Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA.
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
Implement Sci. 2024 Oct 31;19(1):73. doi: 10.1186/s13012-024-01401-8.
Research on determinants of health policy implementation is limited, and conceptualizations of evidence and implementation success are evolving in the field. This study aimed to identify determinants of perceived policy implementation success and assess whether these determinants vary according to: (1) how policy implementation success is operationally defined [i.e., broadly vs. narrowly related to evidence-based practice (EBP) reach] and (2) the role of a person's organization in policy implementation. The study focuses on policies that earmark taxes for behavioral health services.
Web-based surveys of professionals involved with earmarked tax policy implementation were conducted between 2022 and 2023 (N = 272). The primary dependent variable was a 9-item score that broadly assessed perceptions of the tax policy positively impacting multiple dimensions of outcomes. The secondary dependent variable was a single item that narrowly assessed perceptions of the tax policy increasing EBP reach. Independent variables were scores mapped to determinants in the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Multiple linear regression estimated associations between measures of determinants and policy implementation success.
Perceptions of tax attributes (innovation determinant), tax EBP implementation climate (inner-context determinant), and inter-agency collaboration in tax policy implementation (outer-context and bridging factor determinant) were significantly associated with perceptions of policy implementation success. However, the magnitude of associations varied according to how success was operationalized and by respondent organization type. For example, the magnitude of the association between tax attributes and implementation success was 42% smaller among respondents at direct service organizations than non-direct service organizations when implementation success was operationalized broadly in terms of generating positive impacts (β = 0.37 vs. β = 0.64), and 61% smaller when success was operationalized narrowly in terms of EBP reach (β = 0.23 vs. β = 0.59). Conversely, when success was operationalized narrowly as EBP reach, the magnitude of the association between EBP implementation climate and implementation success was large and significant among respondents at direct service organizations while it was not significant among respondents from non-direct service organizations (β = 0.48 vs. β=-0.06).
Determinants of perceived policy implementation success may vary according to how policy implementation success is defined and the role of a person's organization in policy implementation. This has implications for implementation science and selecting policy implementation strategies.
健康政策实施决定因素的研究有限，并且该领域对证据和实施成功的概念化仍在不断发展。本研究旨在确定感知政策实施成功的决定因素，并评估这些决定因素是否因以下因素而异：(1) 政策实施成功的操作定义[即与循证实践 (EBP) 实施的广泛程度相关与狭窄程度相关]；(2) 一个人的组织在政策实施中的作用。该研究侧重于为行为健康服务指定税收的政策。
在 2022 年至 2023 年期间，对参与指定税收政策实施的专业人员进行了基于网络的调查（N=272）。主要因变量是一个 9 项评分，该评分广泛评估了对税收政策的看法，认为该政策积极影响了多个结果维度。次要因变量是一个单一项目，该项目狭隘地评估了税收政策对 EBP 实施的影响。自变量是映射到探索、准备、实施和维持 (EPIS) 框架中的决定因素的分数。多元线性回归估计了决定因素和政策实施成功之间的关联。
税收属性的看法（创新决定因素）、税收 EBP 实施氛围（内部环境决定因素）以及税收政策实施中的机构间合作（外部环境和桥梁因素决定因素）与对政策实施成功的看法显著相关。然而，关联的大小因如何操作成功和受访者组织类型而异。例如，在将成功广泛地定义为产生积极影响时（β=0.37 vs. β=0.64），税收属性与实施成功之间的关联程度比非直接服务组织中的受访者小 42%；而在将成功狭义地定义为 EBP 实施范围时（β=0.23 vs. β=0.59），这种关联程度则小 61%。相反，当成功狭义地定义为 EBP 实施范围时，EBP 实施氛围与实施成功之间的关联程度在直接服务组织中的受访者中很大且显著，而在非直接服务组织中的受访者中则不显著（β=0.48 vs. β=-0.06）。
感知政策实施成功的决定因素可能因政策实施成功的定义方式以及个人组织在政策实施中的作用而异。这对实施科学和选择政策实施策略具有影响。
