Second, while there are no available measures of transition readiness, we will use a combination of measures that assess skills central to successful transition and thus reflect the multidimensional approach to transition, as recommended [ 19].
Of these, no studies were longitudinal or followed the participants significantly past the transitional period, and three studies were qualitative and thus lacked a comparison group and dealt with patient perceptions rather than provided measures of transition outcomes [ 31, 32, 34].
No reported reliable and valid measures of transitions are known to exist that are congruent with the definition of transitions as processes of integrating significant changes into a person's life.
The starting point of our analysis is to define what constitutes a transition from one variable to another and from this, develop a measure of transition frequency and significance.
Analysis of logistic models, correlations, and sensitivity and specificity estimates identified TSM as the most reliable measure of transition failure on both the individual cow level as well as the farm level across all study herds, with best performance achieved in herds with the most intensive postpartum cow management.
The criterion validity of transition-readiness tools is difficult to establish when there is no 'gold standard' measure of transition readiness.
Most of the tools have been validated by measures of self-efficacy, medication knowledge, or age (which is known to be a poor measure of transition readiness).
For M&E that is designed to aid learning processes and cast light on what constitutes effective transition practice, it will likely be important to have measures of both transition activities and institutionalization and outcomes to allow investigation of how transition activities affect final outcomes.
A priori, we identified three measures of "unsuccessful transition": inadequate preparation (i.e., lack of receipt of recommended transition elements) by patient self-report, prolonged gap between pediatric and adult care, and patient dissatisfaction with the transition process.
It is likely that other measures of a transition may need to be taken into account like education, health care, infrastructure (i.e., roads and water) or that this is an early stage of a transition.
However, Although GPE scales have been found to be reliable and valid measures of health transition [ 39], this study is weakened by the fact that we did not assess the psychometric properties of the scale beyond correlations to baseline, follow up and change scores.
