The contribution of community leadership upon the performance of mutual health organisations in Ghana

Understanding implementation science from the standpoint of health organisation and management: an interdisciplinary exploration of selected theories, models and frameworks

Purpose

As a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship remains under-utilised in the field of implementation science. This under-engagement between fields potentially constrains the understanding of mechanisms influencing the implementation of evidence-based innovations in health care. The aim of this viewpoint article is to examine how a selection of theories, models and frameworks (theoretical approaches) have been applied to better understand phenomena at the micro, meso and macro systems levels for the implementation of health care innovations. The purpose of which is to illustrate the potential applicability and complementarity of embedding health organisation and management scholarship within the study of implementation science.

Design/methodology/approach

The authors begin by introducing the two fields, before exploring how exemplary theories, models and frameworks have been applied to study the implementation of innovations in the health organisation and management literature. In this viewpoint article, the authors briefly reviewed a targeted collection of articles published in the Journal of Health Organization and Management (as a proxy for the broader literature) and identified the theories, models and frameworks they applied in implementation studies. The authors then present a more detailed exploration of three interdisciplinary theories and how they were applied across three different levels of health systems: normalization process theory (NPT) at the micro individual and interpersonal level; institutional logics at the meso organisational level; and complexity theory at the macro policy level. These examples are used to illustrate practical considerations when implementing change in health care organisations that can and have been used across various levels of the health system beyond these presented examples.

Findings

Within the Journal of Health Organization and Management, the authors identified 31 implementation articles, utilising 34 theories, models or frameworks published in the last five years. As an example of how theories, models and frameworks can be applied at the micro individual and interpersonal levels, behavioural theories originating from psychology and sociology (e.g. NPT) were used to guide the selection of appropriate implementation strategies or explain implementation outcomes based on identified barriers and enablers to implementing innovations of interest. Projects aiming to implement change at the meso organisational level can learn from the application of theories such as institutional logics, which help elucidate how relationships at the macro and micro-level have a powerful influence on successful or unsuccessful organisational action. At the macro policy level, complexity theory represented a promising direction for implementation science by considering health care organisations as complex adaptive systems.

Originality/value

This paper illustrates the utility of a range of theories, models and frameworks for implementation science, from a health organisation and management standpoint. The authors’ viewpoint article suggests that increased crossovers could contribute to strengthening both disciplines and our understanding of how to support the implementation of evidence-based innovations in health care.

Use of a community-led prevention strategy to enhance behavioral changes towards Ebola virus disease prevention: a qualitative case study in Western Côte d'Ivoire

Background

Starting in December 2013, the Ebola virus disease (EVD) epidemic spread in West Africa through five countries (Sierra Leone, Liberia, Guinea, Nigeria, and Mali), killing over 11,300 people. In partnership with Côte d’Ivoire’s Ministry of Health, the International Rescue Committee instigated a community-led strategy aimed at promoting behavior change in order to prevent potential Ebola outbreaks in the country. The strategy was implemented in Western districts bordering Liberia, Guinea, and Mali. This study aims to analyze the community-led strategy, to document lessons learned from the experience, and to capitalize on the achievements.

Methods

A case study in four districts of Western Côte d’Ivoire, i.e. Biankouma, Danané, Odienné and Touba districts was carried out. Qualitative data in 12 villages (i.e., three villages per district) was collected from 62 healthcare workers, community leaders, and ordinary community members. Data was de-identified, coded and analyzed using a thematic approach.

Results

The community-led strategy was socially accepted in the villages. Even though some community leaders reported that sensitization had been, at times, constrained by a lack of equipment, the people interviewed demonstrated accurate understanding of information about prevention practices. Some practices were easily adopted, while others remained difficult to implement (e.g., ensuring safe and dignified dead body management).

Conclusion

This research demonstrates that sensitization efforts led by well-integrated and respected community leaders can be conducive of behavior change. Lessons learned from the community-led strategy could be applied to future disease outbreaks.