Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory

Courtney H Van Houtven; Connor Drake; Teri L Malo; Kasey Decosimo; Matthew Tucker; Caitlin Sullivan; Josh D'Adolf; Jaime M Hughes; Leah Christensen; Janet M Grubber; Cynthia J Coffman; Nina R Sperber; Virginia Wang; Kelli D Allen; S Nicole Hastings; Christopher M Shea; Leah L Zullig

doi:10.1186/s43058-023-00447-x

Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory

Implement Sci Commun. 2023 Jun 19;4(1):69. doi: 10.1186/s43058-023-00447-x.

Authors

Courtney H Van Houtven^{1

2

3}, Connor Drake^{1

2}, Teri L Malo¹, Kasey Decosimo⁴, Matthew Tucker¹, Caitlin Sullivan¹, Josh D'Adolf¹, Jaime M Hughes^{1

5

6}, Leah Christensen⁷, Janet M Grubber^{1

8}, Cynthia J Coffman^{1

9}, Nina R Sperber^{1

2}, Virginia Wang^{1

2

3}, Kelli D Allen^{1

10}, S Nicole Hastings^{1

2

11

12

13}, Christopher M Shea¹⁴, Leah L Zullig^{1

2}

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
² Department of Population Health Sciences, Duke University, Durham, NC, USA.
³ Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
⁴ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA. Kasey.decosimo@va.gov.
⁵ Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁶ Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁷ Veteran's Health Administration Central Office, Washington, DC, USA.
⁸ Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA.
⁹ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
¹⁰ Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹¹ Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.
¹² Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
¹³ Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁴ Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Background: Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST.

Methods: In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters."

Results: Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption.

Conclusions: To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption.

Trial registration: ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.

Keywords: Family caregivers; Implementation science; Informal care; Skills training; Veterans.

Associated data

ClinicalTrials.gov/NCT03474380

Abstract

Associated data

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