Assessment of organizational readiness for integrating primary eye care into primary healthcare: a mixed-method pre-implementation study in rural Xinjiang

Most evidence on integrating primary eye care (PEC) into primary healthcare (PHC) comes from retrospective analyses of implementation successes or failures, often documenting challenges related to workforce skills, service compatibility, and health system constraints. However, far less attention has been given to assessing organizational readiness before implementation—despite readiness being a critical determinant of whether new service innovations can be effectively adopted and sustained. To address this gap, this study provides the first systematic, theory-informed evaluation of pre-implementation readiness for PEC–PHC integration, examining motivational, capacity-related, and contextual factors that may influence implementation success. An explanatory sequential mixed-methods study was conducted in two rural counties in Xinjiang, China, during the pre-implementation phase of a stepped-wedge cluster randomized trial. Quantitative readiness data were collected using an adapted Organizational Readiness for Implementing Change (ORIC) tool, guided by the R = MC² heuristic. Participants included 14 township health center (THC) directors and 14 THC training doctors (selected via census), and 28 village doctors (selected via simple random sampling). For the qualitative phase, semi-structured interviews were conducted with 48 purposively sampled stakeholders. This included 42 providers derived from the quantitative sample, plus 6 county-level administrators and ophthalmologists. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using directed content analysis. Findings were integrated at the interpretation phase to explain quantitative scores through qualitative contextual insights, generating a comprehensive readiness profile. Overall readiness for PEC integration was moderate to high (mean composite score 3.63, SD 0.80). Motivation was the strongest dimension across cadres, with 85.7% of providers agreeing that PEC should be embedded within routine PHC services. Innovation-specific capacity showed greater variability, with THC training doctors demonstrating higher confidence in PEC skills than village doctors. General capacity exhibited the greatest constraints, including staffing shortages, limited equipment, and perceived workload burden. Qualitative findings revealed strong normative support for PEC integration but highlighted competing PHC priorities, uneven clinical skills, and structural resource limitations as key factors shaping readiness. Opportunities for integration were identified within existing public health programs and county medical alliance governance structures. This study underscores the critical value of assessing readiness before implementing new health service models. While rural providers in Xinjiang exhibit strong motivation to integrate PEC, disparities in capacity and persistent system-level constraints may hinder effective and sustainable implementation. The findings offer actionable insights for tailoring readiness-building strategies—including targeted training, supportive supervision, workflow integration, and policy alignment—to strengthen the feasibility of PEC–PHC integration and advance progress toward universal eye health coverage.