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Table 2 Health policy implementation outcomes and determinants assessed in included measures (N = 70 unique measures in 66 health policy implementation studies)

From: Quantitative measures of health policy implementation determinants and outcomes: a systematic review



Included measures (N = 70)

n (%)



Implementation outcomes


17 (24%)

Perceptions by staff in organizations mandated to implement the policy, or perceptions of other stakeholders, that the policy mandate is agreeable, palatable, or satisfactory

Proctor et al. 2011 [25]


8 (11%)

Intention and initial actions of mandated organizations to revise their organizational policies to address policy mandates (not policy development or passage of bills into law).

Proctor et al. 2011 [25]


12 (17%)

“Perceived fit, relevance, or compatibility of the [policy] for a given practice setting, provider, or consumer; and/or perceived fit of the [policy] to address a particular issue or problem”; context fit

Proctor et al. 2011, pg. 69 [25]


10 (14%)

“Cost impact of an implementation effort”

Proctor et al. 2011, pg. 69 [25]


12 (17%)

“Extent to which a new [policy] can be successfully used or carried out within a given agency or setting”

Level of administration required to implement a policy, often called policy automaticity

Proctor et al. 2011, pg. 69 [25]

Howlett et al. 2015 [19]


18 (26%)

“Degree to which a [policy] was implemented as it was prescribed” [mandated]

Proctor et al. 2011, pg. 69 [25]


8 (11%)

“Integration of a [policy] within a service setting and its subsystems”

Proctor et al. 2011, pg. 70 [25]


1 (1%)

“Extent [new policy] is maintained or institutionalized within a service setting’s ongoing, stable operations”

Proctor et al. 2011, pg. 70 [25]

Determinants of implementation assessed


7 (10%)

“Degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs”

Damschroder et al. 2009, pg. 6 [33]


4 (6%)

“Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement”

Damschroder 2009, pg. 6 [33]

Presence of champions

3 (4%)

Field or practice leaders, people who can facilitate, and support practice change among professionals

Bullock 2019 [34], Damschroder et al. 2009 [33]

Organizational culture and climate (general)

27 (39%)

Culture: “Norms, values, and basic assumptions of a given organization”; or Climate: “Absorptive capacity for change”, extent policy compliance will be “rewarded, supported, and expected within their organization”

Damschroder et al. 2009, pg. 8 [33]

Damschroder et al. 2009, pg.8 [33]

Policy implementation climate

16 (23%)


a. Goals and feedback

6 (9%)

“Degree [the policy-mandate] goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals”

Damschroder et al. 2009, pg. 9 [33]

b. Relative priority

8 (11%)

“Individuals’ shared perception of importance of the [policy] implementation within the organization”, competing priorities

Damschroder et al. 2009, pg. 8 [33]

Readiness for implementation

43 (61%)


Damschroder et al. 2009 [33]

a. Communication of policy

22 (31%)

Actions taken to disseminate policy requirements and guidelines to implementers.

Identified in screening [33]

b. Policy awareness and knowledge

18 (26%)

Implementing staff/provider awareness the policy mandate exists, or knowledge of policy content

Identified in screening [33]

c. Leadership for implementation

13 (19%)

“Commitment, involvement, and accountability of leaders and managers with the implementation”

Damschroder et al. 2009, pg. 9 [33]

d. Training

14 (20%)

Training of staff/providers on how to implement the policy-mandated practices

Identified in screening [33]

e. Non-training resources

19 (27%)

“Level of resources dedicated for implementation and on-going operations including money…physical space, and time” other than training resources

Damschroder et al. 2009, pg. 9 [33]

Structure of organization

2 (3%)

“The social architecture, age, maturity, and size of an organization”

Damschroder et al. 2009, pg. 7 [33]

Actor relationships and networks

12 (17%)

Presence and characteristics of relationships between parallel organizations that must collaborate for policy implementation to be effective

Bullock 2019 [34]

Visibility of policy role/policy actors

7 (10%)

Perceived presence and importance of different actors pertinent to implementation of the policy

Bullock 2019 [34]

Political will for policy implementation

8 (11%)

Societal desire and commitment to generate resources to carry out policies

Bullock 2019 [34]

Target population characteristics

3 (4%)

Demographics, norms, neighborhood environments of population groups that affect implementation

Bullock 2019 [34]