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) Office nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all 142 VA medical centers (VAMCs) to implement locally. Performance plan inclusion may create incentives to adopt but may be insufficient for early program implementation. Instead, organizational readiness for change, a theory-driven determinant of implementation, may be an important predictor of implementation. 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. We compared ORIC change commitment (5 items) and change efficacy (7 items) domains among VAMCs that implemented Caregivers FIRST within one year (‘adopters’) to those that did not (‘non-adopters’). We categorized adopters from earliest to latest, as: ‘innovators’, ‘early adopters’, ‘early majority’ and ‘late adopters’ or ‘laggards’. We examined differences in ORIC domains and site characteristics between ‘adopters’, ‘non-adopters’, and between ‘adopter’ subcategories. We fit separate logistic regression models 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 categorized as an ‘innovator’, ‘early adopter’, or ‘early majority’. Site level characteristics were not associated with Caregivers FIRST early adoption category. 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: This study was registered on March 22, 2018 at ClinicalTrials.gov (identifier NCT03474380).