Measuring readiness for implementation: A systematic review of measures' psychometric and pragmatic properties

Systematic measure reviews can facilitate advances in implementation research and practice by locating reliable, valid, pragmatic measures; identifying promising measures needing refinement and testing; and highlighting measurement gaps. This review identifies and evaluates the psychometric and pragmatic properties of measures of readiness for implementation and its sub-constructs as delineated in the Consolidated Framework for Implementation Research: leadership engagement, available resources, and access to knowledge and information.

The systematic review methodology is described fully elsewhere. The review, which focused on measures used in mental or behavioral health, proceeded in three phases. Phase I, data collection, involved search string generation, title and abstract screening, full text review, construct assignment, and cited citation searches. Phase II, data extraction, involved coding relevant psychometric and pragmatic information. Phase III, data analysis, involved two trained specialists independently rating each measure using Psychometric and Pragmatic Evidence Rating Scales (PAPERS). Frequencies and central tendencies summarized information availability and PAPERS ratings.

Searches identified 9 measures of readiness for implementation, 24 measures of leadership engagement, 17 measures of available resources, and 6 measures of access to knowledge and information. Information about internal consistency was available for most measures. Information about other psychometric properties was often not available. Ratings for internal consistency were "adequate" or "good." Ratings for other psychometric properties were less than "adequate." Information on pragmatic properties was most often available regarding cost, language readability, and brevity. Information was less often available regarding training burden and interpretation burden. Cost and language readability generally exhibited "good" or "excellent" ratings, interpretation burden generally exhibiting "minimal" ratings, and training burden and brevity exhibiting mixed ratings across measures.

Measures of readiness for implementation and its sub-constructs used in mental health and behavioral health care are unevenly distributed, exhibit unknown or low psychometric quality, and demonstrate mixed pragmatic properties. This review identified a few promising measures, but targeted efforts are needed to systematically develop and test measures that are useful for both research and practice.

Successful implementation of effective mental health or behavioral health treatments in service delivery settings depends in part on the readiness of the service providers and administrators to implement the treatment; the engagement of organizational leaders in the implementation effort; the resources available to support implementation, such as time, money, space, and training; and the accessibility of knowledge and information among service providers about the treatment and how it works. It is important that the methods for measuring these factors are dependable, accurate, and practical; otherwise, we cannot assess their presence or strength with confidence or know whether efforts to increase their presence or strength have worked. This systematic review of published studies sought to identify and evaluate the quality of questionnaires (referred to as measures) that assess readiness for implementation, leadership engagement, available resources, and access to knowledge and information. We identified 56 measures of these factors and rated their quality in terms of how dependable, accurate, and practical they are. Our findings indicate there is much work to be done to improve the quality of available measures; we offer several recommendations for doing so.