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Larkins A, Vannamahaxay S, Puttana V, Chittavong M, Southammavong F, Mayxay M, Boyd D, Bruce M, Ash A. Scaling up One Health: A network analysis in Lao PDR. One Health 2024; 18:100661. [PMID: 38179311 PMCID: PMC10761780 DOI: 10.1016/j.onehlt.2023.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Background One Health focuses on sustainable health for humans, animals, and ecosystems. The approach has been well demonstrated, yet most efforts have not been scaled up. Understanding the organisations involved in scaling up processes is critical to translating research into practice. The Lao People's Democratic Republic has successfully implemented One Health projects for multiple decades; however, the organisational network has not been described and scaling up efforts have been limited. Methods Data from organisations involved in One Health projects over the past five years were collected by key-informant interview or workshop. The network was investigated using a mixture of quantitative network analysis and qualitative thematic analysis. Results The organisational network was quantitatively described as sparse and centralised. Organisations were required to harness pre-existing relationships to maximise scarce resources and make co-ordination and alignment of priorities more efficient. A lack of international organisations in the top 10% of resource sharing metrics suggests a potential disconnect between donors. This was reflected in the challenges faced by national organisations and a feeling of being stretched thin over numerous externally funded projects with donor-driven priorities. Conclusions It appears that high-level political support for country ownership of development and aid priorities remains unrealised. Developing network capacity and capability may assist scaling up efforts and build resilience in the network and its core organisations. This may allow for the inclusion of more development, education, environment, and water, sanitation, and hygiene organisations that were perceived to be lacking. Future One Health programmes should focus on practical activities that do not overload staff capacity. There is much for One Health to learn about the art of scaling up and organisations are encouraged to include implementation science in their research to inform future scaling up efforts.
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Affiliation(s)
- Andrew Larkins
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, Australia
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, Australia
| | - Soulasack Vannamahaxay
- Faculty of Agriculture, National University of Laos, Vientiane, Lao Democratic People’s Republic
| | - Vannaphone Puttana
- Faculty of Agriculture, National University of Laos, Vientiane, Lao Democratic People’s Republic
- Lao One Health University Network, Vientiane, Lao Democratic People’s Republic
| | - Malavanh Chittavong
- Faculty of Agriculture, National University of Laos, Vientiane, Lao Democratic People’s Republic
- Lao One Health University Network, Vientiane, Lao Democratic People’s Republic
| | - Fongsamouth Southammavong
- Faculty of Agriculture, National University of Laos, Vientiane, Lao Democratic People’s Republic
- Lao One Health University Network, Vientiane, Lao Democratic People’s Republic
| | - Mayfong Mayxay
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao Democratic People’s Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao Democratic People’s Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao One Health University Network, Vientiane, Lao Democratic People’s Republic
| | - Davina Boyd
- Centre for Sustainable Farming Systems, Food Futures Institute, Murdoch University, Perth, Australia
| | - Mieghan Bruce
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, Australia
- School of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Amanda Ash
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, Australia
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, Australia
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Wang J, Wang P, Liu B, Kinney PL, Huang L, Chen K. Comprehensive evaluation framework for intervention on health effects of ambient temperature. ECO-ENVIRONMENT & HEALTH 2024; 3:154-164. [PMID: 38646097 PMCID: PMC11031729 DOI: 10.1016/j.eehl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 04/23/2024]
Abstract
Despite the existence of many interventions to mitigate or adapt to the health effects of climate change, their effectiveness remains unclear. Here, we introduce the Comprehensive Evaluation Framework for Intervention on Health Effects of Ambient Temperature to evaluate study designs and effects of intervention studies. The framework comprises three types of interventions: proactive, indirect, and direct, and four categories of indicators: classification, methods, scope, and effects. We trialed the framework by an evaluation of existing intervention studies. The evaluation revealed that each intervention has its own applicable characteristics in terms of effectiveness, feasibility, and generalizability scores. We expanded the framework's potential by offering a list of intervention recommendations in different scenarios. Future applications are then explored to establish models of the relationship between study designs and intervention effects, facilitating effective interventions to address the health effects of ambient temperature under climate change.
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Affiliation(s)
- Jiaming Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Peng Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
- Faculty of Civil Engineering and Mechanics, Jiangsu University, Zhenjiang 212013, China
| | - Beibei Liu
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lei Huang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
- Center for Public Health Research, Medical School of Nanjing University, Nanjing 210093, China
| | - Kai Chen
- Department of Environmental Health Sciences, Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT 06510, USA
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Finkle C, Martin K, Salas I, Mirano J, Mwaikambo L, Lokko K, Rimon J. A Platform for Sustainable Scale: The Challenge Initiative's Innovative Approach to Scaling Proven Interventions. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200167. [PMID: 38772722 PMCID: PMC11111104 DOI: 10.9745/ghsp-d-22-00167] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/30/2022] [Indexed: 05/23/2024]
Abstract
INTRODUCTION The global health community continues to face barriers in scaling up evidence-based interventions for widespread adoption. Although many effective interventions have been developed over the years, expanding their reach to benefit broader populations has happened slowly or not at all. OVERVIEW The Challenge Initiative (TCI) is a nontraditional development platform that supports local urban governments to rapidly scale up proven family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions for the urban poor. TCI prioritizes sustainability and local ownership and uses a health systems approach when planning for and managing scale. TCI strengthens urban health systems with seed funding, coaching, and technical assistance (TA), and TCI University houses "how-to" guidance and tools for implementing the interventions. In turn, local governments commit political will and financial and human resources while using TCI coaching to integrate interventions into routine practice and systems to achieve widespread and sustained impact at scale. RESULTS As of June 2021, TCI has supported 104 local governments across 11 countries in scaling up effective FP and AYSRH interventions, while also mobilizing about US$28 million from those local governments to facilitate their implementation. TCI has increased capacity and bolstered urban health systems, with 39 local governments "graduating" from TCI support and 2.02 million additional FP clients across 4 regional TA hubs. CONCLUSION TCI aims to change how local governments coordinate, finance, and implement proven interventions to improve access to quality FP information and services. With built-in incentives for local governments, partners, and donors to participate, TCI is generating significant learning on how local governments can realize sustainable scale and demonstrating how organizations like TCI that facilitate governments to scale up effective interventions can accelerate the scale-up of these interventions across multiple geographies.
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Affiliation(s)
| | - Kim Martin
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ian Salas
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Mirano
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Mwaikambo
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Kojo Lokko
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jose Rimon
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Ishola OD, Holcombe SJ, Ferrand A, Ajijola L, Anieto NN, Igharo V. What Underlies State Government Performance in Scaling Family Planning Programming? A Study of The Challenge Initiative State Partnerships in Nigeria. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200228. [PMID: 38621820 PMCID: PMC11111101 DOI: 10.9745/ghsp-d-22-00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/26/2022] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Relatively few studies rigorously examine the factors associated with health systems strengthening and scaling of interventions at subnational government levels. We aim to examine how The Challenge Initiative (TCI) coaches subnational (state government) actors to scale proven family planning and adolescent and youth sexual and reproductive health approaches rapidly and sustainably through public health systems to respond to unmet need among the urban poor. METHODS This mixed-methods comparative case study draws on 32 semistructured interviews with subnational government leaders and managers, nongovernmental organization leaders, and TCI Nigeria staff, triangulated with project records and government health management information system (HMIS) data. Adapting the Consolidated Framework for Implementation Research (CFIR), we contrast experience across 2 higher-performing states and 1 lower-performing state (identified through HMIS data and selected health systems strengthening criteria from 13 states) to identify modifiable factors linked with successful adoption and implementation of interventions and note lessons for supporting scale-up. RESULTS Informants reported that several TCI strategies overlapping with CFIR were critical to states' successful adoption and sustainment of interventions, most prominently external champions' contributions and strengthened state planning and coordination, especially in higher-performing states. Government stakeholders institutionalized new interventions through their annual operational plans. Higher-performing states incorporated mutually reinforcing interventions (including service delivery, demand generation, and advocacy). Although informants generally expressed confidence that newly introduced service delivery interventions would be sustained beyond donor support, they had concerns about government financing of demand-side social and behavior change work. CONCLUSION As political and managerial factors, even more than technical factors, were most linked with successful adoption and scale-up, these processes and systems should be assessed and prioritized from the start. Government leaders, TCI coaches, and other stakeholders can use these findings to shape similar initiatives to sustainably scale social service interventions.
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Affiliation(s)
- Oluwayemisi Denike Ishola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Sarah Jane Holcombe
- The Challenge Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Ferrand
- The Challenge Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lekan Ajijola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Nneoma Nonyelum Anieto
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Victor Igharo
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
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Bakare AA, Salako J, King C, Olojede OE, Bakare D, Olasupo O, Burgess R, McCollum ED, Colbourn T, Falade AG, Molsted-Alvesson H, Graham HR. 'Let him die in peace': understanding caregiver's refusal of medical oxygen treatment for children in Nigeria. BMJ Glob Health 2024; 9:e014902. [PMID: 38760025 PMCID: PMC11103205 DOI: 10.1136/bmjgh-2023-014902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Efforts to improve oxygen access have focused mainly on the supply side, but it is important to understand demand barriers, such as oxygen refusal among caregivers. We therefore aimed to understand caregiver, community and healthcare provider (HCP) perspectives and experiences of medical oxygen treatments and how these shape oxygen acceptance among caregivers of sick children in Lagos and Jigawa states, which are two contrasting settings in Nigeria. METHODS Between April 2022 and January 2023, we conducted an exploratory qualitative study using reflexive thematic analysis, involving semistructured interviews with caregivers (Jigawa=18 and Lagos=7), HCPs (Jigawa=7 and Lagos=6) and community group discussions (Jigawa=4 and Lagos=5). We used an inductive-deductive approach to identify codes and themes through an iterative process using the theoretical framework of acceptability and the normalisation process theory as the analytic lens. RESULTS Medical oxygen prescription was associated with tension, characterised by fear of death, hopelessness about a child's survival and financial distress. These were driven by community narratives around oxygen, past negative experiences and contextual differences between both settings. Caregiver acceptance of medical oxygen was a sense-making process from apprehension and scepticism about their child's survival chances to positioning prescribed oxygen as an 'appropriate' or 'needed' intervention. Achieving this transition occurred through various means, such as trust in HCPs, a perceived sense of urgency for care, previous positive experience of oxygen use and a symbolic perception of oxygen as a technology. Misconceptions and pervasive negative narratives were acknowledged in Jigawa, while in Lagos, the cost was a major reason for oxygen refusal. CONCLUSION Non-acceptance of medical oxygen treatment for sick children is modifiable in the Nigerian context, with the root causes of refusal being contextually specific. Therefore, a one-size-fits-all policy is unlikely to work. Financial constraints and community attitudes should be addressed in addition to improving client-provider interactions.
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Affiliation(s)
- Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Julius Salako
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Omotayo E Olojede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Damola Bakare
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Olabisi Olasupo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Rochelle Burgess
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Department of Paediatrics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Hamish R Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Victoria, Australia
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Audibert C, Aspinall A, Tchouatieu AM, Hugo P. Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries. Trop Med Infect Dis 2024; 9:93. [PMID: 38787026 PMCID: PMC11125622 DOI: 10.3390/tropicalmed9050093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Several studies recently confirmed the emergence of resistance to antimalarial drugs in sub-Saharan Africa. Multiple first-line treatment (MFT) is one of the measures envisaged to respond to the emergence and spread of this resistance. The aim of this study was to identify the perceived advantages and disadvantages of several MFT deployment strategies and to better understand potential implementation drivers and barriers. METHODS A qualitative survey was conducted in seven sub-Saharan countries amongst key opinion leaders, national decision makers, and end users. A total of 200 individual interviews were conducted and findings were analyzed following a thematic inductive approach. RESULTS From a policy perspective, the new MFT intervention would require endorsement at the global, national, and regional levels to ensure its inclusion in guidelines. Funding of the MFT intervention could be a bottleneck due to costs associated with additional training of healthcare workers, adaptation of drug delivery mechanisms, and higher costs of drugs. Concerning the MFT deployment strategies, a slight preference for the segmentation strategy was expressed over the rotation and geographic approaches, due to the perception that a segmentation approach is already in place at country level. CONCLUSIONS The findings highlighted the need for a collective approach to MFT deployment through the engagement of stakeholders at all levels of malaria management.
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Affiliation(s)
- Celine Audibert
- Medicines for Malaria Venture (MMV), Route de Pre-Bois 20, 1215 Meyrin, Switzerland; (A.A.)
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Metta E, Unkels R, Mselle LT, Hanson C, Alvesson HM, Al-Beity FMA. Exploring women's experiences of care during hospital childbirth in rural Tanzania: a qualitative study. BMC Pregnancy Childbirth 2024; 24:290. [PMID: 38641769 PMCID: PMC11027221 DOI: 10.1186/s12884-024-06396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/07/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Women's childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations. Recently, quality improvement interventions that incorporate women's childbirth experiences are thought to result in healthcare services that are more responsive and grounded in the end-user's needs. AIM This study aimed to explore women's childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania. METHODS This exploratory qualitative study used semi-structured interviews with women after childbirth (n = 25) in two hospitals in Southern Tanzania. Reflexive thematic analysis was applied using the World Health Organization's Quality of Care framework on experiences of care domains. RESULTS Three themes emerged from the data: (1) Women's experiences of communication with providers varied (2) Respect and dignity during intrapartum care is not guaranteed; (3) Women had varying experience of support during labour. Verbal mistreatment and threatening language for adverse birthing outcomes were common. Women appreciated physical or emotional support through human interaction. Some women would have wished for more support, but most accepted the current practices as they were. CONCLUSION The experiences of care described by women during childbirth varied from one woman to the other. Expectations towards empathic care seemed low, and the little interaction women had during labour and birth was therefore often appreciated and mistreatment normalized. Potential co-designed interventions should include strategies to (i) empower women to voice their needs during childbirth and (ii) support healthcare providers to have competencies to be more responsive to women's needs.
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Affiliation(s)
- Emmy Metta
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Regine Unkels
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lilian Teddy Mselle
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Fadhlun M Alwy Al-Beity
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Obstetrics/Gynaecology, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Niang M, Alami H, Gagnon MP, Dupéré S. A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action. Glob Health Action 2023; 16:2230813. [PMID: 37459240 DOI: 10.1080/16549716.2023.2230813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. OBJECTIVE By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. METHOD We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. RESULTS The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. CONCLUSION From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health.
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Affiliation(s)
- Marietou Niang
- Department of Social Work and Psychosociology, Université du Québec à Rimouski, Lévis, QC, Canada
| | - Hassane Alami
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | | | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, Québec, QC, Canada
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Semahegn A, Manyazewal T, Hanlon C, Getachew E, Fekadu B, Assefa E, Kassa M, Hopkins M, Woldehanna T, Davey G, Fekadu A. Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review. Health Res Policy Syst 2023; 21:131. [PMID: 38057873 PMCID: PMC10699029 DOI: 10.1186/s12961-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review. METHODS The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question. RESULTS A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. CONCLUSION Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | | | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
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Hakizimana D, Shitu K, Rankin KC, Alemie GA, Walson J, Guthrie BL, Means AR. Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia. BMJ Open 2023; 13:e075817. [PMID: 38011972 PMCID: PMC10685948 DOI: 10.1136/bmjopen-2023-075817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Child mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact of pairing Orthodox priests with community health workers, known locally as the Health Development Army (HDA), on newborns' nutritional status, early illness identification and treatment, and vaccination completeness.Ensuring intervention efficacy with scientific rigour is essential, but there are often delays in adopting evidence into policy and programmes. Here, we present a protocol for conducting parallel implementation research alongside an efficacy study to understand intervention implementability and scalability. This will help develop a scale-up strategy for effective elements of the intervention to ensure rapid implementation at scale. METHODS AND ANALYSIS We will conduct a stakeholder analysis of key implementation stakeholders and readiness surveys to assess their readiness to scale up the intervention. We will conduct semistructured interviews and focus group discussions with stakeholders, including HDA members, health workers, Orthodox priests, and caregivers, to determine the core intervention elements that need to be scaled, barriers and facilitators to scaling up the intervention in diverse sociocultural settings, as well as the human and technical requirements for national and regional implementation. Finally, to determine the financial resources necessary for sustaining and scaling the intervention, we will conduct activity-based costing to estimate implementation costs from the provider's perspective. ETHICS AND DISSEMINATION The study received approval from the University of Gondar Institutional Review Board (approval no: VP/RTT/05/1030/2022) and the University of Washington Human Subjects Division (approval no: STUDY00015369). Participants will consent to participate. Results will be disseminated through workshops with stakeholders, local community meetings, presentations at local and international conferences, and journal publications. The study will provide evidence for factors to consider in developing a scale-up strategy to integrate the intervention into routine health system practices.
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Affiliation(s)
| | - Kegnie Shitu
- Department of Health Education and Behavioral Sciences, University of Gondar, Gondar, Ethiopia
| | - Katherine C Rankin
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Getahun A Alemie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Global Health/Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
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CORÔA ROBERTADECARVALHO, GOGOVOR AMÉDÉ, BEN CHARIF ALI, HASSINE ASMABEN, ZOMAHOUN HERVÉTCHALAVIGNON, MCLEAN ROBERTKD, MILAT ANDREW, PLOURDE KARINEV, RHEAULT NATHALIE, WOLFENDEN LUKE, LÉGARÉ FRANCE. Evidence on Scaling in Health and Social Care: An Umbrella Review. Milbank Q 2023; 101:881-921. [PMID: 37186312 PMCID: PMC10509507 DOI: 10.1111/1468-0009.12649] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
Policy Points More rigorous methodologies and systematic approaches should be encouraged in the science of scaling. This will help researchers better determine the effectiveness of scaling, guide stakeholders in the scaling process, and ultimately increase the impacts of health innovations. The practice and the science of scaling need to expand worldwide to address complex health conditions such as noncommunicable and chronic diseases. Although most of the scaling experiences described in the literature are occurring in the Global South, most of the authors publishing on it are based in the Global North. As the science of scaling spreads across the world with the aim of reducing health inequities, it is also essential to address the power imbalance in how we do scaling research globally. CONTEXT Scaling of effective innovations in health and social care is essential to increase their impact. We aimed to synthesize the evidence base on scaling and identify current knowledge gaps. METHODS We conducted an umbrella review according to the Joanna Briggs Institute Reviewers' Manual. We included any type of review that 1) focused on scaling, 2) covered health or social care, and 3) presented a methods section. We searched MEDLINE (Ovid), Embase, PsycINFO (Ovid), CINAHL (EBSCO), Web of Science, The Cochrane Library, Sociological Abstracts (ProQuest), Academic Search Premier (EBSCO), and ProQuest Dissertations & Theses Global from their inception to August 6, 2020. We searched the gray literature using, e.g., Google and WHO-ExpandNet. We assessed methodological quality with AMSTAR2. Paired reviewers independently selected and extracted eligible reviews and assessed study quality. A narrative synthesis was performed. FINDINGS Of 24,269 records, 137 unique reviews were included. The quality of the 58 systematic reviews was critically low (n = 42). The most frequent review type was systematic review (n = 58). Most reported on scaling in low- and middle-income countries (n = 59), whereas most first authors were from high-income countries (n = 114). Most reviews concerned infectious diseases (n = 36) or maternal-child health (n = 28). They mainly focused on interventions (n = 37), barriers and facilitators (n = 29), frameworks (n = 24), scalability (n = 24), and costs (n = 14). The WHO/ExpandNet scaling definition was the definition most frequently used (n = 26). Domains most reported as influencing scaling success were building scaling infrastructure (e.g., creating new service sites) and human resources (e.g., training community health care providers). CONCLUSIONS The evidence base on scaling is evolving rapidly as reflected by publication trends, the range of focus areas, and diversity of scaling definitions. Our study highlights knowledge gaps around methodology and research infrastructures to facilitate equitable North-South research relationships. Common efforts are needed to ensure scaling expands the impacts of health and social innovations to broader populations.
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Affiliation(s)
- ROBERTA DE CARVALHO CORÔA
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
| | - AMÉDÉ GOGOVOR
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
| | | | - ASMA BEN HASSINE
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Faculty of NursingUniversité Laval
| | - HERVÉ TCHALA VIGNON ZOMAHOUN
- Faculty of MedicineUniversité Laval
- School of Physical and Occupational TherapyFaculty of Medicine and Health Sciences, McGill University
| | - ROBERT K. D. MCLEAN
- International Development Research Centre
- Faculty of Medicine and Health SciencesStellenbosch University
| | - ANDREW MILAT
- School of Public HealthUniversity of Sydney
- Centre for Epidemiology and EvidenceNSW Ministry of Health
| | - KARINE V. PLOURDE
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
| | - NATHALIE RHEAULT
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
| | - LUKE WOLFENDEN
- School of Medicine and Public HealthUniversity of Newcastle
- National Centre of Implementation ScienceUniversity of Newcastle
- Hunter New England Population Health
| | - FRANCE LÉGARÉ
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
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Mao W, Zimmerman A, Urli Hodges E, Ortiz E, Dods G, Taylor A, Udayakumar K. Comparing research and development, launch, and scale up timelines of 18 vaccines: lessons learnt from COVID-19 and implications for other infectious diseases. BMJ Glob Health 2023; 8:e012855. [PMID: 37696544 PMCID: PMC10496705 DOI: 10.1136/bmjgh-2023-012855] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023] Open
Abstract
Over the next decade, millions of deaths could be prevented by increasing access to vaccines in low-income and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that the research and development (R&D), launch and scale up timelines of vaccines can be drastically shortened. This study compares such timelines for eighteen vaccines and identifies lessons and implications for accelerating the R&D, launch and scale up process for other vaccine candidates. To replicate the rapid R&D process of the COVID-19 vaccines, future vaccine R&D should capitalise on public-private knowledge sharing partnerships to promote technology innovation, establish regional clinical trial centres and data sharing networks to optimise clinical trial efficiency, and create a funding mechanism to support research into novel vaccine platforms that may prove valuable to quickly developing vaccine candidates in future global health emergencies. To accelerate the launch timeline, future efforts to bring safe and efficacious vaccines to market should include LMICs in the decision-making processes of global procurement and delivery alliances to optimise launch in these countries, strengthen the WHO prequalification and Emergency Use Listing programs to ensure LMICs have a robust and transparent regulatory system to rely on, and invest in LMIC regulatory and manufacturing capacity to ensure these countries are vaccine self-sufficient. Lastly, efforts to accelerate scale up of vaccines should include the creation of regional pooled procurement mechanisms between LMICs to increase purchasing power among these countries and an open line of clear communication with the public regarding pertinent vaccine information to combat misinformation and vaccine hesitancy.
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Affiliation(s)
- Wenhui Mao
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Armand Zimmerman
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
| | - Elina Urli Hodges
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Ernesto Ortiz
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Galen Dods
- Science and Society, Duke University, Durham, North Carolina, USA
| | - Andrea Taylor
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
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Landon B, Thomas ED, Orlando L, Evans R, Murray T, Mohammed L, Noel J, Isaac R, Waechter R. Spare the rod, spoil the child: measurement and learning from an intervention to shift corporal punishment attitudes and behaviors in Grenada, West Indies. Front Public Health 2023; 11:1127687. [PMID: 37744480 PMCID: PMC10512176 DOI: 10.3389/fpubh.2023.1127687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
Childrearing practices in the Caribbean and other postcolonial states have long been associated with corporal punishment and are influenced by expectations of children for respectfulness and obedience. Evidence across settings shows that physical punishment of young children is both ineffective and detrimental. Saving Brains Grenada (SBG) implemented a pilot study of an intervention based on the Conscious Discipline curriculum that aimed to build adult caregivers' skills around non-violent child discipline. We hypothesized that attitudes towards corporal punishment would shift to be negative as adults learned more positive discipline methods, and that child neurodevelopment would correspondingly improve. This report reviews the impact of monitoring and evaluation on the design and implementation of the intervention. Study 1 presents findings from the pilot study. Despite positive gains in neurodevelopmental outcomes among children in the intervention compared to controls, attitudes towards corporal punishment and reported use of it did not change. Additionally, several internal conflicts in the measures used to assess corporal punishment behaviors and attitudes were identified. Study 2 is a response to learning from Study 1 and highlights the importance for monitoring and evaluation to be data-informed, adaptive, and culturally appropriate. In Study 2, the SBG research team conducted cognitive interviews and group discussions with stakeholders to assess the content and comprehensibility of the Attitudes Towards Corporal Punishment Scale (ACP). This yielded insights into the measurement of attitudes towards corporal punishment and related parenting behavior, and prompted several revisions to the ACP. To accurately evaluate the intervention's theory of change and its goal to reduce violence against children, reliable and appropriate measures of attitudes towards corporal punishment and punishment behaviors are needed. Together, these two studies emphasize the value of continuous monitoring, evaluation, and learning in the implementation, adaptation, evaluation, and scaling of SBG and similar early childhood development interventions.
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Affiliation(s)
- Barbara Landon
- Windward Islands Research and Education Foundation, St. George’s, Grenada
- Psychological Services Center, St. George's University, St. George’s, Grenada
| | | | - Lauren Orlando
- Department of Public Health, St. George's University, St. George’s, Grenada
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Toni Murray
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Lauren Mohammed
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Jesma Noel
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Rashida Isaac
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St. George’s, Grenada
- Department of Neuroscience, School of Medicine, St. George's University, St. George’s, Grenada
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Douine M, Cairo H, Galindo MS, Vreden S, Lambert Y, Adenis A, Jimeno I, Suarez-Mutis M, Sanna A, Hiwat H. From an interventional study to a national scale-up: lessons learned from the Malakit strategy at the French Guiana-Suriname border. Malar J 2023; 22:237. [PMID: 37587474 PMCID: PMC10429066 DOI: 10.1186/s12936-023-04672-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
Scaling-up an experimental intervention is always a challenge. On the border between French Guiana, Brazil and Suriname, an interventional study demonstrated the effectiveness of distributing self-diagnosis and self-treatment kits (Malakits) to control malaria in mobile and hard-to-reach populations. Its integration into the Suriname's National Malaria Elimination Plan after a 2-year experiment faced numerous challenges, including human resources to cope with the additional workload of coordinators and to maintain the motivation of community health workers. The economic recession in Suriname, the Covid pandemic, and logistical issues also hampered the scale-up. Finally, thanks to the commitment of stakeholders in Suriname and French Guiana, the integration of Malakit distribution into the Surinamese national programme was proved possible.
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Affiliation(s)
- Maylis Douine
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana.
- TBIP, CNRS, Inserm, U1019-UMR9017-CIIL Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, Université de Guyane, Université de Lille, Cayenne, French Guiana.
| | - Hedley Cairo
- National Malaria Elimination Programme, Ministry of Health of Suriname, Paramaribo, Suriname
| | - Muriel Suzanne Galindo
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana
| | - Stephen Vreden
- Foundation for the Advancement of Scientific Research, Paramaribo, Suriname
| | - Yann Lambert
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana
| | - Antoine Adenis
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana
- TBIP, CNRS, Inserm, U1019-UMR9017-CIIL Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, Université de Guyane, Université de Lille, Cayenne, French Guiana
| | - Irene Jimeno
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana
| | - Martha Suarez-Mutis
- Laboratory of Parasitic Diseases, Institute Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Alice Sanna
- Inserm CIC 1424, Cayenne Hospital, Centre d'Investigation Clinique Antilles-Guyane, Cayenne, French Guiana
| | - Hélène Hiwat
- National Malaria Elimination Programme, Ministry of Health of Suriname, Paramaribo, Suriname
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Domingo A, Yessis J, Charles KA, Skinner K, Hanning RM. Integrating knowledge and action: learnings from an implementation program for food security and food sovereignty with First Nations communities within Canada. Implement Sci 2023; 18:34. [PMID: 37573323 PMCID: PMC10422772 DOI: 10.1186/s13012-023-01291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. METHODS A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. RESULTS Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. CONCLUSIONS Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.
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Affiliation(s)
- Ashleigh Domingo
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Jennifer Yessis
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Kelly Skinner
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Estifanos AS, Haile Mariam D, Fikre A, Kote M, Tariku A, Chan GJ. Implementation science to design, test and scale up effective Kangaroo Mother Care in Oromia region, Ethiopia. Acta Paediatr 2023; 112 Suppl 473:56-64. [PMID: 35691617 DOI: 10.1111/apa.16413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
AIM To develop a locally tested and optimised Kangaroo Mother Care (KMC) scale-up model to achieve high population-based effective coverage of KMC in Oromia region. METHOD We conducted an implementation research study to design and test KMC scale-up models from March 2017 to March 2019 in five hospitals and 39 health centres covering a population of 1.1 million in Oromia region, Ethiopia. We evaluated the models by measuring effective KMC coverage (at least 8 hours of skin-to-skin care plus exclusive breastfeeding) for newborns weighing <2000 g in the 24 hours before discharge from the KMC facility and on the 7th-day post-discharge. RESULTS After three cycles of iterative model implementation, we developed a KMC scale-up model that resulted in increased population-based effective KMC coverage. We enhanced the existing health system by strengthening the health system, reinforcing the linkages between the health system and communities and improving community engagement. Our final model achieved effective KMC coverage of 54%: 95% CI [49, 60] in the 24 hours before discharge from the facility and 38%: 95% CI [32, 43] on the 7th-day post-discharge. CONCLUSION Through iterative testing and adaptations, a model to scale up KMC that achieves 54% population-based effective coverage of KMC can be developed.
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Affiliation(s)
- Abiy Seifu Estifanos
- Department of Reproductive, Family, and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisalem Fikre
- HaSET Maternal, Neonatal, and Child Health Research Program, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesfin Kote
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Grace J Chan
- Division of Medical Critical Care, Department of Paediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Wainwright M, Zahroh RI, Tunçalp Ö, Booth A, Bohren MA, Noyes J, Cheng W, Munthe-Kaas H, Lewin S. The use of GRADE-CERQual in qualitative evidence synthesis: an evaluation of fidelity and reporting. Health Res Policy Syst 2023; 21:77. [PMID: 37491226 PMCID: PMC10369711 DOI: 10.1186/s12961-023-00999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/12/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) is a methodological approach to systematically and transparently assess how much confidence decision makers can place in individual review findings from qualitative evidence syntheses. The number of reviews applying GRADE-CERQual is rapidly expanding in guideline and other decision-making contexts. The objectives of this evaluation were, firstly, to describe the uptake of GRADE-CERQual in qualitative evidence synthesis by review authors and, secondly, to assess both reporting of and fidelity to the approach. METHODS The evaluation had two parts. Part 1 was a citation analysis and descriptive overview of the literature citing GRADE-CERQual. Authors worked together to code and chart the citations, first by title and abstract and second by full text. Part 2 was an assessment and analysis of fidelity to, and reporting of, the GRADE-CERQual approach in included reviews. We developed fidelity and reporting questions and answers based on the most recent guidance for GRADE-CERQual and then used NVivo12 to document assessments in a spreadsheet and code full-text PDF articles for any concerns that had been identified. Our assessments were exported to Excel and we applied count formulae to explore patterns in the data. We employed a qualitative content analysis approach in NVivo12 to sub-coding all the data illustrating concerns for each reporting and fidelity criteria. RESULTS 233 studies have applied the GRADE-CERQual approach, with most (n = 225, 96.5%) in the field of health research. Many studies (n = 97/233, 41.6%) were excluded from full fidelity and reporting assessment because they demonstrated a serious misapplication of GRADE-CERQual, for example interpreting it as a quality appraisal tool for primary studies or reviews. For the remaining studies that applied GRADE-CERQual to assess confidence in review findings, the main areas of reporting concern involved terminology, labelling and completeness. Fidelity concerns were identified in more than half of all studies assessed. CONCLUSIONS GRADE-CERQual is being used widely within qualitative evidence syntheses and there are common reporting and fidelity issues. Most of these are avoidable and we highlight these as gaps in knowledge and guidance for applying the GRADE-CERQual approach.
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Affiliation(s)
- Megan Wainwright
- Department of Anthropology, Faculty of Social Sciences and Health, Durham University, South Road, Durham, United Kingdom
| | - Rana Islamiah Zahroh
- Gender and Women’s Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Carlton, VIC Australia
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Andrew Booth
- Faculty of Medicine, Dentistry and Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Carlton, VIC Australia
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, Wales United Kingdom
| | - Weilong Cheng
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, VIC Australia
| | - Heather Munthe-Kaas
- The Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Division of Health Services and Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
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Aderoba AK, Steyn PS, Kiarie JN. Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review. Syst Rev 2023; 12:114. [PMID: 37403147 PMCID: PMC10318699 DOI: 10.1186/s13643-023-02216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/06/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up. OBJECTIVE To describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs. METHOD Recent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach. RESULTS Of the 755 retrieved documents, 34 were included in this review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018-2021). This review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes. CONCLUSION This scoping review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes. REGISTRATION The protocol for this review was registered in the protocols.io repository ( https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1 ).
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Affiliation(s)
- Adeniyi Kolade Aderoba
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Centre for Population Health and Interdisciplinary Research, Box 603, HealthMATE 360, Ondo Town, Ondo State, 350001, Nigeria.
| | - Petrus Schoken Steyn
- UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Headquarters, Geneva, Switzerland
| | - James Njogu Kiarie
- UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Headquarters, Geneva, Switzerland
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Chham S, Van Olmen J, Van Damme W, Chhim S, Buffel V, Wouters E, Ir P. Scaling-up integrated type-2 diabetes and hypertension care in Cambodia: what are the barriers to health system performance? Front Public Health 2023; 11:1136520. [PMID: 37333565 PMCID: PMC10272385 DOI: 10.3389/fpubh.2023.1136520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Background Non-communicable diseases (NCDs) such as type-2 diabetes (T2D) and hypertension (HTN) pose a massive burden on health systems, especially in low- and middle-income countries. In Cambodia, to tackle this issue, the government and partners have introduced several limited interventions to ensure service availability. However, scaling-up these health system interventions is needed to ensure universal supply and access to NCDs care for Cambodians. This study aims to explore the macro-level barriers of the health system that have impeded the scaling-up of integrated T2D and HTN care in Cambodia. Methods Using qualitative research design comprised an articulation between (i) semi-structured interviews (33 key informant interviews and 14 focus group discussions), (ii) a review of the National Strategic Plan and policy documents related to NCD/T2D/HTN care using qualitative document analysis, and (iii) direct field observation to gain an overview into health system factors. We used a health system dynamic framework to map macro-level barriers to the health system elements in thematic content analysis. Results Scaling-up the T2D and HTN care was impeded by the major macro-level barriers of the health system including weak leadership and governance, resource constraints (dominantly financial resources), and poor arrangement of the current health service delivery. These were the result of the complex interaction of the health system elements including the absence of a roadmap as a strategic plan for the NCD approach in health service delivery, limited government investment in NCDs, lack of collaboration between key actors, limited competency of healthcare workers due to insufficient training and lack of supporting resources, mis-match the demand and supply of medicine, and absence of local data to generate evidence-based for the decision-making. Conclusion The health system plays a vital role in responding to the disease burden through the implementation and scale-up of health system interventions. To respond to barriers across the entire health system and the inter-relatedness of each element, and to gear toward the outcome and goals of the health system for a (cost-)effective scale-up of integrated T2D and HTN care, key strategic priorities are: (1) Cultivating leadership and governance, (2) Revitalizing the health service delivery, (3) Addressing resource constraints, and (4) Renovating the social protection schemes.
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Affiliation(s)
- Savina Chham
- National Institute of Public Health, Phnom Penh, Cambodia
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Josefien Van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Srean Chhim
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Veerle Buffel
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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Birkholz L, Weber P, Helsper N, Kohler S, Dippon L, Rütten A, Pfeifer K, Semrau J. Multi-level stakeholders' perspectives on implementation and scaling up community-based health promotion in Germany. Health Promot Int 2023; 38:7151550. [PMID: 37140350 DOI: 10.1093/heapro/daad045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'International human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept.
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Affiliation(s)
- Leonie Birkholz
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Philipp Weber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Natalie Helsper
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Simone Kohler
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Lea Dippon
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Alfred Rütten
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
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Lee K, Crane M, Grunseit A, O’Hara B, Milat A, Wolfenden L, Bauman A, van Nassau F. Development and Application of the Scale-Up Reflection Guide (SRG). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6014. [PMID: 37297618 PMCID: PMC10253157 DOI: 10.3390/ijerph20116014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/12/2023]
Abstract
Scaling up effective interventions in public health is complex and comprehensive, and published accounts of the scale-up process are scarce. Key aspects of the scale-up experience need to be more comprehensively captured. This study describes the development of a guide for reflecting on and documenting the scale-up of public health interventions, to increase the depth of practice-based information of scaling up. Reviews of relevant scale-up frameworks along with expert input informed the development of the guide. We evaluated its acceptability with potential end-users and applied it to two real-world case studies. The Scale-up Reflection Guide (SRG) provides a structure and process for reflecting on and documenting key aspects of the scale-up process of public health interventions. The SRG is comprised of eight sections: context of completion; intervention delivery, history/background; intervention components; costs/funding strategies and partnership arrangements; the scale-up setting and delivery; scale-up process; and evidence of effectiveness and long-term outcomes. Utilization of the SRG may improve the consistency and reporting for the scale-up of public health interventions and facilitate knowledge sharing. The SRG can be used by a variety of stakeholders including researchers, policymakers or practitioners to more comprehensively reflect on and document scale-up experiences and inform future practice.
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Affiliation(s)
- Karen Lee
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Melanie Crane
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Public Health, The University of Technology Sydney, 15 Broadway, Sydney, NSW 2007, Australia
| | - Blythe O’Hara
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Andrew Milat
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Public Health, The University of Technology Sydney, 15 Broadway, Sydney, NSW 2007, Australia
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 1 Reserve Road, St. Leonards, NSW 2065, Australia
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Abramovsky L, Augsburg B, Lührmann M, Oteiza F, Rud JP. Community matters: Heterogeneous impacts of a sanitation intervention. WORLD DEVELOPMENT 2023; 165:106197. [PMID: 37138929 PMCID: PMC10008727 DOI: 10.1016/j.worlddev.2023.106197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 05/05/2023]
Abstract
Sanitation is at the heart of public health policies in most of the developing world, where around 85% of the population still lack access to safe sanitation. We study the effectiveness of a widely adopted participatory community-level information intervention aimed at improving sanitation. Results from a randomized controlled trial, implemented at scale in rural Nigeria, reveal stark heterogeneity in impacts: the intervention has immediate, strong and lasting effects on sanitation practices in less wealthy communities, realized through increased sanitation investments. In contrast, we find no evidence of impacts among wealthier communities. This suggests that a targeted implementation of CLTS may increase its effectiveness in improving sanitation. Our findings can be replicated in other contexts, using microdata from evaluations of similar interventions.
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Affiliation(s)
- Laura Abramovsky
- The Institute for Fiscal Studies (IFS), United Kingdom
- Overseas Development Institute (ODI), United Kingdom
| | - Britta Augsburg
- The Institute for Fiscal Studies (IFS), United Kingdom
- Corresponding author.
| | - Melanie Lührmann
- Department of Economics, Royal Holloway, and IFS, United Kingdom
- CESifo (Center for Economic Studies and Ifo Institute for Economic Research), Germany
| | - Francisco Oteiza
- The Institute for Fiscal Studies (IFS), United Kingdom
- Oslo Economics, Norway
| | - Juan Pablo Rud
- Department of Economics, Royal Holloway, and IFS, United Kingdom
- Institute of Labour Economics (IZA), Germany
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Baker-Henningham H, Bowers M, Francis T. The Process of Scaling Early Childhood Violence Prevention Programs in Jamaica. Pediatrics 2023; 151:e2023060221M. [PMID: 37125879 DOI: 10.1542/peds.2023-060221m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Violence is a global public health problem, and early childhood interventions are a core component of violence prevention programming. Interventions to support parents and teachers of young children can prevent violence against children by caregivers and prevent the early development of antisocial behavior. However, there is limited guidance on how to scale up these programs in low- and middle-income countries. METHODS In this article, we describe how we applied implementation science principles in the design, implementation, evaluation, and initial scaling of 2 complementary early childhood, violence prevention, caregiver training programs in Jamaica: the Irie Classroom Toolbox (a teacher-training program) and the Irie Homes Toolbox (a parenting program). RESULTS We identified 7 implementation science principles most relevant to our work in scaling the Irie Toolbox programs and describe how these principles were operationalized in the Jamaican context. The principles are: (1) design programs for scale from the outset; (2) use learning cycles for quality improvement; (3) plan strategically for government agency adoption; (4) provide high-quality initial and ongoing training and regular supervision; (5) monitor implementation quality; (6) use flexible delivery modes; and (7) plan for program sustainment. CONCLUSIONS Through applying these principles to scale the Irie Toolbox programs, we aim to promote a consistent approach to reducing violence against children, reducing child behavior problems, and increasing caregiver and child competencies across both home and school contexts at the population level. The principles and processes described in this article are relevant to other behavior change interventions in early childhood development, education, and public health.
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Affiliation(s)
- Helen Baker-Henningham
- School of Human and Behavioral Sciences, Bangor University, UK
- Caribbean Institute for Health Research, University of the West Indies, Jamaica
| | - Marsha Bowers
- Caribbean Institute for Health Research, University of the West Indies, Jamaica
| | - Taja Francis
- Caribbean Institute for Health Research, University of the West Indies, Jamaica
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Kokole D, Jané-Llopis E, Mercken L, Natera Rey G, Arroyo M, Pérez Gómez A, Mejía-Trujillo J, Piazza M, Bustamante I, O'Donnell A, Kaner E, Schulte B, de Vries H, Anderson P. Protocol for a process evaluation of SCALA study - Intervention targeting scaling up of primary health care-based prevention and management of heavy drinking and comorbid depression in Latin America. EVALUATION AND PROGRAM PLANNING 2023; 97:102217. [PMID: 36603348 DOI: 10.1016/j.evalprogplan.2022.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
This paper describes the plan for a process evaluation of a quasi-experimental study testing the municipal level scale-up of primary health care-based measurement and brief advice programmes to reduce heavy drinking and comorbid depression in Colombia, Mexico, and Peru. The main aims of the evaluation are to assess the implementation of intervention components; mechanisms of impact that influenced the outcomes; and characteristics of the context that influenced implementation and outcomes. Based on this information, common drivers of successful outcomes will be identified. A range of data collection methods will be used: questionnaires; interviews; observations; logbooks; and document analysis. All participating providers will complete a pen-and-paper questionnaire at recruitment and two time points during the implementation period. Providers attending training will complete post-training questionnaires. Additionally, 1080 patients will be invited to self-complete a patient questionnaire. One-in-ten participating providers and fifteen other key stakeholders will participate in semi-structured interviews. Training sessions and community advisory board meetings will be observed by a neutral observer. Logbooks will be kept by local research teams to document events affecting the implementation. Project related documentation and other relevant reports describing the context will be examined.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain; Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Department of Health Psychology, Open University, Valkenburgerweg 1776419 AT Heerlen, the Netherlands.
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | | | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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Cutherell M, Bwire J, Mtei E, Musau A, Kahabuka C, Luhanga I, Julius A, Kihwele G. Accelerated institutionalization of an adolescent sexual and reproductive health (ASRH) intervention in Tanzania: Findings from a mixed-methods evaluation. Front Glob Womens Health 2023; 4:942418. [PMID: 37009090 PMCID: PMC10050757 DOI: 10.3389/fgwh.2023.942418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/06/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionFrom 2018 to 2020, Adolescents 360 (A360), aiming to increase demand for and voluntary uptake of modern contraception among adolescent girls 15–19 years, designed and scaled an intervention in Tanzania (Kuwa Mjanja) to 13 regions through project-funded expansion. In 2020, the project began to develop a strategy for its follow-on phase, focusing on program sustainability. In this process, funder priorities led to a decision to exit A360's programming in Tanzania over a 15-month exit period. A360 elected to pursue a process of expedited institutionalization of Kuwa Mjanja into government systems during this period.Materials and methodsThe institutionalization process was facilitated in 17 local government authorities in Tanzania. Quantitative and qualitative data were gathered and analyzed including time-trend analysis of routine performance data, statistical analysis of two rounds of client exit interviews, and thematic analysis of qualitative research.ResultsThe sociodemographic characteristics of adolescent girls reached under government-led implementation were comparable to those reached by A360-led implementation. Intervention productivity decreased under government-led implementation but remained consistent. Adopter method mix shifted slightly toward greater long-acting and reversible contraceptive uptake under a government-led model. Factors that enabled successful institutionalization of Kuwa Mjanja included the presence of youth-supportive policies, the establishment of school clubs which provided sexual and reproductive health education, commitment of government stakeholders, and appreciation of adolescent pregnancy as a problem. Some intervention components were important for program effectiveness but proved difficult to institutionalize, primarily because of resource constraints. Lack of adolescent sexual and reproductive health (ASRH)-focused targets and indicators disincentivized Kuwa Mjanja implementation.DiscussionThere is significant potential in operationalizing user-centered ASRH models within government structures, even in a narrow time frame. A360 saw similar performance under government-led implementation and fidelity to the unique experience that the program was designed to deliver for adolescent girls. However, beginning this process earlier presents greater opportunities, as some aspects of the institutionalization process that are critical to sustained impact, for example, shifting government policy and measurement and mobilizing government resources, require heavy coordination and long-term efforts. Programs pursuing institutionalization in a shorter time frame would benefit from setting realistic expectations. This may include prioritizing a smaller subset of program components that have the greatest impact.
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Affiliation(s)
- Meghan Cutherell
- Population Services International (PSI), Washington, DC, United States
- Correspondence: Meghan Cutherell
| | - Juliana Bwire
- Population Services International (PSI) Tanzania, Dar es Salaam, Tanzania
| | - Edwin Mtei
- Population Services International (PSI) Tanzania, Dar es Salaam, Tanzania
| | - Abednego Musau
- Population Services International (PSI), Washington, DC, United States
| | - Catherine Kahabuka
- Itad, London, United Kingdom
- CSK Research Solutions, Dar es Salaam, Tanzania
| | - Isabellah Luhanga
- Itad, London, United Kingdom
- CSK Research Solutions, Dar es Salaam, Tanzania
| | - Augustino Julius
- Population Services International (PSI) Tanzania, Dar es Salaam, Tanzania
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Abrahams N, Khodabakhsh S, Toumpakari Z, Marais F, Lambert EV, Foster C. Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review. Int J Behav Nutr Phys Act 2023; 20:8. [PMID: 36707866 PMCID: PMC9883854 DOI: 10.1186/s12966-023-01412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Community-based programmes [CBPs], targeting increased physical activity and/or healthier eating, have been used in the prevention and management of non-communicable diseases. However, CBPs are only useful, insofar as they can be scaled up and sustained in some meaningful way. Social networks-defined as "social structures that exists between actors, individuals or organizations"-may serve as an important tool to identify underlying mechanisms that contribute to this process. This scoping review aimed to map and collate literature on the role of social network research in scaling-up and sustaining physical activity and/or diet CBPs in low-and middle-income countries [LMICs]. METHODS Arksey and O'Malley's framework and its enhancement were followed. Inclusion criteria were peer-reviewed articles exploring the role of social networks in scaled-up and/or sustained physical activity and/or diet CBPs in adult populations, published in English since 2000, and based in a LMIC. Databases searched were PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, International Bibliography of the Social Sciences, and Google Scholar. Books, conference abstracts, and programmes focused on children were excluded. Two reviewers independently selected and extracted eligible studies. Included publications were thematically analysed using the Framework Approach. RESULTS Authors identified 12 articles for inclusion, covering 13 CBPs. Most were based in Latin America, with others in the Caribbean, the Pacific Islands, Iran, and India. All articles were published since 2009. Only three used social network analysis methods (with others using qualitative methods). Five main social network themes were identified: centralisation, cliques, leaders, quality over quantity, and shared goals. Contextual factors to be considered when scaling-up programmes in LMICs were also identified. CONCLUSIONS This review has shown that the evidence of the use of social network research in programme scale-up has not yet caught up to its theoretical possibilities. Programmes aiming to scale should consider conducting social network research with identified network themes in mind to help improve the evidence-base of what network mechanisms, in what contexts, might best support the strengthening of networks in physical activity and diet programmes. Importantly, the voice of individuals and communities in these networks should not be forgotten.
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Affiliation(s)
- Nina Abrahams
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK ,grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sahar Khodabakhsh
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
| | - Zoi Toumpakari
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
| | - Frederick Marais
- grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa ,grid.451392.80000 0000 8557 0256Healthy Lifestyle Services, Public Health, Somerset County Council, Taunton, UK ,grid.25881.360000 0000 9769 2525Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Estelle V. Lambert
- grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charlie Foster
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
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Bulthuis S, Kok M, Onvlee O, O’Byrne T, Amon S, Namakula J, Chikaphupha K, Gerold J, Mansour W, Raven J, Broerse JEW, Dieleman M. How to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda. BMC Health Serv Res 2023; 23:35. [PMID: 36642734 PMCID: PMC9840942 DOI: 10.1186/s12913-023-09034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/04/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. METHODS The study took a comparative case study approach with two rounds of data collection (2019 and 2021) in which a combination of different qualitative methods was applied. Interviews and group discussions took place with district, regional and national stakeholders who were involved in the implementation and scale-up of the intervention. RESULTS A shared vision among the different stakeholders about how to institutionalize the intervention into the existing system facilitated scale-up. The importance of champions was also identified, as they influence buy-in from key decision makers, and when decision makers are convinced, political and financial support for scale-up can increase. In two countries, a specific window of opportunity facilitated scale-up. Taking a flexible approach towards scale-up, allowing adaptations of the intervention and the scale-up strategy to the context, was also identified as a facilitator. The context of decentralization and the politics and power relations between stakeholders involved also influenced scale-up. CONCLUSIONS Despite the identification of the facilitators of the scale-up, full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (e.g. improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system.
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Affiliation(s)
- Susan Bulthuis
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Athena Institute, VU University, Amsterdam, the Netherlands
| | - Maryse Kok
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Olivier Onvlee
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Thomasena O’Byrne
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, Dublin, Ireland
| | - Samuel Amon
- grid.8652.90000 0004 1937 1485Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Legon Ghana
| | - Justine Namakula
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Kingsley Chikaphupha
- grid.463633.7Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Jana Gerold
- grid.416786.a0000 0004 0587 0574Swiss Centre for International Health, Swiss Tropical and Public Health Institute, University of Basel, Allschwil, Switzerland
| | - Wesam Mansour
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Marjolein Dieleman
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Athena Institute, VU University, Amsterdam, the Netherlands
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Abimbola S, Liu H. Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis. Health Policy Plan 2023; 38:15-27. [PMID: 36271837 PMCID: PMC9825725 DOI: 10.1093/heapol/czac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 01/12/2023] Open
Abstract
Efforts to promote the adoption and scale-up of health system innovations must contend with the existing institutional context. But there are no commonly used frameworks to ensure that the insights of actors involved in such institutional efforts connect to one another. To test and modify a potential framework-the 'four-by-four' framework-we interviewed researcher-entrepreneurs involved in the unfolding story of the cardiovascular Polypill. The framework has four types/levels of institutions that affect adoption and scale-up: (1) informal institutions (L1, e.g. social norms), (2) formal institutions (L2, e.g. government policies and regulation), (3) organizational structures (L3, e.g. organizational boards and mission) and (4) everyday exchange (L4, e.g. service delivery), vis-à-vis four potential entrepreneurial strategies in response: (1) abide by existing institutions, (2) evade them, (3) alter them and/or (4) exit entrepreneurial action. Using this framework, we conducted a realist-informed analysis to understand how context (i.e. institutions) and mechanism (i.e. entrepreneurial strategies) influence each other to shape outcomes (i.e. adoption and scale-up). We found that researcher-entrepreneurs began with efforts to abide with existing institutions but encountered institutional obstacles at each level. Efforts to abide were followed by seeking to evade and/or alter unfavourable institutions, with greater success evading and/or altering lower (L3 and L4) than upper (L1 and L2) institutions. Exit considerations followed the failure of the evade or alter strategy. Shifts between strategies were propelled by 'learning'. The 'four-by-four' framework can be used as a scaffold to generate narratives of adoption or scale-up efforts, a sensitizing tool to prospectively map out contingencies and a matrix to synthesize narratives and experiences across multiple innovations or settings. Used in these ways, the 'four-by-four' framework can help to optimize the transferability and cumulation of insights on how to promote the adoption and scale-up of health system innovations.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Akinyemi O, Danfakha N, Adefalu A, Easley E, Afolabi K, Latunji O. Scale-up of the DMPA-SC in Nigeria: Why policy matters. BMC Womens Health 2022; 22:535. [PMID: 36544189 PMCID: PMC9768394 DOI: 10.1186/s12905-022-02109-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred means of contraception among women in the country. Enabling policies are required to assure contraceptive access, security, and use. This study aimed to investigate the policy environment and how it supports or limits Nigeria's introduction and scale-up of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC). METHODS The design of this mixed-methods study was cross-sectional. Desk reviews of policy papers, key informant interviews, and in-depth interviews were used to obtain information from respondents about the introduction of DMPA-SC in Nigeria and how existing policies influenced its scale-up. Data on DMPA-SC and other injectables were gathered from Nigeria's national electronic logistics management information system. RESULTS The findings suggest that policies such as task-shifting and task-sharing, cost-free policies, reproductive health policies, and others created an enabling environment for the scale-up of DMPA-SC adoption in Nigeria. The inclusion of DMPA-SC on the essential medicines list and the approved patent medicines list facilitated the scale-up process by ensuring private sector participation, removing economic barriers to access, fostering greater collaboration among health worker cadres, improving intersectoral partnerships, and improving logistics and client access. Despite significant anomalies in some implementing policies, injectable contraceptive consumption data demonstrate a progressive increase in DMPA-SC use during the study period. The results also indicate that policy initiatives have a favorable impact on the use of DMPA-SC throughout the country. CONCLUSION The existence of policies, the active participation of stakeholders, and the political will of the Nigerian health system's leadership have all aided in the scaling-up of the DMPA-SC. Understanding how to build an enabling policy climate is critical for providing women with family planning options. These lessons from Nigeria emphasize the importance of these levers, which should be considered by teams intending to introduce innovative health products, particularly in developing countries.
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Affiliation(s)
- Oluwaseun Akinyemi
- grid.9582.60000 0004 1794 5983Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Nicole Danfakha
- grid.420559.f0000 0000 9343 1467John Snow Inc., Capitol Heights, MD USA
| | | | - Ebony Easley
- grid.420559.f0000 0000 9343 1467John Snow Inc., Philadelphia, PA USA
| | - Kayode Afolabi
- grid.434433.70000 0004 1764 1074Federal Ministry of Health, Abuja, Nigeria
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Obi-Jeff C, Garcia C, Adewumi F, Bamiduro T, David W, Labrique A, Wonodi C. Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework. BMC Public Health 2022; 22:2370. [PMID: 36528596 PMCID: PMC9758467 DOI: 10.1186/s12889-022-14822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Short Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention's internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs. METHODS In June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews. RESULTS The perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants' participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state's priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention's impact on improving coverage was critical for scalability. CONCLUSIONS Our study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.
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Affiliation(s)
- Chisom Obi-Jeff
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Cristina Garcia
- grid.21107.350000 0001 2171 9311Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
| | - Funmi Adewumi
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Tobi Bamiduro
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Winnie David
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Alain Labrique
- grid.21107.350000 0001 2171 9311Department of International Health and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
| | - Chizoba Wonodi
- grid.21107.350000 0001 2171 9311Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
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Roll A, Saxena M, Orlan E, Titus A, Juvekar SK, Gwayi-Chore MC, Avokpaho E, Chabi F, Togbevi CI, Belou Elijan A, Nindi P, Walson JL, Ajjampur SSR, Ibikounlé M, Kalua K, Aruldas K, Means AR. Policy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths. Glob Health Res Policy 2022; 7:47. [PMID: 36461087 PMCID: PMC9716752 DOI: 10.1186/s41256-022-00281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Recent evidence suggests that soil-transmitted helminth (STH) transmission interruption may be feasible through community-wide mass drug administration (cMDA) that deworms community members of all ages. A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries. We conducted formative qualitative research in Benin, India, and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective. METHODS We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national, state/district, and sub-district levels. Participants included World Health Organization country office staff, implementing partners, and national and sub-national government officials. We used the Consolidated Framework for Implementation Research to guide data collection, coding, and analysis. Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder. RESULTS Key facilitators to launching a cMDA program included availability of high-quality, tailored sensitization materials, and human and material resources that could be leveraged from previous MDA campaigns. Key barriers included the potential to overburden existing health workers, uncertainty of external funding to sustain a cMDA program, and concerns about weak intragovernmental coordination to implement cMDA. Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA, and implementation evidence to effectively operationalize cMDA. Importantly, if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term. CONCLUSIONS Overall, policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available. Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement. However, launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers. Trial registration This study was registered in the U.S. National Library of Medicine Clinical Trials registry (NCT03014167).
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Affiliation(s)
- Amy Roll
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | - Malvika Saxena
- grid.11586.3b0000 0004 1767 8969The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Elizabeth Orlan
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | - Angelin Titus
- grid.11586.3b0000 0004 1767 8969The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sanjay Kamlakar Juvekar
- grid.46534.300000 0004 1793 8046Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Marie-Claire Gwayi-Chore
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | - Félicien Chabi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin
| | | | | | | | - Judd L. Walson
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, WA USA
| | - Sitara S. R. Ajjampur
- grid.11586.3b0000 0004 1767 8969The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin ,grid.412037.30000 0001 0382 0205Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales (CReMIT/TIDRC), Université d’Abomey-Calavi, Godomey, Bénin
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Kumudha Aruldas
- grid.11586.3b0000 0004 1767 8969The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Arianna Rubin Means
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
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Montejo M, Paniagua N, Pijoan JI, Saiz-Hernando C, Castelo S, Martin V, Sánchez A, Benito J. Reducing Unnecessary Treatment of Bronchiolitis Across a Large Regional Health Service in Spain. Pediatrics 2022; 150:189721. [PMID: 36222087 DOI: 10.1542/peds.2021-053888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES A bronchiolitis integrated care pathway (BICP) proved useful in reducing the use of unnecessary medications at a local level. The aim of this study was to reduce overtreatment by scaling up the BICP across our regional health service in the 2019 and 2020 bronchiolitis season. METHODS We conducted a quality improvement (QI) initiative in 115 primary care (PC) centers and 7 hospitals in the Basque Country, Spain, from October 2019 to March 2020. The primary outcome measure was the percentage of children prescribed salbutamol comparing the rate to that in the previous bronchiolitis season (October 2018-March 2019). Secondary outcomes were the use of other medications. Balancing measures were hospitalization and unscheduled return rates. RESULTS We included 8153 PC visits, 3424 emergency department (ED) attendances, and 663 inpatient care episodes, of which 3817 (46.8%), 1614 (47.1%), and 328 (49.4%) occurred in the postintervention period, respectively. Salbutamol use decreased from 27.1% to 4.7%, 29.5% to 3.0%, and 44.4% to 3.9% (P < .001) in PC centers, Eds, and hospital wards, respectively. In PC, corticosteroid and antibiotic prescribing rates fell from 10.1% to 1.7% and 13.7% to 5.1%, respectively (P < .001). In EDs and hospital wards, epinephrine use rates fell from 14.2% to 4.2% (P < .001) and 30.4% to 19.8% (P = .001), respectively. No variations were noted in balancing measures. CONCLUSIONS The scaling up of the BICP was associated with significant decreases in the use of medications in managing bronchiolitis across a regional health service without unintended consequences.
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Affiliation(s)
| | | | | | | | | | | | - Alvaro Sánchez
- Primary Care Research Department, Biocruces Bizkaia Health Research Institute, Biscay, Basque Country, Spain
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital
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Koorts H, Bauman A, Edwards N, Bellew W, Brown WJ, Duncan MJ, Lubans DR, Milat AJ, Morgan PJ, Nathan N, Searles A, Lee K, Plotnikoff RC. Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114284. [PMID: 36361159 PMCID: PMC9657872 DOI: 10.3390/ijerph192114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 05/21/2023]
Abstract
Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - William Bellew
- Sydney Medical School & Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Mitch J. Duncan
- School of Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - David R. Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyvaskyla, Finland
| | - Andrew J. Milat
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, 1 Reserve Rd., St Leonards, NSW 2065, Australia
| | - Philip J. Morgan
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW 2287, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Karen Lee
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Ronald C. Plotnikoff
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Correspondence: ; Tel.: +61-(02)-49854465
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Ameme DK, Akweongo P, Afari EA, Noora CL, Anthony R, Kenu E. Effectiveness of adjunct telephone-based postnatal care on maternal and infant illness in the Greater Accra Region, Ghana: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:800. [DOI: 10.1186/s12884-022-05138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Globally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana’s Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR.
Methods
An open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis.
Results
Of 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm (p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants (p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71–0.92] and PP analysis [RR = 0.8 (95%CI = 0.67–0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54–95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51–0.94)].
Conclusion
Telephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health.
Trial registration
This trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.
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Kagaruki GB, Mahande MJ, Kreppel KS, Mbata D, Kilale AM, Shayo EH, Mfinanga SG, Bonfoh B. Barriers to the implementation, uptake and scaling up of the healthy plate model among regular street food consumers: a qualitative inquiry in Dar-es-Salaam city, Tanzania. BMC Nutr 2022; 8:110. [PMID: 36203200 PMCID: PMC9541087 DOI: 10.1186/s40795-022-00589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The healthy plate model is considered one of the practical approaches to reduce the average portion of staple food in main meals, consequently reducing the risks associated with diabetes and other Non-communicable Diseases (NCDs). Despite its potential benefits, studies on the implementation of the healthy plate model are limited in Africa. An inquiry explored barriers to implementation, uptake, and scaling up of the healthy plate model among street food vendors and consumers in three districts of Dar-es-Salaam city in Tanzania. Methods A qualitative research design was adopted. Qualitative data collection techniques were employed including; Key Informant Interviews (KIIs) with purposefully selected food and nutrition stakeholders at the National, Regional, District and Ward levels. Focus Group Discussions (FGDs) were conducted with purposefully selected street food consumers and vendors. A total of (13) KIIs were conducted as well as (6) FGDs with street food vendors (2 FGDs) and consumers (4 FGDs). Interview data was managed using Nvivo 12 Software and analyzed thematically. Results Three key themes emerged from participants’ accounts: (i) strategic policy barriers, (ii) food production and preparation environment barriers (producers and vendors), and (iii) individual barriers (consumers and vendors). The strategic policy barriers included absence of guidelines and regulations that focus on NCDs linked to nutrition and lack of education guidance for vendors and consumers. The food production and preparation environment barriers included safety and risks concerns regarding the quality of water used for irrigation and washing fruits and vegetables and the areas where vegetables and fruits are grown and prepared. Individual barriers included low consumer income, knowledge on nutrition, unhealthy eating practices and; low vendors’ knowledge as well as low investment capital. Conclusion Implementation, uptake and scaling up of the healthy plate model for street food consumers in Dar es Salaam City continues to be constrained by barriers in policy, food production and preparation environment, and individual obstacles. Strengthening of food and nutrition policies, ensuring safety of the food production and preparation environment and, consumer and vendor awareness creation and income generation efforts, provide useful entry points for the successful scaling up of a healthy plate model. This could consequently contribute towards prevention of diet related NCDs, including diabetes.
Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00589-6.
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Affiliation(s)
- Gibson B Kagaruki
- Research Programs, National Institute for Medical Research, Tukuyu Medical Research Centre, Tukuyu, Box 538, Mbeya, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Michael J Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Katharina S Kreppel
- School of Life Science and Bioengineering, the Nelson Mandela African Institution of Science and Technology, Box 447, Arusha, Tanzania.,Department of Public Health, Institute of Tropical Medicine, Antwerp Belgium, Antwerp, Belgium
| | - Doris Mbata
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Andrew M Kilale
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania
| | - Elizabeth H Shayo
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Sayoki G Mfinanga
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania.,Department of Epidemiology & Biostatistics, Public Health Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Bassirou Bonfoh
- Departiment of Research and Development, Centre Suisse de Recherches Scientifiques en Côte d'Ivoir, Abidjan, Côte d'Ivoire
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Barrios‐Rodríguez YF, Salas‐Calderón KT, Orozco‐Blanco DA, Gentile P, Girón‐Hernández J. Cocoa Pod Husk: A High‐Pectin Source with Applications in the Food and Biomedical Fields. CHEMBIOENG REVIEWS 2022. [DOI: 10.1002/cben.202100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Karen Tatiana Salas‐Calderón
- Universidad Surcolombiana Departamento de Ingeniería Agrícola Av. Pastrana Borrero Carrera 1a 410001 Neiva Huila Colombia
| | - Dayana Alejandra Orozco‐Blanco
- Universidad Surcolombiana Departamento de Ingeniería Agrícola Av. Pastrana Borrero Carrera 1a 410001 Neiva Huila Colombia
| | - Piergiorgio Gentile
- Newcastle University School of Engineering Claremont Road NE17RU Newcastle upon Tyne United Kingdom
| | - Joel Girón‐Hernández
- Universidad Surcolombiana Departamento de Ingeniería Agrícola Av. Pastrana Borrero Carrera 1a 410001 Neiva Huila Colombia
- Northumbria University Department of Applied Sciences Ellison Pl NE18ST Newcastle upon Tyne United Kingdom
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Jackson A, Ashworth A, Annan RA. The International Malnutrition Task Force: A model for the future? Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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An Y, Ntombela N, Hoffmann CJ, Fashina T, Mabuto T, Owczarzak J. "That makes me feel human": a qualitative evaluation of the acceptability of an HIV differentiated care intervention for formerly incarcerated people re-entering community settings in South Africa. BMC Health Serv Res 2022; 22:1092. [PMID: 36028825 PMCID: PMC9415240 DOI: 10.1186/s12913-022-08469-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Correctional settings in South Africa have disproportionately high rates of HIV infection; a large number of inmates living with HIV return to the community each year. The transition community adherence club (TCAC) intervention was a differentiated care delivery approach with structural and peer components designed to increase antiretroviral therapy (ART) adherence and HIV care engagement following release from incarceration. The objective of this study was to assess the acceptability of the TCAC intervention among HIV-infected community re-entrants to inform program revisions and future intervention designs. Methods This was a qualitative study set within a randomized controlled trial (RCT) of the TCAC intervention in South Africa. We conducted semi-structured, in-depth interviews with 16 re-entrants living with HIV and assigned to the intervention arm. All interviews were audio-recorded, transcribed, translated, and de-identified. Transcripts were coded and analyzed using content analysis, and acceptability was assessed using the Theoretical Framework of Acceptability (TFA). Results Overall, study participants reported that the TCAC intervention was acceptable. Development of supportive relationships between participants, non-judgmental attitudes from peer-facilitators, and perceived effectiveness of the intervention to support ART adherence and HIV care were noted as the most valued components. An altruistic desire to help other participants facing similar post-incarceration and HIV-related challenges was a key motivator for TCAC attendance. A lack of access to reliable transportation to intervention sites and clinic-based medication collection were described as burdens to program participation. Illicit drug use by other group members and negative social influences were also identified as potential barriers to optimal program engagement. Conclusion The TCAC was a well-accepted model of differentiated care delivery among re-entrants living with HIV in South Africa. To further enhance intervention acceptability for future scale-ups, program revisions should address logistical barriers related to reaching TCAC sites and implementing ART distribution at TCAC group sessions.
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Affiliation(s)
- Yangxi An
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA
| | | | - Christopher J Hoffmann
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA. .,Aurum Institute, Johannesburg, South Africa. .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. .,Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
| | - Tolulope Fashina
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA
| | | | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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Kok M, Bulthuis S, Dieleman M, Onvlee O, Murphy R, Akweongo P, Namakula J, Banda H, Wyss K, Raven J, Martineau T. Using a theory of change in monitoring, evaluating and steering scale-up of a district-level health management strengthening intervention in Ghana, Malawi, and Uganda - lessons from the PERFORM2Scale consortium. BMC Health Serv Res 2022; 22:1001. [PMID: 35932015 PMCID: PMC9356464 DOI: 10.1186/s12913-022-08354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Since 2017, PERFORM2Scale, a research consortium with partners from seven countries in Africa and Europe, has steered the implementation and scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. This article presents PERFORM2Scale’s theory of change (ToC) and reflections upon and adaptations of the ToC over time. The article aims to contribute to understanding the benefits and challenges of using a ToC-based approach for monitoring and evaluating the scale-up of health system strengthening interventions, because there is limited documentation of this in the literature. Methods The consortium held annual ToC reflections that entailed multiple participatory methods, including individual scoring exercises, country and consortium-wide group discussions and visualizations. The reflections were captured in detailed annual reports, on which this article is based. Results The PERFORM2Scale ToC describes how the management strengthening intervention, which targets district health management teams, was expected to improve health workforce performance and service delivery at scale, and which assumptions were instrumental to track over time. The annual ToC reflections proved valuable in gaining a nuanced understanding of how change did (and did not) happen. This helped in strategizing on actions to further steer the scale-up the intervention. It also led to adaptations of the ToC over time. Based on the annual reflections, these actions and adaptations related to: assessing the scalability of the intervention, documentation and dissemination of evidence about the effects of the intervention, understanding power relationships between key stakeholders, the importance of developing and monitoring a scale-up strategy and identification of opportunities to integrate (parts of) the intervention into existing structures and strategies. Conclusions PERFORM2Scale’s experience provides lessons for using ToCs to monitor and evaluate the scale-up of health system strengthening interventions. ToCs can help in establishing a common vision on intervention scale-up. ToC-based approaches should include a variety of stakeholders and require their continued commitment to reflection and learning on intervention implementation and scale-up. ToC-based approaches can help in adapting interventions as well as scale-up processes to be in tune with contextual changes and stakeholders involved, to potentially increase chances for successful scale-up.
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Affiliation(s)
- Maryse Kok
- KIT Royal Tropical Institute, Amsterdam, the Netherlands.
| | - Susan Bulthuis
- KIT Royal Tropical Institute, Amsterdam, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Amsterdam, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
| | - Olivier Onvlee
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Rebecca Murphy
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Patricia Akweongo
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Hastings Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Bulthuis S, Kok M, Onvlee O, Martineau T, Raven J, Ssengooba F, Namakula J, Banda H, Akweongo P, Dieleman M. Assessing the scalability of a health management-strengthening intervention at the district level: a qualitative study in Ghana, Malawi and Uganda. Health Res Policy Syst 2022; 20:85. [PMID: 35907964 PMCID: PMC9338559 DOI: 10.1186/s12961-022-00887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. To ensure optimal use of resources, assessment of the scalability of an intervention is recognized as a crucial step in the scale-up process. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. Methods Qualitative interviews were conducted with intervention users (district health management teams, DHMTs) and implementers of the scale-up of the intervention (national-level actors) in Ghana, Malawi and Uganda, before and 1 year after the scale-up had started. To assess the scalability of the intervention, the CORRECT criteria from WHO/ExpandNet were used during analysis. Results The MSI was seen as credible, as regional- and national-level Ministry of Health officials were championing the intervention. While documented evidence on intervention effectiveness was limited, district- and national-level stakeholders seemed to be convinced of the value of the intervention. This was based on its observed positive results regarding management competencies, teamwork and specific aspects of health workforce performance and service delivery. The perceived need for strengthening of management capacity and service delivery showed the relevance of the intervention, and relative advantages of the intervention were its participatory and sustainable nature. Turnover within the DHMTs and limited (initial) management capacity were factors complicating implementation. The intervention was not contested and was seen as compatible with (policy) priorities at the national level. Conclusion We conclude that the MSI is scalable. However, to enhance its scalability, certain aspects should be adapted to better fit the context in which the intervention is being scaled up. Greater involvement of regional and national actors alongside improved documentation of results of the intervention can facilitate scale-up. Continuous assessment of the scalability of the intervention with all stakeholders involved is necessary, as context, stakeholders and priorities may change. Therefore, adaptations of the intervention might be required. The assessment of scalability, preferably as part of the monitoring of a scale-up strategy, enables critical reflections on next steps to make the intervention more scalable and the scale-up more successful.
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Affiliation(s)
- Susan Bulthuis
- KIT Royal Tropical Institute, Amsterdam, The Netherlands. .,Athena Institute, VU University, Amsterdam, The Netherlands.
| | - Maryse Kok
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Olivier Onvlee
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Hastings Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Patricia Akweongo
- Department of Health Policy, Planning & Management. School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
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Gyamfi J, Vieira D, Iwelunmor J, Watkins BX, Williams O, Peprah E, Ogedegbe G, Allegrante JP. Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review. PLoS One 2022; 17:e0272071. [PMID: 35901114 PMCID: PMC9333290 DOI: 10.1371/journal.pone.0272071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning. Methods Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions. Main results Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3). Conclusion This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting. Trial registration Registration PROSPERO (CRD42019117750).
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Affiliation(s)
- Joyce Gyamfi
- Teachers College, Columbia University, New York, NY, United States of America
- NYU School of Global Public Health, New York, NY, United States of America
- * E-mail:
| | - Dorice Vieira
- NYU School of Global Public Health, New York, NY, United States of America
- NYU Health Sciences Library, New York, NY, United States of America
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States of America
| | | | - Olajide Williams
- Columbia University Medical Center, New York, NY, United States of America
| | - Emmanuel Peprah
- NYU School of Global Public Health, New York, NY, United States of America
| | - Gbenga Ogedegbe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - John P. Allegrante
- Teachers College, Columbia University, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Kinney M, Bergh AM, Rhoda N, Pattinson R, George A. Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach. BMJ Glob Health 2022; 7:bmjgh-2022-009242. [PMID: 35738843 PMCID: PMC9226866 DOI: 10.1136/bmjgh-2022-009242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study set out to understand how and why a perinatal audit programme, a form of MPDSR, has sustained practice in South Africa from the perspectives of those engaged in implementation. Methods A multiple case study design was carried out in four rural subdistricts of the Western Cape with over 10 years of implementing the programme. Data were collected from October 2019 to March 2020 through non-participant observation of seven meetings and key informant interviews with 41 purposively selected health providers and managers. Thematic analysis was conducted inductively and deductively adapting the extended normalisation process theory to examine the capability, contribution, potential and capacity of the users to implement MPDSR. Results The perinatal audit programme has sustained practice due to integration of activities into routine tasks (capability), clear value-add (contribution), individual and collective commitment (potential), and an enabling environment to implement (capacity). The complex interplay of actors, their relationships and context revealed the underlying individual-level and organisational-level factors that support sustainability, such as trust, credibility, facilitation and hierarchies. Local adaption and the broad social and structural resources were required for sustainability. Conclusion This study applied theory to explore factors that promote sustained practice of perinatal audit from the perspectives of the users. Efforts to promote and sustain MPDSR will benefit from overall good health governance, specific skill development, embedded activities, and valuing social processes related to implementation. More research using health policy and system approaches, including use of implementation theory, will further advance our understanding on how to support sustained MPDSR practice in other settings.
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Affiliation(s)
- Mary Kinney
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Anne-Marie Bergh
- Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Natasha Rhoda
- Department of Neonatology, Mowbray Maternity Hospital, Cape Town, South Africa.,Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Pattinson
- Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Asha George
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
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Bytyci-Katanolli A, Merten S, Kwiatkowski M, Obas K, Gerold J, Zahorka M, Jerliu N, Ramadani Q, Fota N, Probst-Hensch N. Non-communicable disease prevention in Kosovo: quantitative and qualitative assessment of uptake and barriers of an intervention for healthier lifestyles in primary healthcare. BMC Health Serv Res 2022; 22:647. [PMID: 35568906 PMCID: PMC9107010 DOI: 10.1186/s12913-022-07969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. Their prevention is a priority to relieve the health system of from costly non-communicable disease treatments. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate change in the domains of smoking, diet, alcohol consumption and physical inactivity for at-risk patients. This study quantitatively assesses the uptake of motivational counselling and the distribution of health behaviours and stages of health behaviour change of the participants according to the intervention, as well as qualitatively describes experiences and perceived benefits of motivational counselling. METHODS Study participants (n = 907) were recruited consecutively in 2019 from patients visiting the Main Family Medical Centres in 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study as part of the Accessible Quality Healthcare project. For the quantitative study, we used baseline and first follow-up data on smoking status, physical inactivity, obesity, fruit and vegetable as well as alcohol consumption, uptake of counselling, and stages for behavioural change. For the qualitative study, in-depth interviews were conducted with a subset of 26 cohort participants who had undergone motivational counselling. RESULTS Motivational counselling was obtained by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours are high even in persons who underwent counselling (of whom 13% are smokers; 86% physically inactive; 93% with inadequate fruit and vegetable consumption; and 61% are obese); only the rate of smoking was lower in those who obtained counselling. Among smokers, over 80% were still in the pre-contemplation phase of behaviour change. More advanced stages of behaviour change were observed among the highly prevalent group of inactive persons and participants with poor dietary habits, among the 5 intervention municipalities. According to the qualitative study results, the participants who obtained motivational counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation. CONCLUSIONS More tailored and additional primary health care approaches in accordance with patients' views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change.
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Affiliation(s)
- Ariana Bytyci-Katanolli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Katrina Obas
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Jana Gerold
- University of Basel, Basel, Switzerland.,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Manfred Zahorka
- University of Basel, Basel, Switzerland.,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Naim Jerliu
- National Institute of Public Health Kosovo, Prishtina, Kosovo.,University of Prishtina, Medical Faculty, Prishtina, Kosovo
| | | | - Nicu Fota
- Accessible Quality Healthcare Project, Prishtina, Kosovo
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland.
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G S, Tan WA, Lee ARYB, Chen MZ. Behavioral Interventions for the Patient-Caregiver Unit in Patients with Chronic Heart Failure: A Systematic Review of Caregiver Outcomes. J Multidiscip Healthc 2022; 15:921-939. [PMID: 35519152 PMCID: PMC9064481 DOI: 10.2147/jmdh.s357179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic heart failure (CHF) is a debilitating condition that affects millions worldwide. It is accompanied by a myriad of adverse consequences, such asdiminishing of quality of life and deterioration of mental health. Caregivers play a pivotal role in helping CHF patients manage their conditions and symptoms, as a result the physical, mental and emotional state of caregivers have a direct impact on CHF patients and the management of this condition. Purpose This systematic review aims to synthesize data about the effectiveness of behavioral interventions targeted at patients with chronic heart failure (CHF) and/or informal caregivers of CHF patients to improve overall management and treatment of CHF in the population. Patients and Methods Three databases were searched for published studies and studies that included evaluated outcomes of interventions that targeted CHF patients or informal caregivers. All randomized controlled trials, trials of either experimental or quasi-experimental design were included. Studies that only involved formal caregivers, patient populations of adolescents/young adults and patients with non-chronic conditions were excluded. Results Across the 21 included studies, no study reported a significant improvement in all three domains of quality of life (QoL), depression and loneliness of caregivers while only three studies reported a significant improvement in two outcomes. Within each domain, heterogeneity in measures limited quantitative pooling. Conclusion This review provides data on the efficacy of interventions targeted at CHF patients and/or informal caregivers. It also highlights successful interventions and its features. Following this, additional resources need to be invested and directed towards implementing these interventions.
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Affiliation(s)
- Suthershinii G
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Weiling Amanda Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
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Kauchali S, Puoane T, Aguilar AM, Kathumba S, Nkoroi A, Annan R, Choi S, Jackson A, Ashworth A. Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00411. [PMID: 35487561 PMCID: PMC9053151 DOI: 10.9745/ghsp-d-21-00411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
We report lessons learned in 4 countries from scaling up the implementation of World Health Organization guidelines on inpatient management of severe acute malnutrition within routine health services. We provide evidence that implementation is achievable at scale within different contexts and health systems. Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development. We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within under-resourced public sector health services in South Africa, Bolivia, Malawi, and Ghana. Drawing on implementation reports, qualitative and quantitative data from our research, prospective and retrospective data collection, self-reflection, and our shared experiences, we review our capacity-building approaches for improving quality of care, implementation effectiveness, and lessons learned. These country studies provide important evidence that improved inpatient management of SAM is scalable in routine health services and scalability is achievable within different contexts and health systems. Effectiveness in reducing inpatient SAM deaths appears to be retained at scale. The country studies show evidence of impact on mortality early in the implementation and scaling-up process. However, it took many years to build workforce capacity, establish monitoring and mentoring procedures, and institutionalize the guidelines within health systems. Key features for success included collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. For frontline staff to be confident in their ability to deliver appropriate care competently, an enabling environment and supportive policies and processes are needed at all levels of the health system.
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Affiliation(s)
- Shuaib Kauchali
- Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa.,National Department of Health, Pretoria, South Africa
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Ana Maria Aguilar
- Instituto de Investigación en Salud y Desarrollo, Universidad Mayor de San Andrés, La Paz, Bolivia
| | | | - Alice Nkoroi
- Food and Nutrition Technical Assistance Project (FANTA)/FHI360, Washington, DC, USA
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sunhea Choi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alan Jackson
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,International Malnutrition Task Force of the International Union of Nutritional Sciences, London, United Kingdom
| | - Ann Ashworth
- International Malnutrition Task Force of the International Union of Nutritional Sciences, London, United Kingdom. .,Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Turmaine K, Dumas A, Chevreul K. Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis. J Med Internet Res 2022; 24:e30218. [PMID: 35451977 PMCID: PMC9077507 DOI: 10.2196/30218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-04464-2
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Affiliation(s)
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris, URC Eco Ile-de-France, Paris, France, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
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- See Authors' Contributions,
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Koorts H, Maple JL, Eakin E, Lawrence M, Salmon J. Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia. Front Public Health 2022; 10:771235. [PMID: 35419340 PMCID: PMC8995799 DOI: 10.3389/fpubh.2022.771235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. Methods A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. Results Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. Conclusion Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jaimie-Lee Maple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Elizabeth Eakin
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Nolte E, Kamano JH, Naanyu V, Etyang A, Gasparrini A, Hanson K, Koros H, Mugo R, Murphy A, Oyando R, Pliakas T, Were V, Willis R, Barasa E, Perel P. Scaling up the primary health integrated care project for chronic conditions in Kenya: study protocol for an implementation research project. BMJ Open 2022; 12:e056261. [PMID: 35296482 PMCID: PMC8928278 DOI: 10.1136/bmjopen-2021-056261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Amid the rising number of people with non-communicable diseases (NCDs), Kenya has invested in strengthening primary care and in efforts to expand existing service delivery platforms to integrate NCD care. One such approach is the AMPATH (Academic Model Providing Access to Healthcare) model in western Kenya, which provides the platform for the Primary Health Integrated Care Project for Chronic Conditions (PIC4C), launched in 2018 to further strengthen primary care services for the prevention and control of hypertension, diabetes, breast and cervical cancer. This study seeks to understand how well PIC4C delivers on its intended aims and to inform and support scale up of the PIC4C model for integrated care for people with NCDs in Kenya. METHODS AND ANALYSIS The study is guided by a conceptual framework on implementing, sustaining and spreading innovation in health service delivery. We use a multimethod design combining qualitative and quantitative approaches, involving: (1) in-depth interviews with health workers and decision-makers to explore experiences of delivering PIC4C; (2) a cross-sectional survey of patients with diabetes or hypertension and in-depth interviews to understand how well PIC4C meets patients' needs; (3) a cohort study with an interrupted time series analysis to evaluate the degree to which PIC4C leads to health benefits such as improved management of hypertension or diabetes; and (4) a cohort study of households to examine the extent to which the national hospital insurance chronic care package provides financial risk protection to people with hypertension or diabetes within PIC4C. ETHICS AND DISSEMINATION The study has received approvals from Moi University Institutional Research and Ethics Committee (FAN:0003586) and the London School of Hygiene & Tropical Medicine (17940). Workshops with key stakeholders at local, county, national and international levels will ensure early and wide dissemination of our findings to inform scale up of this model of care. We will also publish findings in peer-reviewed journals.
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Affiliation(s)
- Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Hillary Koros
- Academic Model Providing Access to HealthCare (AMPATH), Eldoret, Kenya
| | - Richard Mugo
- Academic Model Providing Access to HealthCare (AMPATH), Eldoret, Kenya
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Vincent Were
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ruth Willis
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Mabunda D, Oliveira D, Sidat M, Cavalcanti MT, Cumbe V, Mandlate F, Wainberg M, Cournos F, de Jesus Mari J. Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. Int J Ment Health Syst 2022; 16:14. [PMID: 35168650 PMCID: PMC8845308 DOI: 10.1186/s13033-022-00526-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. AIMS This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. METHODS We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. RESULTS Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. CONCLUSION Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors.
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Affiliation(s)
- Dirceu Mabunda
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique.
| | - Déborah Oliveira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | | | - Vasco Cumbe
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Milton Wainberg
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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50
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Willey B, Umar N, Beaumont E, Allen E, Anyanti J, Bello AB, Bhattacharya A, Exley J, Makowiecka K, Okolo M, Sani R, Schellenberg J, Spicer N, Usman UA, Gana AM, Shuaibu A, Marchant T. Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study. BMJ Open 2022; 12:e048877. [PMID: 35105566 PMCID: PMC8808391 DOI: 10.1136/bmjopen-2021-048877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING Gombe state, Northeast Nigeria. PARTICIPANTS Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES Eighteen indicators of maternal and newborn healthcare. RESULTS Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings.
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Affiliation(s)
- Barbara Willey
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nasir Umar
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Beaumont
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Neil Spicer
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ahmed Mohammed Gana
- Office of the Honourable Commissioner for Health (and former Executive Secretary GSPCDA), Gombe State Ministry, Gombe, Nigeria
| | - Abdulrahman Shuaibu
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
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