# Assessing hospital antibiotic stewardship program (ASP) implementation: validation of an implementation science-informed survey

## TL;DR

This paper validates a survey based on implementation science to assess antibiotic stewardship program implementation in hospitals.

## Contribution

The study introduces a validated survey rooted in the CFIR framework for assessing ASP implementation determinants.

## Key findings

- The survey showed good fit for most CFIR constructs in confirmatory factor analyses.
- Internal consistency ranged from modest to strong (Cronbach’s alpha 0.54–0.96).
- Highly rated determinants included Self-Efficacy, Engaging, Evidence Strength and Quality, and Relative Advantage.

## Abstract

Antibiotic stewardship programs (ASPs) are crucial to prevent the emergence of antibiotic resistance and to improve outcomes for patients. A validated instrument rooted in a theoretically derived implementation science framework will increase our understanding of ASP implementation and enable comparisons across implementation sites.

Antibiotic stewards (infectious disease pharmacists and physicians) were recruited from Veterans Affairs (VA) hospitals to complete a survey on stewardship implementation. We used the Consolidated Framework for Implementation Research (CFIR) to guide development of an ASP implementation survey assessing 22 potential determinants of implementation across five domains of CFIR. We conducted confirmatory factor analyses (CFA) to assess construct validity of 8 construct measures and evaluated internal consistency.

A total of 150 stewards completed the survey from 110 VA hospitals. CFA for most CFIR constructs exhibited good fit. Internal consistency for CFIR construct subscales (Cronbach’s alpha) ranged from 0.54–0.96, indicating modest to strong internal consistency. Determinants that were rated highly present at the sites (across site means ≥ 4.0 or above) included Self-Efficacy, Engaging, Evidence Strength and Quality and Relative Advantage, indicating stewards found ASP evidence compelling and felt their personal involvement was effective in engendering positive results for the ASP.

Psychometric properties indicate validity of the first CFIR-based survey of determinants for ASP implementation outcomes. Clinical, quality improvement, and research teams can use this survey to identify contextual determinants of ASP implementation and use this information to guide selection of strategies and compare results across multiple sites.