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



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.



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.



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.



Current ClinicalTrial.gov protocol ID NCT02234973 . Date of Registration: July 30, 2014.
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. Mariam.Naqshbandi-Hayward@schulich.uwo.ca.
Mariam Naqshbandi
MN
Hayward
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
Selam
S
Mequanint
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
Jann
J
Paquette-Warren
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Ross
R
Bailie
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
Alexandra
A
Chirila
Canadian Center for Health and Safety in Agriculture, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Roland
R
Dyck
Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Michael
M
Green
Departments of Nutritional Sciences and Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Anthony
A
Hanley
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
Jordan
J
Tompkins
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
Stewart
S
Harris
D002170:Canada / Q000208:ethnology; D002908:Chronic Disease / Q000208:ethnology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007198:Indians, North American / Q000208:ethnology; D008134:Long-Term Care; D008913:Minority Groups; D010865:Pilot Projects; D058996:Quality Improvement / Q000458:organization & administration; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012111:Residence Characteristics
Chronic disease; Diabetes mellitus; First Nations; Indigenous; Quality improvement; Readiness