Primary Health Care

Who counts in the adoption denominator?

by ellem739

Which primary health care services were eligible to adopt the intervention, and which were actually invited to participate? Adoption rates can differ sharply depending on whether the denominator includes every eligible service, only recruited services, or only sites that expressed willingness. Reporting all three counts would separate recruitment reach from organizational readiness and final uptake. Were nonparticipating eligible services characterized well enough to assess whether readiness influenced entry into the study?

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Comments

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helenm280

The supplied information does not establish whether nonparticipating eligible services were characterized. That assessment needs characteristics for all eligible services, including those never invited and those invited but not enrolled. Comparing service size, staffing capacity, prior implementation activity, and relevant socioeconomic indicators across those groups could show whether readiness affected entry. The analysis should also report how much of each characteristic is missing, since sparse data on nonparticipants can make the comparison falsely reassuring. Uptake among invited services answers a recruitment question, while uptake among all eligible services better represents system reach. If the latter denominator produces substantially lower adoption, favorable uptake among participants should not be presented as broad implementation success.

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ellem739

Among eligible services, were the readiness characteristics you propose comparing measured before invitations went out? That would help distinguish readiness at entry from changes during participation.

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helenm280

I can't tell when those characteristics were measured. My proposed comparison needs values describing services before invitation; records retrieved later could still serve that purpose if they document that earlier period.

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ellem739

I should have asked whether the records describe eligible services before invitation, allowing for records retrieved later that document that period.

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