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

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.

Fig. 1

Caregivers FIRST ORIC Survey Respondents. ^{^}As of January 2021, the CSP staff identified as program managers or back-ups through CSP program manager distribution list. *Excluding 18 pre-identified CSP Whole Health pilot sites, who will not be considering Caregivers FIRST as a strong practice program in FY21: VA Illiana VA HCS, St. Cloud VA HCS, VA Hudson Valley HCS, James H. Quillen VAMC, Phoenix VA HCS, Ann Arbor VAMC, VA Northern California HCS, Harry S. Truman Memorial, Salisbury - W.G. (Bill) Hefner VAMC, VA Texas Valley Coastal Bend HCS, Hershel “Woody” Williams VAMC, Southeast Louisiana VA HCS, VA Boston HCS, VA Caribbean HCS, Columbia VA HCS, Corporal Michael J. Crescenz VAMC, VA Eastern Colorado Health Care System (ECHCS), and White City or VA Southern Oregon Rehabilitation Center. ^†Respondents who had already adopted Caregivers FIRST prior to the “strong practice” announcement were part of the Function QUERI implementation study 2018–2020

Fig. 2

Adopter categories by program launch date for Caregivers FIRST, adopter categories are driven by Rogers’ distribution, based on launch date between 1/1/2021 and 9/30/2021. Of the sites who adopted between 1/1/2021 and 9/30/2021 (n = 51 sites): late adopters + laggards defined as launch between 6/15/2021 and 9/30/2021. These sites represent 51% of launchers (n = 26 sites). Innovators + early adopters + early majority defined as launch between 1/1/2021 and 6/14/2021. These sites represent the first 50% of launchers (n = 25 sites). Innovators + early adopters defined as launch between 1/1/2021 and 4/7/2021. These sites represent the first 16% of launchers (n = 8 sites)

Fig. 3

Proportion of VAMCs across “non-adopters” and “adopter” categories who agree/somewhat agree with ORIC items. Abbreviations: CGF, Caregivers FIRST; CSP, Caregiver Support Program. Adopter categories are driven by Rogers’ distribution, based on a launch date between 1/1/2021 and 9/30/2021. Non-adopters defined as sites that did not launch between 1/1/2021 and 9/30/2021, n = 12 sites. Of the sites who adopted between 1/1/2021 and 9/30/2021 (n = 51 sites): late adopters + laggards defined as launch between 6/15/2021 and 9/30/2021. These sites represent 51% of launchers (n = 26 sites). Innovators + early adopters + early majority defined as launch between 1/1/2021 and 6/14/2021. These sites represent the first 50% of launchers (n = 25 sites). Innovators + early adopters defined as launch between 1/1/2021 and 4/7/2021. These sites represent the first 16% of launchers (n = 8 sites)