Table 2_The CATALYTIC tool to assess feasibility of implementing evidence-based interventions for cardiovascular diseases in 46 low- and middle-income countries: survey outcomes and tool reliability testing.docx

BackgroundEvidence-based interventions (EBI) for cardiovascular disease (CVD) in low- and middle-income countries (LMIC) may face feasibility challenges due to the inadequacy of existing instruments. To address this, researchers developed the Contextual Index of Feasibility on Early-Stage Implementation in LMIC (CATALYTIC) tool, which integrates contextual factors into the assessment of feasibility.
MethodsThe tool’s items were developed through a systematic review and key informant interviews, and were later assessed for relevance and importance by 13 LMIC researchers and implementers employing a Delphi technique. The survey was then tested for usability by five individuals with CVD experience in LMIC. The CATALYTIC tool consists of 17 items that measure contextual factors that directly influence early-stage LMIC implementation. Descriptive analysis, logistic regression, item reliability using Cronbach’s alpha, and exploratory factor analysis (EFA) were performed on survey data.
ResultsIn a survey of 216 respondents from 46 countries, 63.4 to 81.5% of respondents noted a significant impact of contextual factors on implementation feasibility, with high reliability (Cronbach’s alpha 0.88) for 12 items. The majority of interventions focused on patient-level care in rural settings. The survey items align primarily with constructs related to implementation climate and readiness for implementation, as well as inductive themes addressing existing needs and barriers to inform intervention design. The survey found diversity in geographic and experiential backgrounds, with significant representation from South Africa, Mexico, and India. Over a third identified as researchers, and 15% held multiple roles. The survey identified three distinct factors influencing how researchers and implementers assess CVD intervention feasibility in LMIC. A 6% increase in odds for moderately feasible interventions was linked to each point increase in the composite score of perceived contextual influence.
ConclusionOverall, the CATALYTIC tool with 12 reliable survey items can help researchers and implementers elucidate perceptions of contextual factors influencing the feasibility of CVD-related EBI in LMIC. The survey items reflect respondents’ practical focus in resource-limited settings and can inform intervention design by addressing existing needs and barriers. The tool’s integration of contextual factors into the assessment of feasibility can help overcome the inadequacy of existing instruments by providing more tailored and conceptually clear assessments of feasibility.

背景：针对低收入和中等收入国家（low- and middle-income countries, LMIC）的心血管疾病（cardiovascular disease, CVD）循证干预措施（Evidence-based interventions, EBI），由于现有工具存在不足，其可行性评估往往面临诸多挑战。为此，研究人员开发了低收入和中等收入国家早期实施可行性情境指数（Contextual Index of Feasibility on Early-Stage Implementation in LMIC，简称CATALYTIC）工具，该工具将情境因素纳入可行性评估体系。
方法：该工具的条目通过系统综述与关键知情人访谈开发形成，随后由13名来自低收入和中等收入国家的研究人员与实施者采用德尔菲法对条目相关性与重要性进行评估。随后，由5名具备低收入和中等收入国家心血管疾病研究经验的人员对该问卷的可用性进行测试。CATALYTIC工具共包含17个条目，用于评估直接影响低收入和中等收入国家早期项目实施的情境因素。研究人员对调研数据开展描述性分析、逻辑回归分析、基于克朗巴赫α系数（Cronbach’s alpha）的条目信度分析以及探索性因子分析（exploratory factor analysis, EFA）。
结果：针对来自46个国家的216名受访者开展的调研显示，63.4%至81.5%的受访者认为情境因素对项目实施可行性存在显著影响，其中12个条目的信度较高（克朗巴赫α系数为0.88）。多数干预措施聚焦于农村地区的患者级照护。调研条目主要与实施氛围、实施准备度等结构相关，同时涵盖了用于指导干预方案设计的、针对现有需求与障碍的归纳式主题。调研对象的地域与研究背景具有多样性，其中南非、墨西哥与印度的受访者占比突出。超过三分之一的受访者为研究人员，15%的受访者身兼多职。调研明确了3个影响低收入和中等收入国家研究人员与实施者评估心血管疾病干预措施可行性的独立因素。感知情境影响的综合评分每提升1分，中等可行性干预措施的发生比将提升6%。
结论：总体而言，包含12个可靠调研条目的CATALYTIC工具可帮助研究人员与实施者阐明影响低收入和中等收入国家心血管疾病相关循证干预措施可行性的情境因素认知。调研条目反映了受访者在资源受限环境中的实践关注点，可通过梳理现有需求与障碍为干预方案设计提供参考。该工具将情境因素纳入可行性评估体系，可通过提供更具针对性、概念更清晰的可行性评估方案，弥补现有工具的不足。