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Structured Assessment of FEasibility (SAFE)

What is SAFE?

Structured Assessment of FEasibility (SAFE) is a measure designed to assess the feasibility of implementing a complex intervention within mental health services within the NHS. The measure is designed for reviewers and policy makers when assessing the evidence base for an intervention and for researchers developing an intervention to ensure they consider factors related to implementation. It was developed at King’s College London.

The measure can be completed by systematic reviewers, commissioners, managers and researchers. There are 16 questions in two sections. The first eight questions assess blocks to implementation, with the final eight questions assessing facilitators of implementation. Best practice recommends against using summary scores on assessments to categorise papers within a systematic review, since items within the scale may have unequal weight. Instead it is recommended that reviewers attend to the individual items of the scale when conducting sensitivity and sub-group analyses. This same approach has been adopted for scoring SAFE – the reviewer rates individual items, without providing an overall summary score.

SAFE Reporting Guidelines

We have also developed SAFE reporting guidelines, to identify the information needed in intervention reports which allow SAFE to be rated. These reporting guidelines are intended to be used by authors reporting an intervention, to make it possible for the feasibility of the assessment to be reported.

Accessing SAFE

The reference for SAFE is:

Bird V, Le Boutillier C, Leamy M, Williams J, Bradstreet S, Slade M (2014) Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines, British Journal of Psychiatry, 204¸ 316-321

This paper included SAFE Version 1.0. Ongoing evaluation identified the need for minor modifications (SAFE Version 1.1) and a rating manual to further improve the reliability of SAFE ratings.

You can download SAFE Version 1.1 here

You can download SAFE Version 1.1 rating manual here

You can download SAFE Version 1 reporting guidelines here

SAFE was used to evaluate the feasibility of recovery interventions:

van der Krieke L, Bird V, Leamy M, Bacon F, Dunn R, Pesola F, Janosik M, Le Boutillier C, Williams J, Slade M (2105) The feasibility of implementing recovery, psychosocial and pharmacological interventions for psychosis: comparison study, Implementation Science, 10, 73.

SAFE has been developed as part of the REFOCUS programme of work. SAFE is copyrighted and the content cannot be changed. You do not need a licence to use SAFE for teaching, research or clinical purposes. If you wish to use SAFE in another way, such as including it in a publication, please email researchintorecovery@nottingham.ac.uk.

Translating SAFE

If you wish to translate SAFE, please email researchintorecovery@nottingham.ac.uk.

We will give you permission to proceed with your translation if:

a) the first page of your translation includes the statement: ‘SAFE was developed in English by Victoria Bird, Clair Le Boutillier, Mike Slade and colleagues in the Section for Recovery, Institute of Psychiatry, King’s College London. Further information from researchintorecovery.com/SAFE. This version was translated into <language> by <your name and contact details>‘;

b) the translation is distributed free of charge by you to academic and clinical colleagues who request a copy;

c) the translation is of acceptable and publishable quality.

To ensure that the translation is of acceptable and publishable quality, you will need to develop a translation protocol, which has four stages:

1) ensure the cultural validity of all items. You will need to investigate whether the items included in the English version are sufficient for your setting – by using surveys or focus groups, for example;

2) translate SAFE from English into your language and then back-translate. Different people should do the translation and the back-translation. The back-translation will need to be checked for its conformance with the original English SAFE;

3) pilot the resulting translation and make amendments to the items as necessary;

4) undertake a formal reliability and validity study.

If possible, please follow a formal methodology, such as the one described in:

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P (2005) Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation, Value in Health, 8, 2.

Each translation must be comparable with the original English SAFE. Minor modifications can be made to the wording for each item to maximize conceptual equivalence, but other elements (sub-scale structure, number of items, rating scale etc) cannot be changed. If you wish to publish a book or other publication including the translated version of SAFE, please email researchintorecovery@nottingham.ac.uk to obtain permission.