The Concept of Facilitation in the Implementation of Evidence-Based Practice: Development of an Instrument to Measure Facilitation

Abstract

In 2001 the Institute of Medicine identified a significant gap between what is known about how we care for patients and the care that they receive. This identified gap renewed interest in the development and implementation of evidence-based practice (EBP). A number of research studies have evaluated barriers to EBP yet questions still arise as to why evidence is not routinely incorporated into practice. This led to a new field of inquiry called implementation science focused on methods for translating evidence into practice. The Promoting Action on Research Implementation in Health Services (PARiHS) framework purports that successful implementation of EBP is a function of the strength of the evidence to be implemented, the quality of the context into which it will be implemented and appropriate facilitation. There currently are levels of evidence and measures of context that can be utilized but no measures of appropriate facilitation. The purpose of this research was to develop an instrument (the Facilitation Assessment Index) to measure facilitation. This methodological study was conducted to determine the psychometric properties of an investigator-developed instrument to define and measure the concept of facilitation. The instrument was distributed to1025 Registered Nurses in an Academic Medical Center. The response rate was 28%. The majority of respondents were in a staff nurse role, over age 35 and had at least a Bachelor's degree. The Facilitation Assessment Index (FAI) demonstrated adequate psychometrics. Factor analysis delineated four subscales entitled Support, Leadership, Respect and Autonomy. The overall reliability of the scale was r = .93 and the range of reliability of the subscales was r = .85-.93. The test-retest correlation for the total scale was r = .85 (p<.001). Correlations for the subscales ranged from r = .61-.85 (p<.01).Relationships between demographic variables and facilitation were evaluated. Both unit and job title variables demonstrated relationships with scale scores but group sizes were not equal. Future research is needed to strengthen the psychometric properties of the FAI. Subsequent research could focus on use in strengthening the PARiHS framework and quantifying the amount of facilitation needed to implement EBP.