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Table 2 Implementation outcomes and determinants assessed in measurement tools (N = 86), then split by large-scale and unique tools

From: A systematic review of school health policy measurement tools: implementation determinants and outcomes

Domain

 

Included measures (N = 86)

%

Large-scale tools (n = 23)

%

Unique tools (n = 63)

%

Definition

Source

Implementation outcomes

Acceptability

18

20.9

0

0.0

18

28.6

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. [19]

Adoption

32

37.2

10

43.5

22

34.9

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. [19]

Appropriateness

9

10.5

0

0.0

9

14.3

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. [19]

Feasibility

8

9.3

1

4.3

7

11.1

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. [19]

Fidelity/compliance

70

81.4

21

91.3

49

77.8

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

Proctor et al. [19]

Penetration

15

17.4

8

34.8

7

11.1

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

Proctor et al. [19]

Sustainability

3

3.5

1

4.3

2

3.2

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

Proctor et al. [19]

Cost of implementation

5

5.8

0

0.0

5

7.9

Cost impact of an implementation effort

Proctor et al. [19]

Policy/innovation characteristics

Adaptability

3

3.5

0

0.0

3

4.8

Degree to which [a policy] can be adapted, tailored, refined, or reinvented to meet local needs

Damschroder et al. [24]

Complexity

3

3.5

0

0.0

3

4.8

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

Damschroder et al. [24]

Organizational characteristics/inner setting

Champions

6

7.0

0

0.0

6

9.5

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

Damschroder et al. [24]

Organizational culture and climate

9

10.5

1

4.3

8

12.7

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. [24]; Bullock [47]

Policy implementation climate (IC)

4

4.7

0

0.0

4

6.3

Organizational climate specific to the policy mandate

Damschroder et al. [24]

IC: goals and feedback

6

7.0

3

13.0

3

4.8

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. [24]

IC: relative priority

21

24.4

2

8.7

19

30.2

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

Damschroder et al. [24]

Opinion leaders

7

8.1

0

0.0

7

11.1

Individuals in an organization who have formal or informal influence on attitudes and beliefs of their colleagues with respect to implementing the policy

Damschroder et al. [24]

Readiness to implement (RI)

5

5.8

0

0.0

5

7.9

 

Damschroder et al. [24]

RI: communication of policy

41

47.7

18

78.3

23

36.5

Communication plans and channels created for how the regulatory agency or implementing organization/s will disseminate policy mandate content information to implementers. Actions taken to disseminate policy requirements and guidelines to implementers.

Damschroder et al. [24]

RI: policy awareness/knowledge

27

31.4

2

8.7

25

39.7

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

Damschroder et al. [24]

RI: leadership for implementation

42

48.8

22

95.7

20

31.7

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

Damschroder et al. [24]

RI: non-training resources

43

50.0

15

65.2

28

44.4

Level of resources dedicated for implementation and ongoing operations including money…physical space, and time, other than training resources

Damschroder et al. [24]

RI: training

35

40.7

16

69.6

19

30.2

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

Damschroder et al. [24]

Structure of organization

2

2.3

0

0.0

2

3.2

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

Damschroder et al. [24]

Implementation process

Enforcement

10

11.6

1

4.3

9

14.3

Strategies used to hold individuals accountable for implementation fidelity/compliance

From screening/coding

Evaluation

35

40.7

18

78.3

17

27.0

Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience.

Damschroder et al. [24]

General barriers and facilitators

20

23.3

2

8.7

18

28.6

Factors which facilitate/enable or hinder implementation

From screening/coding

Collaboration

11

12.8

7

30.4

4

6.3

Active involvement of other stakeholders in the organization to implement the policy

From screening/coding

Innovation participants

19

22.1

10

43.5

9

14.3

Engaging individuals who will directly benefit/receive the policy action

Damschroder et al. [24]

Actor relationships/networks

Actor relationships/networks

45

52.3

22

95.7

23

36.5

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

Bullock [47]

Visibility of policy role and policy actors

23

26.7

8

34.8

15

23.8

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

Bullock [47]

Actor context

Political will for policy implementation

12

14.0

3

13.0

9

14.3

Societal desire and commitment to generate resources to carry out policies

Bullock [47]

Target population characteristics

1

1.2

0

0.0

1

1.6

Demographics, norms, and neighborhood environments of the population groups that are affecting policy implementation

Bullock [47]

Other domain (not in manual)

CFIR process-planning

2

2.3

0

0.0

2

3.2

The degree to which a scheme or method of behavior and tasks for implementing [a policy] are developed in advance, and the quality of those schemes or methods

Damschroder et al. [24]

CFIR innovation characteristics-relative advantage

1

1.2

0

0.0

1

1.6

Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution

Damschroder et al. [24]

CFIR inner setting-tension for change

1

1.2

0

0.0

1

1.6

The degree to which stakeholders perceive the current situation as intolerable or needing change

Damschroder et al. [24]