Table 3 CFIR constructs, measures, samples items and sources

Intervention Characteristics

 Relative advantage

Perception that remote services provides an advantage over existing care options

X

X

 Adaptability

Perception that the intervention could be modified to meet practice, provider or patient needs, recommendations for improvement

X

X

 Complexity

Perception that services were too complex

X

X

X

 Cost

Perception that remote services genetic counseling or testing would be too costly for patient, practice (cost or resources)

X

X

X

Outer setting

 Provider needs and resources

Awareness of genetic risk and cancer prevention; importance within practice

X

 Provider incentives and disincentives

External mandates for genetic testing (e.g. accreditation)

X

Inner Setting

 Structural characteristics

EMR, medical staff #, structure

X

X

 Climate for implementation

Previous innovation implementation, compatibility with practice, relative priority, quality metrics/rewards

X

 Readiness for Implementation

Available staff resources, practice experience with genetic services

X

X

Characteristics of Individuals

 Practice background

Type of practice, practice setting

X

 Provider practice characteristics

Years in practice, gender, comfort with genetic testing, champion for genetic testing

X

 Patient background

Age, race, ethnicity, education, insurance

X

 Patient attitude toward genetic testing

Attitudes about genetic testing scale (8 items)³

X

 Patient preference for shared medical decision making

Control Preference Scale (5 items)⁴

X

 Patient comfort with technology

HINTS 5, Cycle 1 selected items related to internet and social media use (8 items) and electronic medical record use and perceptions of privacy (14 items)⁵

X

 Patients baseline genetic knowledge, health literacy and affect

See Table 2 and corresponding measures in Section C6. Effectiveness outcomes

X

Process

 Planning

Planning process for PCPs, quality of materials to introduce the program, steps for PCPs/practice and supports provided

–

X^b

X

 Opinion leaders

Who in the practice was most influential, how did they influence others or what could have helped them to be more effective

X

 Champions

Who in the practice helped ensure that all steps were completed? What did they do to make the practice successful?

X

X

 Reflecting and evaluation

What procedures are working? Which are not? What can we change to make the process easier? etc

X^c

X^c