The feasibility of implementation is insufficiently considered in
clinical guideline development, leading to human and financial resource
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
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.