learn not only if the respondent thinks or not that there are advantages or challenges, but also what those advantages and challenges are.

Just some thoughts!

Re: Selby Homework 6

by Sanithia -

Hi Kevin, 

 

I don't think the purpose of the HW was to create survey type questions (it was a bit confusing), so the likert scale might not be appropriate. That being said, your questions are actually easily adaptable to a qualitative/interview frame, and you would likely gather much more information asking them in an open-ended manner than the closed option of a likert scale. 

Re: Selby Homework 6

by Adrienne -

Hi Kevin,

I think you are on the right track with your questions but I know this assignment was maybe unclear since you missed the last class lecture on qualitative data. I think having a quantitative and qualitative response to these questions can still be very useful and meaningful. You are off to a good start and hopefully we can clarify tomorrow in section.