Domains & Subscales | Items | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|---|
Factors outside your organization | ||||||
Community Support | Consultations with community members about the overall fit and acceptability of [INTERVENTION] from a diversity and inclusivity perspective are… | Non-existent; no consultations with community members | Between 1&3 | Mixed; occasional consultations with community members | Between 3&5 | Ongoing and frequent; routine consultations with community members |
Factors within your organization | ||||||
Person Focused Care | Our program collects and examines patient data by demographic or other social indicators to identify potential inequities in delivery of [INTERVENTION]… | Program collects demographic data but does not examine it for potential inequities | Between 1&3 | Program collects demographic data and examines it for potential inequities, but the results are not shared within the clinic | Between 3&5 | Program collects demographic data for potential inequities & uses it to set quality improvement aims to address inequity, sharing results within the clinic regularly |
Factors about the intervention | ||||||
Fit | [INTERVENTION] fit for our organization and patients… | Most patient care staff are not convinced that this intervention is a suitable fit for our organization and patients | Between 1&3 | Patient care staff hold mixed opinions, with some believing that intervention is a good fit for patients while others have reservations | Between 3&5 | Patient care staff are firmly convinced that this intervention is a suitable fit for both our organization and patients |
Factors about the persons receiving the intervention | ||||||
Recipients Needs and Values | Adaptability to patient’s cultural beliefs… | [INTERVENTION] is not adaptable to patients’ cultural beliefs. It cannot be tailored and delivered in a way that fits patients’ cultural beliefs | Between 1&3 | [INTERVENTION] is somewhat adaptable to patients’ cultural beliefs. Some aspects can be tailored and delivered to fit patients’ cultural beliefs | Between 3&5 | [INTERVENTION] is very adaptable to patients’ cultural beliefs, it can be tailored and delivered in a way that fits patients’ cultural beliefs |