Complex implementation mechanisms in primary care: do physicians’ beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study

Table 2 Standardized estimates of structural equation modeling

Path (a – c)	Direct effect	Indirect effect	Total effect
Path a:
Organizational Readiness (ORIC) – > Contextualized beliefs (CB)	0.560** [CI: 0.25 – 0.69]	N/A	0.560** [CI: 0.25 – 0.69]
Std. Error	0.112		0.112
Path a (with covariates):
Organizational Readiness (ORIC) – > Contextualized beliefs (CB)	0.548** [CI: 0.24 – 0.64]	N/A	0.548** [CI: 0.24 – 0.64]
Std. Error	0.103		0.103
Path b:
Contextualized beliefs (CB) – > Behavioral Intention (BI)	0.510** [CI: 0.23 – 0.90]	N/A	0.510** [CI: 0.23 – 0.90]
Std. Error	0.169		0.169
Path b (with covariates):
Contextualized beliefs (CB) – > Behavioral Intention (BI)	0.478** [CI: 0.25 – 0.92]	N/A	0.478** [CI: 0.25 – 0.92]
Std. Error	0.170		0.170
Path c:
Organizational Readiness (ORIC) – > Behavioral Intention (BI)	0.388** [CI: 0.14 – 0.58]	0.286** [CI: 0.10 – 0.43]	0.674** [CI: 0.48 – 0.78]
Std. Error	0.114	0.082	0.077
Path c (with covariates):
Organizational Readiness (ORIC) – > Behavioral Intention (BI)	0.419** [CI: 0.18 – 0.65]	0.262** [CI: 0.10 – 0.41]	0.681** [CI: 0.49 – 0.87]
Std. Error	0.118	0.079	0.097
Covariates
Age < 50^a	-0.075	-0.031	-0.106
Age > 50^a	0.006	0.047	0.054
Gender	-0.054	0.017	-0.036
Length of PCP experience (Years)	0.004	0.027	0.031
Structural: Practice owner^b	-0.040	-0.007	-0.048
Structural: Urban areac (GP practice)	0.068	0.068	0.137*

Model Fit Statistics: CFI = 0.985; TLI = 0.981; RMSEA = 0.034.; SRMR = 0.055 (with covariates)
Total effects is the sum of direct and indirect effects; Indirect effects are the product of the regression coefficient leading to the outcome. For example, for CB, ORIC predicts CB and CB predicts BI. The indirect effect equals the product of the two regression coefficients from path a * path b
Effects of covariates relate to M and Y
^**Statistically Significant (p < 0.01)
^* Statistically Significant (p < 0.05)
^aCompared to Age > 60
^bCompared to employed primary care physicans (PCP)
^cCompared to rural area

ISSN: 2731-4553