Measuring Organizational Readiness for Implementing Change in Primary Care Facilities in Rural Bushbuckridge, South Africa

Document Type : Short Communication


1 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

2 Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

3 Boston University School of Public Health, Boston, MA, USA

4 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa


Meaningful gains in health outcomes require successful implementation of evidence-based interventions. Organizations such as health facilities must be ready to implement efficacious interventions, but tools to measure organizational readiness have rarely been validated outside of high-income settings. We conducted a pilot study of the organizational readiness to implement change (ORIC) measure in public primary care facilities serving Bushbuckridge Municipality in South Africa in early 2019. We administered the 10-item ORIC to 54 nurses and lay counsellors in 9 facilities to gauge readiness to implement the national Central Chronic Medicine Dispensing and Distribution (CCMDD) programme intended to declutter busy health facilities. We used exploratory factor analysis (EFA) to identify factor structure. We used Cronbach alpha and intraclass correlation (ICC) to assess reliability at the individual and facility levels. To assess validity, we drew on existing data from routine clinic monitoring and a 2018 quality assessment to test the correlation of ORIC with facility resources, value of CCMDD programme, and better programme uptake and service quality. Six items from the ORIC loaded onto a single factor with Cronbach’s alpha of 0.82 and ICC of 0.23. While facility ORIC score was not correlated with implementation of CCMDD, higher scores were correlated with facility resources, perceived value of the CCMDD program, patient satisfaction with wait time, and greater linkage to care following positive HIV testing. The study is limited by measuring ORIC after programme implementation. The findings support the relevance of ORIC, but identify a need for greater adaptation and validation of the measure.


  1. Kruk ME, Yamey G, Angell SY, et al. Transforming global health by improving the science of scale-up. PLoS Biol. 2016;14(3):e1002360. doi:10.1371/journal.pbio.1002360
  2. van den Broek N, Ameh C, Madaj B, et al. Effects of emergency obstetric care training on maternal and perinatal outcomes: a stepped wedge cluster randomised trial in South Africa. BMJ Glob Health. 2019;4(6):e001670. doi:10.1136/bmjgh-2019-001670
  3. Semrau KEA, Hirschhorn LR, Marx Delaney M, et al. Outcomes of a coaching-based WHO safe childbirth checklist program in India. N Engl J Med. 2017;377(24):2313-2324. doi:10.1056/NEJMoa1701075
  4. Yamey G. What are the barriers to scaling up health interventions in low and middle income countries? a qualitative study of academic leaders in implementation science. Global Health. 2012;8:11. doi:10.1186/1744-8603-8-11
  5. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252. doi:10.1016/s2214-109x(18)30386-3
  6. UNAIDS: Joint UN Program on HIV/AIDS. UNAIDS: South Africa. UNAIDS.  Accessed December 11, 2019. Published 2018.
  7. Gouda HN, Charlson F, Sorsdahl K, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017. Lancet Glob Health. 2019;7(10):e1375-e1387. doi:10.1016/s2214-109x(19)30374-2
  8. Meyer JC, Schellack N, Stokes J, et al. Ongoing initiatives to improve the quality and efficiency of medicine use within the public healthcare system in South Africa; a preliminary study. Front Pharmacol. 2017;8:751. doi:10.3389/fphar.2017.00751
  9. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50
  10. Weiner BJ, Amick H, Lee SY. Conceptualization and measurement of organizational readiness for change: a review of the literature in health services research and other fields. Med Care Res Rev. 2008;65(4):379-436. doi:10.1177/1077558708317802
  11. Weiner BJ. A theory of organizational readiness for change. Implement Sci. 2009;4:67. doi:10.1186/1748-5908-4-67
  12. Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implement Sci. 2014;9:7. doi:10.1186/1748-5908-9-7
  13. Kelly P, Hegarty J, Barry J, Dyer KR, Horgan A. A systematic review of the relationship between staff perceptions of organizational readiness to change and the process of innovation adoption in substance misuse treatment programs. J Subst Abuse Treat. 2017;80:6-25. doi:10.1016/j.jsat.2017.06.001
  14. Miake-Lye IM, Delevan DM, Ganz DA, Mittman BS, Finley EP. Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments. BMC Health Serv Res. 2020;20(1):106. doi:10.1186/s12913-020-4926-z
  15. Helfrich CD, Kohn MJ, Stapleton A, et al. Readiness to change over time: change commitment and change efficacy in a workplace health-promotion trial. Front Public Health. 2018;6:110. doi:10.3389/fpubh.2018.00110
  16. Gagnon MP, Attieh R, Ghandour el K, et al. A systematic review of instruments to assess organizational readiness for knowledge translation in health care. PLoS One. 2014;9(12):e114338. doi:10.1371/journal.pone.0114338
  17. Ruest M, Léonard G, Thomas A, Desrosiers J, Guay M. French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC). BMC Health Serv Res. 2019;19(1):535. doi:10.1186/s12913-019-4361-1
  18. Storkholm MH, Mazzocato P, Tessma MK, Savage C. Assessing the reliability and validity of the Danish version of Organizational Readiness for Implementing Change (ORIC). Implement Sci. 2018;13(1):78. doi:10.1186/s13012-018-0769-y
  19. Sharma N, Herrnschmidt J, Claes V, Bachnick S, De Geest S, Simon M. Organizational readiness for implementing change in acute care hospitals: an analysis of a cross-sectional, multicentre study. J Adv Nurs. 2018;74(12):2798-2808. doi:10.1111/jan.13801
  20. Bowles S, Louw J, Myers B. Perceptions of organizational functioning in substance abuse treatment facilities in South Africa. Int J Ment Health Addict. 2011;9(3):308-319. doi:10.1007/s11469-010-9285-2
  21. Brooke-Sumner C, Sorsdahl K, Lombard C, Petersen-Williams P, Myers B. Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa. BMJ Open. 2018;8(4):e020539. doi:10.1136/bmjopen-2017-020539
  22. Arthur K, Christofides N, Nelson G. Educators' perceptions of organisational readiness for implementation of a pre-adolescent transdisciplinary school health intervention for inter-generational outcomes. PLoS One. 2020;15(1):e0227519. doi:10.1371/journal.pone.0227519
  23. World Bank. Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data: Second Enrollment Report. Washington, DC: World Bank; 2017.
  24. Jagaroo N. Efficacy of the Central Chronic Medicine Dispensing and Delivery Programme in South Africa [dissertation]. Johannesburg: University of the Witwatersrand; 2017.
  25. Fox MP, Pascoe S, Huber AN, et al. Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa. PLoS Med. 2019;16(7):e1002874. doi:10.1371/journal.pmed.1002874
  26. Kahn K, Collinson MA, Gómez-Olivé FX, et al. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41(4):988-1001. doi:10.1093/ije/dys115
  27. Gómez-Olivé FX, Angotti N, Houle B, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122-1128. doi:10.1080/09540121.2012.750710
  28. Manne-Goehler J, Montana L, Gómez-Olivé FX, et al. The ART advantage: health care utilization for diabetes and hypertension in rural South Africa. J Acquir Immune Defic Syndr. 2017;75(5):561-567. doi:10.1097/qai.0000000000001445
  29. Lippman SA, Pettifor A, Rebombo D, et al. Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. Implement Sci. 2017;12(1):9. doi:10.1186/s13012-016-0541-0
  30. Kabudula CW, Clark BD, Gómez-Olivé FX, Tollman S, Menken J, Reniers G. The promise of record linkage for assessing the uptake of health services in resource constrained settings: a pilot study from South Africa. BMC Med Res Methodol. 2014;14:71. doi:10.1186/1471-2288-14-71
  31. Lippman SA, West R, Gómez-Olivé FX, et al. Treatment as prevention-provider knowledge and counseling lag behind global campaigns. J Acquir Immune Defic Syndr. 2020;83(2):e9-e12. doi:10.1097/qai.0000000000002197
  32. Gagnon MP, Attieh R, Dunn S, et al. Development and content validation of a transcultural instrument to assess organizational readiness for knowledge translation in healthcare organizations: the OR4KT. Int J Health Policy Manag. 2018;7(9):791-797. doi:10.15171/ijhpm.2018.17
  33. World Health Organization (WHO). Service Availability and Readiness Assessment (SARA) Reference Manual. Geneva, Switzerland: WHO; 2013.
  34. Auerswald M, Moshagen M. How to determine the number of factors to retain in exploratory factor analysis: a comparison of extraction methods under realistic conditions. Psychol Methods. 2019;24(4):468-491. doi:10.1037/met0000200
Volume 11, Issue 7
July 2022
Pages 912-918
  • Receive Date: 09 March 2020
  • Revise Date: 27 October 2020
  • Accept Date: 28 October 2020
  • First Publish Date: 23 November 2020