Bridging policy and implementation science: operationalising political and structural determinants for health policy implementation evaluation.

Abstract

Background: Despite their critical role in shaping public health policy implementation, key political and structural determinants within implementation frameworks are often poorly defined, underreported, or treated as background rather than as core implementation variables. Existing implementation science frameworks acknowledge these determinants, they lack systematic, operationalised guidance for reporting them, resulting in limited explanatory power, poor comparability, and an overemphasis on individual-level factors.

Objective: This paper aims to improve reporting standards in public health policy implementation evaluation by defining key political and structural determinants and proposing their operationalisation within established implementation frameworks.

Methods: The synthesis drew on seven systematic and scoping reviews and three in-depth case studies from the PEN, ASTRA, and STOP projects, covering nutrition, physical activity, and tobacco control. We consolidated predefined, theory-informed extraction categories from the underlying reviews, together with recurring reporting gaps, into overarching reporting dimensions. We then contextualised and refined these dimensions using evidence from the three case studies across diverse governance levels and socio-political settings.

Results: We consolidated and operationalised eight core reporting dimensions: (1) policy objectives and scope, (2) actors, power, and competence, (3) legal status and jurisdiction, (4) policy instruments (regulatory, economic, communicative, behavioural), (5) implementation strategies (centralised vs. decentralised, coordination mechanisms), (6) resources (financial, human, material, and implementation costs), (7) equity impact and (8) policy lifecycle. The dimensions specify political and structural information relevant to policy implementation evaluation and provide a structured basis for more systematic and transparent reporting across diverse policy contexts. The operationalisation is designed to complement and to be integrated into established implementation frameworks.

Conclusion: Systematic and transparent reporting of political and structural determinants is essential for understanding the success or failure of policy implementation. The proposed operationalisation offers researchers and evaluators a practical approach to strengthen public health policy implementation evaluations. Designed for integration into frameworks such as CFIR and CICI, it may help identify leverage points, support adaptive policy design, and contribute to more effective, equitable, and sustainable public health interventions.