Dissemination and Implementation Science Measures

Evaluation of implementation constructs is a critical component of understanding how to implement, scale up and sustain evidence based mental health treatments in low and middle income (LMIC) settings. A barrier to implementation science research globally is the lack of pragmatic, feasible, demonstrably accurate, and relevant implementation measurement tools. We have worked over the past five years to develop a single instrument designed to measure the major implementation science domains of: Acceptability, Adoption, Appropriateness, Feasibility, Fidelity, Penetration/Reach, Organizational Climate and Culture, and Leadership across multiple stakeholder levels. We have also adapted two additional scales focused on capacity for sustainability (Program Sustainability Assessment Tool; PSAT)^[1] and Leadership (Implementation Leadership Scale; ILS)^[2]. We have also developed methods to evaluate fidelity to mental health treatment protocols using a 3-tiered system that is more sustainability and pragmatic that audio-recording.

Our scales are based on the following definitions for each domain which were largely adapted from the Proctor et al. 2010 model: 

• Acceptability: The perception among implementation stakeholders that a given intervention or innovation is agreeable, palatable, or satisfactory
• Adoption: The intention, initial decision, or action to try/employ an innovation or evidence-based practice and the engagement or disengagement with the innovation throughout implementation
• Appropriateness: Perceived fit with respect to needs
• Feasibility: Can be carried out with available resources. These resources include: appropriately trained personnel, money, time, buildings and furniture, technology, communications
• Fidelity: The extent to which a program was delivered as intended; adherence to a protocol
• Penetration/Reach: Proportion of those with a need who have services specific to the need available within a short travel time and affordable to those in need; The proportion of organizations, among those expected to provide a specific service, that are actually providing the service (at least once a week)
• Sustainability: To what extent an evidence-based intervention continues after external support from the donor agency is terminated
• Organizational Climate and Culture: The meanings people attach to interrelated bundles of experiences they have at work
• Leadership: The action of leading a group of people or an organization; characteristics important for facilitating change processes in organizations or creating organizational climates

Our measure was originally developed and piloted in Myanmar and Iraq. We then refined the scales based on local qualitative data, a literature review, and expert feedback. The current versions of the measure and all scales is being tested in Ukraine, Myanmar and Zambia. The measure is available by request.