Victoria J. Bird, BSc, Clair Le Boutillier, MSc, Mary Leamy, PhD, Julie Williams, MSc, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London; Simon Bradstreet, PhD, Scottish Recovery Network, Glasgow; Mike Slade, PhD, PsychD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
Br J Psychiatry. 2014;204:316-21. doi: 10.1192/bjp.bp.113.128314. Epub 2013 Dec 5.
The feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage.
To develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessment.
A focused narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohen's kappa (κ) was calculated for interrater reliability and test-retest reliability.
In total, 95 influences on implementation were identified from 299 references. The final measure - Structured Assessment of FEasibility (SAFE) - comprises 16 items rated on a Likert scale. There was excellent interrater (κ = 0.84, 95% CI 0.79-0.89) and test-retest reliability (κ = 0.89, 95% CI 0.85-0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. The SAFE reporting guidelines include 16 items organised into three categories (intervention, resource consequences, evaluation).
A novel approach to evaluating interventions, SAFE, supplements efficacy and health economic evidence. The SAFE reporting guidelines will allow feasibility of an intervention to be systematically assessed.
临床指南制定中对实施的可行性考虑不足，导致人力和财力资源浪费。
开发（a）一种用于心理健康服务的复杂干预措施实施可行性的基于经验的标准化衡量标准，以及（b）报告准则，以促进可行性评估。
对评估实施障碍和促进因素的研究进行了重点叙述性综述，采用主题分析和投票计数来确定衡量标准的候选项目。共有 20 项有针对性抽样的研究（15 项试验报告，5 项方案）纳入了心理测量评估，涵盖了不同的干预类型。使用 Cohen's kappa（κ）计算了组内相关系数（interrater reliability）和重测信度（test-retest reliability）。
从 299 篇参考文献中总共确定了 95 种对实施有影响的因素。最终的衡量标准 - 结构评估可行性（SAFE）- 包括 16 项李克特量表评分项目。具有极好的组内相关系数（κ=0.84，95%置信区间 0.79-0.89）和重测信度（κ=0.89，95%置信区间 0.85-0.93）。成本信息和培训时间是干预论文中最不可能报告的两个影响因素。SAFE 报告准则包括 16 项组织成三个类别（干预、资源后果、评估）的项目。
一种评估干预措施的新方法，SAFE，补充了疗效和健康经济证据。SAFE 报告准则将能够系统地评估干预措施的可行性。
