The FORGE AHEAD clinical readiness consultation tool: a validated tool to assess clinical readiness for chronic disease care mobilization in Canada's First Nations

Mariam Naqshbandi Hayward, Selam Mequanint, Jann Paquette-Warren, Ross Bailie, Alexandra Chirila, Roland Dyck, Michael Green, Anthony Hanley, Jordan Tompkins, Stewart Harris, FORGE AHEAD Program Team, Stewart Harris, Ed Barre, Onil Bhattacharyya, David Dannenbaum, Keith Dawson, Roland Dyck, Jo-Ann Episkenew, Michael Green, Anthony Hanley, Barry Lavallee, Ann Macaulay, Alex McComber, Monica Parry, Sonja Reichert, Jon Salsberg, Amardeep Thind, Sheldon Tobe, Ellen Toth, Audrey Walsh, Jay Wortman, Lloy Wylie, Merrick Zwarenstein, Ross Bailie, Kayla Collins, Claire de Oliveira, Michael Hindmarsh, Valeria Rac, Linda Stanley, Joanne Lewis, Marlene Nosé, Brigitte Parent, Stephen Sundquist, Lillian Houle, Amber Houle, Dawn Montour-Lazare, Joelle Emond, Jessica Jacobs, Randy Littlechild, Bonny Graham, Tina Littlechild, Devon Guy, Chalsea Onespot, Ivan Kimble McComb, Emilie Dufour, Verna Jolly, Charlene Diamond, Jennifer Jones, Danna Hadden, April DeYaeger, Theresa O'Keefe, Ada Roberts, Maggie Organ, Shelley Kirkness, Marie Jebb, Carla Constant, Allen Deleary, Rennie Nawash, Lori Sinclair, Heather McDonald, Bonnie Nickel, Mariam Naqshbandi Hayward, Selam Mequanint, Jann Paquette-Warren, Jordan Tompkins, Susan Webster-Bogaert, Braden Te Hiwi, Harsh Zaran, Jim Esler, Meghan Fournie, Marie Tyler, Jackie McLellan, Marnie Orcutt, Mariam Naqshbandi Hayward, Selam Mequanint, Jann Paquette-Warren, Ross Bailie, Alexandra Chirila, Roland Dyck, Michael Green, Anthony Hanley, Jordan Tompkins, Stewart Harris, FORGE AHEAD Program Team, Stewart Harris, Ed Barre, Onil Bhattacharyya, David Dannenbaum, Keith Dawson, Roland Dyck, Jo-Ann Episkenew, Michael Green, Anthony Hanley, Barry Lavallee, Ann Macaulay, Alex McComber, Monica Parry, Sonja Reichert, Jon Salsberg, Amardeep Thind, Sheldon Tobe, Ellen Toth, Audrey Walsh, Jay Wortman, Lloy Wylie, Merrick Zwarenstein, Ross Bailie, Kayla Collins, Claire de Oliveira, Michael Hindmarsh, Valeria Rac, Linda Stanley, Joanne Lewis, Marlene Nosé, Brigitte Parent, Stephen Sundquist, Lillian Houle, Amber Houle, Dawn Montour-Lazare, Joelle Emond, Jessica Jacobs, Randy Littlechild, Bonny Graham, Tina Littlechild, Devon Guy, Chalsea Onespot, Ivan Kimble McComb, Emilie Dufour, Verna Jolly, Charlene Diamond, Jennifer Jones, Danna Hadden, April DeYaeger, Theresa O'Keefe, Ada Roberts, Maggie Organ, Shelley Kirkness, Marie Jebb, Carla Constant, Allen Deleary, Rennie Nawash, Lori Sinclair, Heather McDonald, Bonnie Nickel, Mariam Naqshbandi Hayward, Selam Mequanint, Jann Paquette-Warren, Jordan Tompkins, Susan Webster-Bogaert, Braden Te Hiwi, Harsh Zaran, Jim Esler, Meghan Fournie, Marie Tyler, Jackie McLellan, Marnie Orcutt

Abstract

Background: Given the astounding rates of diabetes and related complications, and the barriers to providing care present in Indigenous communities in Canada, intervention strategies that take into account contextual factors such as readiness to mobilize are needed to maximize improvements and increase the likelihood of success and sustainment. As part of the national FORGE AHEAD Program, we sought to develop, test and validate a clinical readiness consultation tool aimed at assessing the readiness of clinical teams working on-reserve in First Nations communities to participate in quality improvement (QI) to enhance diabetes care in Canada.

Methods: A literature review was conducted to identify existing readiness tools. The ABCD - SAT was adapted using a consensus approach that emphasized a community-based participatory approach and prioritized the knowledge and wisdom held by community members. The tool was piloted with a group of 16 people from 7 provinces and 11 partnering communities to assess language use, clarity, relevance, format, and ease of completion using examples. Internal reliability analysis and convergence validity were conducted with data from 53 clinical team members from 11 First Nations communities (3-5 per community) who have participated in the FORGE AHEAD program.

Results: The 27-page Clinical Readiness Consultation Tool (CRCT) consists of five main components, 21 sub-components, and 74 items that are aligned with the Expanded Chronic Care Model. Five-point Likert scale feedback from the pilot ranged from 3.25 to 4.5. Length of the tool was reported as a drawback but respondents noted that all the items were needed to provide a comprehensive picture of the healthcare system. Results for internal consistency showed that all sub-components except for two were within acceptable ranges (0.77-0.93). The Team Structure and Function sub-component scale had a moderately significant positive correlation with the validated Team Climate Inventory, r = 0.45, p < 0.05.

Conclusions: The testing and validation of the FORGE AHEAD CRCT demonstrated that the tool is acceptable, valid and reliable. The CRCT has been successfully used to support the implementation of the FORGE AHEAD Program and the health services changes that partnering First Nations communities have designed and undertaken to improve diabetes care.

Trial registration number: Current ClinicalTrial.gov protocol ID NCT02234973 . Date of Registration: July 30, 2014.

Keywords: Chronic disease; Diabetes mellitus; First Nations; Indigenous; Quality improvement; Readiness.

Figures

Fig. 1
Fig. 1
Scatter plot showing the moderate correlation between TCI and TSF sub-components of the CRCT

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