Skip to main content

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

DomainConstructIncluded measures (N = 70)
n (%)
Implementation outcomesAcceptability17 (24%)Perceptions by staff in organizations mandated to implement the policy, or perceptions of other stakeholders, that the policy mandate is agreeable, palatable, or satisfactoryProctor et al. 2011 [25]
Adoption*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]
Appropriateness12 (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 fitProctor et al. 2011, pg. 69 [25]
Costs10 (14%)“Cost impact of an implementation effort”Proctor et al. 2011, pg. 69 [25]
Feasibility12 (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]
Fidelity/compliance18 (26%)“Degree to which a [policy] was implemented as it was prescribed” [mandated]Proctor et al. 2011, pg. 69 [25]
Penetration8 (11%)“Integration of a [policy] within a service setting and its subsystems”Proctor et al. 2011, pg. 70 [25]
Sustainability1 (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 assessedAdaptability7 (10%)“Degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs”Damschroder et al. 2009, pg. 6 [33]
Complexity4 (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 champions3 (4%)Field or practice leaders, people who can facilitate, and support practice change among professionalsBullock 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 climate16 (23%)  
a. Goals and feedback6 (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 priority8 (11%)“Individuals’ shared perception of importance of the [policy] implementation within the organization”, competing prioritiesDamschroder et al. 2009, pg. 8 [33]
Readiness for implementation43 (61%) Damschroder et al. 2009 [33]
a. Communication of policy22 (31%)Actions taken to disseminate policy requirements and guidelines to implementers.Identified in screening [33]
b. Policy awareness and knowledge18 (26%)Implementing staff/provider awareness the policy mandate exists, or knowledge of policy contentIdentified in screening [33]
c. Leadership for implementation13 (19%)“Commitment, involvement, and accountability of leaders and managers with the implementation”Damschroder et al. 2009, pg. 9 [33]
d. Training14 (20%)Training of staff/providers on how to implement the policy-mandated practicesIdentified in screening [33]
e. Non-training resources19 (27%)“Level of resources dedicated for implementation and on-going operations including money…physical space, and time” other than training resourcesDamschroder et al. 2009, pg. 9 [33]
Structure of organization2 (3%)“The social architecture, age, maturity, and size of an organization”Damschroder et al. 2009, pg. 7 [33]
Actor relationships and networks12 (17%)Presence and characteristics of relationships between parallel organizations that must collaborate for policy implementation to be effectiveBullock 2019 [34]
Visibility of policy role/policy actors7 (10%)Perceived presence and importance of different actors pertinent to implementation of the policyBullock 2019 [34]
Political will for policy implementation8 (11%)Societal desire and commitment to generate resources to carry out policiesBullock 2019 [34]
Target population characteristics3 (4%)Demographics, norms, neighborhood environments of population groups that affect implementationBullock 2019 [34]