Refining Expert Recommendations for Implementing Change (ERIC) strategy surveys using cognitive interviews with frontline providers

Abstract

Background The Expert Recommendations for Implementing Change (ERIC) compilation includes 73 defined implementation strategies clustered into nine content areas. This taxonomy has been used to track implementation strategies over time using surveys. This study aimed to improve the ERIC survey using cognitive interviews with non-implementation scientist clinicians. Methods Starting in 2015, we developed and fielded annual ERIC surveys to evaluate liver care in the Veterans Health Administration (VA). We invited providers who had completed at least three surveys to participate in cognitive interviews (October 2020 to October 2021). Before the interviews, participants reviewed the complete 73-item ERIC survey and marked which strategies were unclear due to wording, conceptual confusion, or overlap with other strategies. They then engaged in semi-structured cognitive interviews to describe the experience of completing the survey and elaborate on which strategies required further clarification. Results Twelve VA providers completed surveys followed by cognitive interviews. The “Engage Consumer” and “Support Clinicians” clusters were rated most highly in terms of conceptual and wording clarity. In contrast, the “Financial” cluster had the most wording and conceptual confusion. The “Adapt and Tailor to Context” cluster strategies were considered to have the most redundancy. Providers outlined ways in which the strategies could be clearer in terms of wording (32%), conceptual clarity (51%), and clarifying the distinction between strategies (51%). Conclusions Cognitive interviews with ERIC survey participants allowed us to identify and address issues with strategy wording, combine conceptually indistinct strategies, and disaggregate multi-barreled strategies. Improvements made to the ERIC survey based on these findings will ultimately assist VA and other institutions in designing, evaluating, and replicating quality improvement efforts.

A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022

“…Modifications resulted in 70 named strategies and were made to decrease redundancy and improve clarity. These modifications were based on input from experts, cognitive interview data, and team consensus [ 37 ] (See Additional File 4). Outcomes were then coded into RE-AIM outcome domains following best practices as recommended by framework experts [ 26 – 28 ].…”

“…Also, some have commented that ERIC strategies can be unclear and are missing key domains. Thus, researchers are making definitions clearer for lay users [ 37 , 103 ], increasing the number of discrete strategies for specific domains like HIV treatment, acknowledging strategies for new functions (e.g., de-implementation [ 104 ], local capacity building), accounting for phases of implementation (dissemination, sustainment [ 13 ], scale-up), addressing settings [ 12 , 20 ], actors roles in the process, and making mechanisms of change to select strategies more user-friendly through searchable databases [ 9 , 10 , 54 , 73 , 104 – 106 ]. In sum, we found the utility of the ERIC taxonomy to outweigh any of the taxonomy’s current limitations.…”