Measuring Stakeholder Engagement in Statewide Primary Care Cardiovascular Health Improvement Cooperatives

Cardiovascular disease (CVD) remains a major national health challenge with significant disparities linked to socioeconomic status, race, ethnicity, sex, and geography, prompting federal efforts to build statewide primary care quality improvement (QI) cooperatives to improve heart health. To be effective, cooperatives require high levels of member engagement and leaders need ways to assess engagement. The objective of this study was to develop and validate a novel Cooperative Member Survey to assess cooperative member engagement and assess the value of the cooperative to members across three statewide heart health QI cooperatives. The 14-item survey included fixed-response and open-ended questions and was developed through multiple iterative rounds across the three cooperatives to gain consensus on the wording of final items using a Delphi process. The survey then was administered to the key stakeholders in the three cooperatives. Findings from both the quantitative and qualitative items were analyzed and reported based on frequencies and emerging themes. The survey was then analyzed to determine factor structure and validity. Analysis revealed a two-factor structure which the research team identified as: (1) Cooperative Engagement, consisting of 11 items that measured how well the cooperative functioned overall, and (2) Cooperative Value, consisting of two items that assessed the perceived value of mutual learning and respect within the cooperative. This two-factor structure indicated that the Cooperative Member Survey successfully captured both the practical aspects of how the cooperative operates and the members' perceived benefits of their involvement. Successful QI cooperatives not only require efficient operations but also a sense of shared value among members. These findings suggest that cooperatives designed to improve public health outcomes may benefit from focusing not only on practical aspects of engagement but also on cultivating mutual respect and collective learning.