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
Domain | Construct | Included measures (N = 70) n (%) | Definition | Source |
|---|---|---|---|---|
Implementation outcomes | Acceptability | 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] |
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] | |
Appropriateness | 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] | |
Costs | 10 (14%) | “Cost impact of an implementation effort” | Proctor et al. 2011, pg. 69 [25] | |
Feasibility | 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] | |
Fidelity/compliance | 18 (26%) | “Degree to which a [policy] was implemented as it was prescribed” [mandated] | Proctor et al. 2011, pg. 69 [25] | |
Penetration | 8 (11%) | “Integration of a [policy] within a service setting and its subsystems” | Proctor et al. 2011, pg. 70 [25] | |
Sustainability | 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 | Adaptability | 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] |
Complexity | 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 | ||
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] |