1
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Ernstzen DV. Holistic care is a key research priority for chronic musculoskeletal pain: findings from an evidence and gap map. Evid Based Nurs 2024; 27:101. [PMID: 37968094 DOI: 10.1136/ebnurs-2023-103723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Dawn V Ernstzen
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa
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2
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Leslie HH, Lippman SA, van Heerden A, Manaka MN, Joseph P, Weiner BJ, Steward WT. Adapting and testing measures of organizational context in primary care clinics in KwaZulu-Natal, South Africa. BMC Health Serv Res 2024; 24:744. [PMID: 38886792 PMCID: PMC11184827 DOI: 10.1186/s12913-024-11184-9] [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: 08/04/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Implementation science frameworks situate intervention implementation and sustainment within the context of the implementing organization and system. Aspects of organizational context such as leadership have been defined and measured largely within US health care settings characterized by decentralization and individual autonomy. The relevance of these constructs in other settings may be limited by differences like collectivist orientation, resource constraints, and hierarchical power structures. We aimed to adapt measures of organizational context in South African primary care clinics. METHODS We convened a panel of South African experts in social science and HIV care delivery and presented implementation domains informed by existing frameworks and prior work in South Africa. Based on panel input, we selected contextual domains and adapted candidate items. We conducted cognitive interviews with 25 providers in KwaZulu-Natal Province to refine measures. We then conducted a cross-sectional survey of 16 clinics with 5-20 providers per clinic (N = 186). We assessed reliability using Cronbach's alpha and calculated interrater agreement (awg) and intraclass correlation coefficient (ICC) at the clinic level. Within clinics with moderate agreement, we calculated correlation of clinic-level measures with each other and with hypothesized predictors - staff continuity and infrastructure - and a clinical outcome, patient retention on antiretroviral therapy. RESULTS Panelists emphasized contextual factors; we therefore focused on elements of clinic leadership, stress, cohesion, and collective problem solving (critical consciousness). Cognitive interviews confirmed salience of the domains and improved item clarity. After excluding items related to leaders' coordination abilities due to missingness and low agreement, all other scales demonstrated individual-level reliability and at least moderate interrater agreement in most facilities. ICC was low for most leadership measures and moderate for others. Measures tended to correlate within facility, and higher stress was significantly correlated with lower staff continuity. Organizational context was generally more positively rated in facilities that showed consistent agreement. CONCLUSIONS As theorized, organizational context is important in understanding program implementation within the South African health system. Most adapted measures show good reliability at individual and clinic levels. Additional revision of existing frameworks to suit this context and further testing in high and low performing clinics is warranted.
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Affiliation(s)
- Hannah H Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA.
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair van Heerden
- Division of Human and Social Capabilities, Human Sciences Research Council, Durban, South Africa
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, SAMRC/WITS Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mbali Nokulunga Manaka
- Division of Human and Social Capabilities, Human Sciences Research Council, Durban, South Africa
| | - Phillip Joseph
- Division of Human and Social Capabilities, Human Sciences Research Council, Durban, South Africa
| | - Bryan J Weiner
- Departments of Global Health and Health Systems and Population Health, University of Washington, Seattle, USA
| | - Wayne T Steward
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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3
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Fung WWS, Luyckx VA, Tuttle KR. The authors reply. Kidney Int 2024; 105:1323-1324. [PMID: 38626877 DOI: 10.1016/j.kint.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Winston W S Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA.
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4
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Norton A, Tappis H. Sexual and reproductive health implementation research in humanitarian contexts: a scoping review. Reprod Health 2024; 21:64. [PMID: 38741184 DOI: 10.1186/s12978-024-01793-2] [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: 11/06/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. METHODS A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. RESULTS Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. CONCLUSION This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.
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Affiliation(s)
- Alexandra Norton
- Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Hannah Tappis
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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5
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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AbouNader K, Abou Mourad G, Chalouhi G, Rady A, Von Schreeb J, Halmin M. Assessing quality of critical care during an ongoing health emergency-a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19. Int J Qual Health Care 2024; 36:mzae028. [PMID: 38581654 PMCID: PMC11060481 DOI: 10.1093/intqhc/mzae028] [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: 09/20/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Quality of care has been systematically monitored in hospitals in high-income countries to ensure adequate care. However, in low- and middle-income countries, quality indicators are not readily measured. The primary aim of this study was to assess to what extent it was feasible to monitor the quality of intensive care in an ongoing health emergency, and the secondary aim was to assess a quality of care intervention (twinning project) focused on Intensive Care Unit (ICU) quality of care in public hospitals in Lebanon. METHODS We conducted a retrospective cohort study nested within an intervention implemented by the World Health Organization (WHO) together with partners. To assess the quality of care throughout the project, a monitoring system framed in the Donabedian model and included structure, process, and outcome indicators was developed and implemented. Data collection consisted of a checklist performed by external healthcare workers (HCWs) as well as collection of data from all admitted patients performed by each unit. The association between the number of activities within the interventional project and ICU mortality was evaluated. RESULTS A total of 1679 patients were admitted to five COVID-19 ICUs during the study period. The project was conducted fully across four out of five hospitals. In these hospitals, a significant reduction in ICU mortality was found (OR: 0.83, P < 0.05, CI: 0.72-0.96). CONCLUSION We present a feasible way to assess quality of care in ICUs and how it can be used in assessing a quality improvement project during ongoing crises in resource-limited settings. By implementing a quality of care intervention in Lebanon's public hospitals, we have shown that such initiatives might contribute to improvement of ICU care. The observed association between increased numbers of project activities and reduced ICU mortality underscores the potential of quality assurance interventions to improve outcomes for critically ill patients in resource-limited settings. Future research is needed to expand this model to be applicable in similar settings.
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Affiliation(s)
- Karim AbouNader
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Ghada Abou Mourad
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Georges Chalouhi
- Middle East Academy for Learning Health Systems, Beirut, Lebanon
| | - Alissar Rady
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Märit Halmin
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
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Iroz CB, Ramaswamy R, Bhutta ZA, Barach P. Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:332. [PMID: 38481226 PMCID: PMC10935959 DOI: 10.1186/s12913-024-10802-w] [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: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. METHODS We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. RESULTS We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. CONCLUSIONS Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.
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Affiliation(s)
- Cassandra B Iroz
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, UK
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA, USA
- Imperial College, London, UK
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8
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Idemyor V. Translational research and implementation science: Accelerating the imperative. Am J Health Syst Pharm 2024; 81:190-198. [PMID: 37983043 DOI: 10.1093/ajhp/zxad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Vincent Idemyor
- Department of Clinical Pharmacy and Management, Faculty of Pharmaceutical Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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Drown L, Amberbir A, Teklu AM, Zelalem M, Tariku A, Tadesse Y, Gebeyehu S, Semu Y, Ntawukuriryayo JT, VanderZanden A, Binagwaho A, Hirschhorn LR. Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study. BMC Pediatr 2024; 23:647. [PMID: 38413946 PMCID: PMC10900547 DOI: 10.1186/s12887-023-04388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/26/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Ethiopian government implemented a national community health program, the Health Extension Program (HEP), to provide community-based health services to address persisting access-related barriers to care using health extension workers (HEWs). We used implementation research to understand how Ethiopia leveraged the HEP to widely implement evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) and address health inequities. METHODS This study was part of a six-country case study series using implementation research to understand how countries implemented EBIs between 2000-2015. Our mixed-methods research was informed by a hybrid implementation science framework using desk review of published and gray literature, analysis of existing data sources, and 11 key informant interviews. We used implementation of pneumococcal conjugate vaccine (PCV-10) and integrated community case management (iCCM) to illustrate Ethiopia's ability to rapidly integrate interventions into existing systems at a national level through leveraging the HEP and other implementation strategies and contextual factors which influenced implementation outcomes. RESULTS Ethiopia implemented numerous EBIs known to address leading causes of U5M, leveraging the HEP as a platform for delivery to successfully introduce and scale new EBIs nationally. By 2014/15, estimated coverage of three doses of PCV-10 was at 76%, with high acceptability (nearly 100%) of vaccines in the community. Between 2000 and 2015, we found evidence of improved care-seeking; coverage of oral rehydration solution for treatment of diarrhea, a service included in iCCM, doubled over this period. HEWs made health services more accessible to rural and pastoralist communities, which account for over 80% of the population, with previously low access, a contextual factor that had been a barrier to high coverage of interventions. CONCLUSIONS Leveraging the HEP as a platform for service delivery allowed Ethiopia to successfully introduce and scale existing and new EBIs nationally, improving feasibility and reach of introduction and scale-up of interventions. Additional efforts are required to reduce the equity gap in coverage of EBIs including PCV-10 and iCCM among pastoralist and rural communities. As other countries continue to work towards reducing U5M, Ethiopia's experience provides important lessons in effectively delivering key EBIs in the presence of challenging contextual factors.
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Affiliation(s)
- Laura Drown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alula M Teklu
- MERQ Consultancy PLC, Arbegnoch Street, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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10
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Sayinzoga F, Hirschhorn LR, Ntawukuriryayo JT, Beyer C, Donahoe KB, Binagwaho A. Understanding rapid implementation from discovery to scale: Rwanda's implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality. BMC Pediatr 2024; 23:649. [PMID: 38413897 PMCID: PMC10900536 DOI: 10.1186/s12887-023-03888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/03/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Over the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization's (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda's rapid uptake of these two EBIs developed or adapted during the study period. METHODS We conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research. RESULTS We found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors. CONCLUSION Implementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.
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Affiliation(s)
| | - Lisa R Hirschhorn
- University of Global Health Equity, Kigali, Rwanda
- Northwestern University Feinberg School of Medicine, Chicago, USA
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11
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Fernandes D, Kemigisha E, Achen D, Akatukwasa C, Ruzaaza GN, Coene G, Delobelle P, Nyakato VN, Michielsen K. Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda. BMC Public Health 2024; 24:319. [PMID: 38287314 PMCID: PMC10826092 DOI: 10.1186/s12889-023-17513-7] [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: 01/12/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Previous initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda. METHODS This paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention's causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories. RESULTS The acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention's mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting. CONCLUSION The paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.
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Affiliation(s)
- Danielle Fernandes
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium.
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium.
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya
| | - Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussels, Brussels, 1090, Belgium
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
- Institute for Family and Sexuality Studies, Dept. of Neurosciences, Fac. of Medicine, KU Leuven, Leuven, Belgium
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Peters MA, Cloete K, Odwe G, Tadele G, Hirschhorn LR, Magge H, Roder-DeWan S. Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond. BMJ 2023; 383:e076331. [PMID: 38081643 PMCID: PMC10704412 DOI: 10.1136/bmj-2023-076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Keith Cloete
- Western Cape Department of Health and Wellness, Cape Town, South Africa
| | | | | | | | - Hema Magge
- Bill and Melinda Gates Foundation, Seattle, USA
- Harvard University, Brigham and Women's Hospital, Division of Global Equity, Boston, USA
| | - Sanam Roder-DeWan
- World Bank Group, Washington DC, USA
- Dartmouth University, Hanover, USA
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13
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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Ramaswamy R, Bogdewic S, Williams CR, Deganus S, Bonzi GA, Boakye J, Koranteng E, Mensah R, Amanor A, Bryce F, Owen MD. Implementation matters: assessing the effectiveness and sustainment of an obstetric triage program at a high-volume facility in Ghana. Implement Sci Commun 2023; 4:138. [PMID: 37968768 PMCID: PMC10647175 DOI: 10.1186/s43058-023-00527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Maternal mortality remains stubbornly high in Ghana. Current national efforts are focused on improving the quality of care offered in health facilities. Obstetric triage is one intervention that has been proposed to improve the timeliness and appropriateness of care, two key elements of quality. In this study, we describe and evaluate a theory-based implementation approach to introduce obstetric triage into Tema General Hospital, a high-volume maternity hospital in Greater Accra, that blends concepts from implementation science and quality improvement. This implementation project was a first attempt to scale this intervention into a new facility, following initial development in the Greater Accra Regional Hospital (formerly Ridge Hospital) in Accra. METHODS This was a retrospective mixed-methods evaluation of two stages of implementation: active implementation and sustainment. We triangulated monitoring data captured during active implementation with clinical outcome data (timeliness of first assessment, accuracy of diagnosis, and appropriateness of care plan) from direct observation or patient obstetric triage assessment forms at baseline, at the completion of the active implementation stage, and following a 12-month "washout" period with no contact between hospital staff and the purveyor organization. Finally, we assessed embeddedness of the new triage procedures using the NoMad, a quantitative assessment of constructs from normalization process theory (NPT). RESULTS Patient waiting time decreased substantially during the study. At baseline, the median arrival-to-assessment waiting time was 70.5 min (IQR: 30.0-443.0 min). Waiting time decreased to 6.0 min (IQR: 3.0-15.0 min) following active implementation and to 5.0 min (IQR: 2.0-10.0 min) during the sustainment period. Accuracy of diagnosis was high at the end of active implementation (75.7% correct) and improved during the sustainment period (to 77.9%). The appropriateness of care plans also improved during the sustainment period (from 66.0 to 78.9%). Per NoMad data, hospital staff generally perceive obstetric triage to be well integrated into the facility. CONCLUSIONS This theory-based implementation approach proved to be successful in introducing a novel obstetric triage concept to a busy high-volume hospital, despite resource constraints and a short implementation window. Results proved long-lasting, suggesting this approach has high potential for engendering sustainability in other facilities as well. Our approach will be useful to other initiatives that aim to utilize program data to create and test implementation theories.
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Affiliation(s)
- Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Bogdewic
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitllin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sylvia Deganus
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Joana Boakye
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | | | - Alice Amanor
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Medge D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Mfinanga S, Kanyama C, Kouanfack C, Nyirenda S, Kivuyo SL, Boyer-Chammard T, Phiri S, Ngoma J, Shimwela M, Nkungu D, Fomete LN, Simbauranga R, Chawinga C, Ngakam N, Heller T, Lontsi SS, Aghakishiyeva E, Jalava K, Fuller S, Reid AM, Rajasingham R, Lawrence DS, Hosseinipour MC, Beaumont E, Bradley J, Jaffar S, Lortholary O, Harrison T, Molloy SF, Sturny-Leclère A, Loyse A. Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study. Lancet HIV 2023; 10:e663-e673. [PMID: 37802567 DOI: 10.1016/s2352-3018(23)00182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/19/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference -23%, 95% CI -33 to -13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (-13%, -24 to -3; p=0·01). INTERPRETATION DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS For the French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sayoki Mfinanga
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Cecilia Kanyama
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | - Sokoine Lesikari Kivuyo
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - Timothée Boyer-Chammard
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France
| | | | | | | | | | | | - Rehema Simbauranga
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - Chimwemwe Chawinga
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Elnara Aghakishiyeva
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Sebastian Fuller
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Anne-Marie Reid
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | | | - David S Lawrence
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mina C Hosseinipour
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Emma Beaumont
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John Bradley
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shabbar Jaffar
- UCL Institute for Global Health, University College London, London, UK
| | - Olivier Lortholary
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France; Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Institut Hospitalier Universitaire Imagine, Paris, France
| | - Thomas Harrison
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Síle F Molloy
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Aude Sturny-Leclère
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Angela Loyse
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France; Institute for Infection and Immunity, St George's University of London, London, UK.
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16
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Peterson HB, Dube Q, Lawn JE, Haidar J, Bagenal J, Horton R. Achieving justice in implementation: the Lancet Commission on Evidence-Based Implementation in Global Health. Lancet 2023; 402:168-170. [PMID: 37354916 DOI: 10.1016/s0140-6736(23)00870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Herbert B Peterson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Queen Dube
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joumana Haidar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Faro E, Adeagbo O, Mpinganjira MG, Chirwa T, Matanje B, Mayige M, Kavishe BB, Mmbaga B, Francis JM. Measurement of and training for NCD guideline implementation in LMICs: a scoping review protocol. BMJ Open 2023; 13:e073550. [PMID: 37407038 DOI: 10.1136/bmjopen-2023-073550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Globally, non-communicable diseases (NCDs) are the leading causes of morbidity and mortality with an estimated 41 million deaths (74% of all global deaths) annually. Despite the WHO's Global Action Plan for the Prevention and Control of NCDs since 2013, progress on implementation of the guidelines has been slow. Although research has shown success of some NCD prevention and treatment interventions, there is a dearth of research on NCD care delivery approaches, cost-effectiveness and larger implementation research, especially in low/middle-income countries (LMICs). The objective of this scoping review is to identify the existing variation in how, why and by whom implementation of NCD guidelines is measured as part of implementation research or non-research programme improvement. METHODS AND ANALYSIS Using the methods established by Arksey and O'Malley, the search strategy was developed in consultation with a research librarian together with stakeholder feedback from content experts. We will apply the search to multiple electronic databases and grey literature sources. Two reviewers will independently screen title and abstract for inclusion followed by a full-text screening and all included records will be abstracted using a standardised tool that will be piloted with a sample of articles before application to all records. We will conduct a narrative synthesis of abstracted data and simple quantitative descriptive statistics. DISSEMINATION The results will enable stakeholders in LMICs to leverage existing tools and resources for implementation and ongoing evaluation of NCD guidelines, to improve education and capacity building, and ultimately NCD care across the lifespan.
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Affiliation(s)
- Elissa Faro
- Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Oluwafemi Adeagbo
- Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
- Sociology, University of Johannesburg, Auckland Park, South Africa
| | - Mafuno Grace Mpinganjira
- Family Medicine and Primary Care, University of the Witwatersrand Johannesburg School of Clinical Medicine, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Beatrice Matanje
- The Centre for Public Health, Policy and Development (CPHPRD), Lilongwe, Malawi
| | - Mary Mayige
- Principal Research Scientist, National Institute for Medical Research, Mwanza, Tanzania
| | - Bazil Baltazar Kavishe
- Mwanza Interventions Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Blandina Mmbaga
- Paediatrics, Kilimanjaro Christian Medical University College of the Tumaini University Makumira, Moshi, Tanzania
| | - Joel M Francis
- Family Medicine and Primary Care, University of the Witwatersrand Johannesburg School of Clinical Medicine, Johannesburg, South Africa
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18
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Malone S, Rivera J, Puerto-Torres M, Prewitt K, Sakaan F, Counts L, Al Zebin Z, Arias AV, Bhattacharyya P, Gunasekera S, Johnson S, Kambugu J, Kaye EC, Mandrell B, Mack JW, McArthur J, Mendez A, Morrissey L, Sharara-Chami R, Snaman J, Sniderman E, Luke DA, Graetz DE, Agulnik A. A new measure for multi-professional medical team communication: design and methodology for multilingual measurement development. Front Pediatr 2023; 11:1127633. [PMID: 37334217 PMCID: PMC10272604 DOI: 10.3389/fped.2023.1127633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background As implementation science in global health continues to evolve, there is a need for valid and reliable measures that consider diverse linguistic and cultural contexts. A standardized, reproducible process for multilingual measure development may improve accessibility and validity by participants in global health settings. To address this need, we propose a rigorous methodology for multilingual measurement development. We use the example of a novel measure of multi-professional team communication quality, a determinant of implementation efforts. Methods The development and translation of this novel bilingual measure is comprised of seven steps. In this paper, we describe a measure developed in English and Spanish, however, this approach is not language specific. Participants are engaged throughout the process: first, an interprofessional panel of experts and second, through cognitive interviewing for measure refinement. The steps of measure development included: (1) literature review to identify previous measures of team communication; (2) development of an initial measure by the expert panel; (3) cognitive interviewing in a phased approach with the first language (English); (4): formal, forward-backward translation process with attention to colloquialisms and regional differences in languages; (5) cognitive interviewing repeated in the second language (Spanish); (6) language synthesis to refine both instruments and unify feedback; and (7) final review of the refined measure by the expert panel. Results A draft measure to assess quality of multi-professional team communication was developed in Spanish and English, consisting of 52 questions in 7 domains. This measure is now ready for psychometric testing. Conclusions This seven-step, rigorous process of multilingual measure development can be used in a variety of linguistic and resource settings. This method ensures development of valid and reliable tools to collect data from a wide range of participants, including those who have historically been excluded due to language barriers. Use of this method will increase both rigor and accessibility of measurement in implementation science and advance equity in research and practice.
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Affiliation(s)
- Sara Malone
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jocelyn Rivera
- Department of Pediatrics, Hospital Infantil Teletón de Oncologia (HITO), Querétaro, Mexico
| | - Maria Puerto-Torres
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kim Prewitt
- Center for Public Health Systems Science, Washington University, St. Louis, MO, USA
| | - Firas Sakaan
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lara Counts
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Zebin Al Zebin
- Pediatric Hematology and Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anita V Arias
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | | | - Sherry Johnson
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Joyce Kambugu
- Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Erica C Kaye
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Belinda Mandrell
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer W Mack
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, United States
| | - Jennifer McArthur
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alejandra Mendez
- Pediatric Intensive Care Unit, Unidad Nacional de Oncologia Pediatrica (UNOP), Guatemala City, Guatemala
| | - Lisa Morrissey
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, United States
| | - Rana Sharara-Chami
- Pediatric Critical Care Medicine, American University of Beirut, Beirut, Lebanon
- Pediatric Intensive Care Unit, LJ Murphy Inova Children's Hospital, Fairfax, VA, United States
| | - Jennifer Snaman
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, United States
| | - Elizabeth Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Douglas A Luke
- Center for Public Health Systems Science, Washington University, St. Louis, MO, USA
| | - Dylan E Graetz
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Asya Agulnik
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
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Perry HB, Valdez M, Blanco S, Llanque R, Martin S, Lambden J, Gregg C, Leach K, Olivas E, Muffoletto B, Wallace J, Modanlo N, Pfeiffer E, Westgate CC, Lesnar B, Stollak I. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ approach of Curamericas: 2. Study site, design, and methods. Int J Equity Health 2023; 21:195. [PMID: 36855098 PMCID: PMC9976360 DOI: 10.1186/s12939-022-01754-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The Curamericas/Guatemala Maternal and Child Health Project, 2011-2015, included implementation research designed to assess the effectiveness of an approach referred to as CBIO+ , composed of: (1) the Census-Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. This is the second paper in a supplement of 10 articles describing the implementation research and its findings. Paper 1 describes CBIO+ , the Project Area, and how the Project was implemented. OBJECTIVE This paper describes the implementation research design and details of how it was carried out. METHODS We reviewed the original implementation research protocol and the methods used for all data collection related to this Project. The protocol and methods used for the implementation research related to this Project were all standard approaches to the monitoring and evaluation of child survival projects as developed by the United States Agency for International Development Child Survival and Health Grants Program (CSHGP) and the CORE Group. They underwent independent peer review supervised by the CSHGP before the implementation research began. RESULTS The study area was divided into two sets of communities with a total population of 98,000 people. Project interventions were implemented in Area A from 2011 until the end of the project in 2015 (44 months) and in Area B from late 2013 until 2015 (20 months). Thus, Area B served as a quasi-comparison area during the first two years of Project implementation. The overarching study question was whether the CBIO+ Approach improved the health and well-being of children and mothers. The outcome indicators included (1) changes in population coverage of evidence-based interventions, (2) changes in childhood nutritional status, (3) changes in the mortality of children and mothers, (4) quality of care provided at Community Birthing Centers, (5) the impact of the Project on women's empowerment and social capital, (6) stakeholder assessment of the effectiveness of the CBIO+ Approach, and (7) the potential of wider adoption of the CBIO+ Approach. CONCLUSION The implementation research protocol guided the assessment of the effectiveness of the CBIO+ Approach in improving the health and well-being of children, mothers, and their communities.
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Affiliation(s)
- Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
| | - Mario Valdez
- Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | - Stanley Blanco
- Consejo de Salud Rural Andino/Curamericas, La Paz, Bolivia
| | - Ramiro Llanque
- Consejo de Salud Rural Andino/Curamericas, La Paz, Bolivia
| | - Shayanne Martin
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jason Lambden
- McGaw Medical Center, Northwestern University, Chicago, Illinois, USA
| | - Corey Gregg
- Department of Internal Medicine, Louisiana State University Health Sciences Center at New Orleans (LSUHSC-NO), New Orleans, Louisiana, USA
| | | | - Elijah Olivas
- Student, PhD Program, Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | | | - Nina Modanlo
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Erin Pfeiffer
- Independent Consultant, Winston-Salem, North Carolina, USA
| | | | - Breanne Lesnar
- Program Coordinator for Research Engagement, AVAC (Global Advocacy for HIV Prevention), New York City, New York, USA
| | - Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
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20
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Saab R, Santana V, Obeid A, Devidas M, Belgaumi A, Bhakta N, Naidu P, Saha V, Sultan I, Arora RS, Mukoka L, Jeha S. Addressing the Gap in Research Methodologies Education in Pediatric Oncology in the Eastern Mediterranean Region. JCO Glob Oncol 2023; 9:e2200295. [PMID: 36780591 PMCID: PMC10166560 DOI: 10.1200/go.22.00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Formal training in clinical research methodologies is limited in limited-resource countries. Through collaboration among high- and middle-resource settings and in response to an identified need verbalized by regional pediatric oncology practitioners, Pediatric Oncology East & Mediterranean Group and St Jude Global developed a workshop focused on capacity building in research skills. Here, we describe its structure, implementation, and early results. METHODS Leveraging virtual capabilities, the format included lectures and small group breakout exercise sessions, for 3 hours per day on 2 consecutive days per week for 2 consecutive weeks. Topics included basics of study design, introduction to health care statistics, research ethics, data registries, and scientific writing. Applicants were required to submit an abstract for a potential research project. Each breakout group selected one abstract for further development and presented the final version in a groupwide session. The participants' experience was evaluated through an online survey. RESULTS Attendance included 29 registrants from 12 countries and six disciplines. Each breakout group was assigned a themed category: cohort studies, clinical trials, or registries. Critical feedback from the breakout sessions helped strengthen the selected projects, which included a retrospective study, a prospective observational study, a prospective interventional study, and a registry proposal. After the workshop, participants were invited to further develop their original abstracts, and three proposals received additional mentoring, one of which was a multi-institutional prospective study that was subsequently submitted through the Pediatric Oncology East & Mediterranean Group network for implementation. The postworkshop survey revealed an overall highly positive experience, and feedback provided potential themes for future workshops. CONCLUSION This workshop demonstrated the potential for collaborative network partnerships in targeting research training gaps in pediatric oncology. Lessons learned will be applied to future workshops to strengthen research in limited-resource settings.
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Affiliation(s)
- Raya Saab
- Children's Cancer Institute, Department of Pediatrics & Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Victor Santana
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Anas Obeid
- Children's Cancer Institute, Department of Pediatrics & Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Asim Belgaumi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Paula Naidu
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Vaskar Saha
- Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India.,Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Ramandeep Singh Arora
- Pediatric Oncology Disease Management Group, Max Super-Specialty Hospital, New Delhi, India
| | - Lilly Mukoka
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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21
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Becerril-Montekio V, García-Bello LA, Torres-Pereda P, Alcalde-Rabanal J, Reveiz L, Langlois EV. Collaboration between health system decision makers and professional researchers to coproduce knowledge, a scoping review. Int J Health Plann Manage 2022; 37 Suppl 1:45-58. [PMID: 35643849 DOI: 10.1002/hpm.3513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent literature uses different terms and approaches to the collaboration between researchers and health system decision-makers in the research process. In 2012, the World Health Organisation proposed to "Embed research within decision-making processes". Yet, important contributions use other terms and perspectives for the same issue. This scoping review aimed to identify these terms, approaches, their application and eventual influence on the utilization of evidence. METHODS We searched papers published between January 2000 and February 2019 in English, Spanish, French and Portuguese in the databases of PubMed, Scielo, Google Scholar and EBSCOhost, thus accessing MedicLatina, MEDLINE Complete and eBook Collection. Our main inclusion criterion was the participation of health personnel in non-clinical research activities. We considered three domains for in depth analysis: Definition, name and description of the participation of decision makers and health staff; Forms of collaboration and actual/effective participation of health staff in research; Eventual influence on the utilization of research results. RESULTS We identified 607 articles and selected 74 for full text analysis. Nineteen different terms are currently used in twelve countries to describe the participation of health decision-makers and staff in research activities. Most publications refer to Integrated Knowledge Translation or Embedded Research, and were published in Canada and the United Kingdom. Forty-five papers discuss the participation of health staff in research activities; 20 leading the whole process and 21 as collaborators. CONCLUSIONS The identification of the different terms and approaches to the close collaboration of health staff and decision-makers with professional researchers is essential to promote its effective application and influence on the utilization of evidence. Yet, it is also necessary to insist in their co-participation throughout the whole investigation process as a relevant way to improve research results uptake, strengthen health systems and advance towards universal health coverage.
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Affiliation(s)
| | | | | | | | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, Columbia, USA
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
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22
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Kyomuhangi T, Manalili K, Kabakyenga J, Turyakira E, Matovelo D, Khan S, Kyokushaba C, MacIntosh H, Brenner JL. Health system strengthening using a Maximizing Engagement for Readiness and Impact (MERI) Approach: A community case study. Front Public Health 2022; 10:952213. [PMID: 36504976 PMCID: PMC9727261 DOI: 10.3389/fpubh.2022.952213] [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: 05/24/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The Maximizing Engagement for Readiness and Impact (MERI) Approach uses a system "readiness" theory of change to address implementation obstacles. MERI is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa. Context The MERI Approach is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled MERI Approach adaptation and documentation, using an implementation lens and an implementation science readiness theory of change. Key programmatic elements The MERI Approach comprises three core components. MERI Change Strategies (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The SOPETAR Process Model (Scan, Orient, Plan, Equip, Train, Act, Reflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A MERI Motivational Framework identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures. Discussion This case study demonstrates feasibility of the MERI Approach to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The MERI Approach has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.
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Affiliation(s)
- Teddy Kyomuhangi
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,*Correspondence: Teddy Kyomuhangi
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sobia Khan
- The Center for Implementation, Toronto, ON, Canada
| | - Clare Kyokushaba
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Heather MacIntosh
- Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer L. Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Klein K, Roberti J, Rouvier M, Belizan M, Cafferata ML, Berrueta AM, Alonso JP. Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study. BMC PRIMARY CARE 2022; 23:277. [PMID: 36348310 PMCID: PMC9643922 DOI: 10.1186/s12875-022-01886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022]
Abstract
Background Chagas is a public health problem, especially in Latin America, exacerbated by migratory movements and increasing urbanization. Argentina is among the countries with the highest estimated prevalence in the region, with 1,500,000 people infected, with mother to child as the main mode of transmission. Vertical transmission has been significantly reduced by treating women of childbearing age; several guidelines in the region recommend treatment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment. The objective of this research was to design an implementation strategy to improve using Chagas guidelines focused on attending women of childbearing age and children at the primary healthcare level and pilot it in three primary health care centers in Argentina. Methods We conducted a pilot feasibility study using the Consolidated Framework for Implementation Research. A qualitative process evaluation was conducted using semi-structured interviews with health care providers and observations in primary health care centers. Results We developed a multifaceted implementation strategy including training, flowcharts and reminders, a register of suspected and confirmed cases, and the selection of a management facilitator. The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components, being the facilitating factors, the simplicity of the intervention, professionals’ willingness to expand the indication of serologic tests, and staff commitment to the adoption of intervention components. The main barriers found were the change of authorities at the local level, some professionals´ reluctance to administer etiological treatment, staff shortages, lack of diagnostic supplies, and the health emergency caused by the COVID-19 pandemic. Conclusions Behavioral change strategies should be applied to improve implementation to address some of the main barriers, including support actions offered by opinion leaders, medical experts, and local health authorities. Rapid diagnostic tests should be readily available to maintain behavior changes. We suggest further refinement of the strategy and its implementation in more centers to assess outcomes prospectively with a hybrid implementation research design. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01886-6.
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Affiliation(s)
- Karen Klein
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina.
| | - Javier Roberti
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), City of Buenos Aires, Argentina
| | - Mariel Rouvier
- Ministry of Public Health of Chaco, Resistencia, Chaco, Argentina
| | - Maria Belizan
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina
| | - Maria Luisa Cafferata
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina
| | - Amanda Mabel Berrueta
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Institute of Clinical Effectiveness and Health Policy (IECS), City of Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), City of Buenos Aires, Argentina
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24
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Brima N, Morhason-Bello IO, Charles V, Davies J, Leather AJ. Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions. BMJ Open 2022; 12:e062616. [PMID: 36220318 PMCID: PMC9557325 DOI: 10.1136/bmjopen-2022-062616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to evaluate the impact of the intervention and implementation learning. DESIGN We conducted a systematic literature review and narrative synthesis. SETTING Literature on hospital-based quality improvement studies in sub-Saharan Africa reviewed until 31 December 2021. PARTICIPANTS MEDLINE, EMBASE, Global Health, CINAHL, Web of Science databases and grey literature were searched. INTERVENTION We extracted data on intervention characteristics and how the intervention was delivered and evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES Importantly, we assessed whether clinical, process and implementation outcomes were collected and separately categorised the outcomes under the Institute of Medicine quality domains. Risk of bias was not assessed. RESULTS Of 1573 articles identified, 49 were included from 17/48 sub-Saharan African countries, 16 of which were low-income or lower middle-income countries. Almost two-thirds of the studies took place in East Africa (31/49, 63.2%). The most common intervention focus was reduction of surgical site infection (12/49, 24.5%) and use of a surgical safety checklist (14/49, 28.6%). Use of implementation and quality improvement science methods were rare. Over half the studies measured clinical outcomes (29/49, 59.2%), with the most commonly reported ones being perioperative mortality (13/29, 44.8%) and surgical site infection rate (14/29, 48.3%). Process and implementation outcomes were reported in over two thirds of the studies (34/49, 69.4% and 35, 71.4%, respectively). The most studied quality domain was safety (44/49, 89.8%), with efficiency (4/49, 8.2%) and equitability (2/49, 4.1%) the least studied domains. CONCLUSIONS There are few hospital-based studies that focus on improving the quality of surgical and anaesthesia care in sub-Saharan Africa. Use of implementation and quality improvement methodologies remain low, and some quality domains are neglected. PROSPERO REGISTRATION NUMBER CRD42019125570.
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Affiliation(s)
- Nataliya Brima
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | | | - Justine Davies
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
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25
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Bai Y, Zhang Y, Zotova O, Pineo H, Siri J, Liang L, Luo X, Kwan MP, Ji J, Jiang X, Chu C, Cong N, Lin V, Summerskill W, Luo Y, Yu H, Wu T, Yang C, Li J, Xiao Y, Zhou J, Dou D, Xiong H, Zhang LL, Wang L, Tao S, Fu B, Zhang Y, Xu B, Yang J, Gong P. Healthy cities initiative in China: Progress, challenges, and the way forward. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 27:100539. [PMID: 35854811 PMCID: PMC9286727 DOI: 10.1016/j.lanwpc.2022.100539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED China implemented the first phase of its National Healthy Cities pilot program from 2016-20. Along with related urban health governmental initiatives, the program has helped put health on the agenda of local governments while raising public awareness. Healthy City actions taken at the municipal scale also prepared cities to deal with the COVID-19 pandemic. However, after intermittent trials spanning the past two decades, the Healthy Cities initiative in China has reached a crucial juncture. It risks becoming inconsequential given its overlap with other health promotion efforts, changing public health priorities in response to the pandemic, and the partial adoption of the Healthy Cities approach advanced by the World Health Organization (WHO). We recommend aligning the Healthy Cities initiative in China with strategic national and global level agendas such as Healthy China 2030 and the Sustainable Development Goals (SDGs) by providing an integrative governance framework to facilitate a coherent intersectoral program to systemically improve population health. Achieving this alignment will require leveraging the full spectrum of best practices in Healthy Cities actions and expanding assessment efforts. FUNDING Tsinghua-Toyota Joint Research Fund "Healthy city systems for smart cities" program.
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Affiliation(s)
- Yuqi Bai
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Yutong Zhang
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Olena Zotova
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Helen Pineo
- Institute for Environmental Design and Engineering, University College London, WC1H 0NN London, UK
| | - José Siri
- Independent Consultant, Urban Health, Philadelphia, PA 19103, United States of America
| | - Lu Liang
- Department of Geography and the Environment, University of North Texas, 1155 Union Circle, Denton, TX 76203, United States of America
| | - Xiangyu Luo
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management and Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - John Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaopeng Jiang
- Office of the WHO Representative in People's Republic of China, WHO, Beijing, China
| | - Cordia Chu
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Nathan, QLD 4111, Australia
| | - Na Cong
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Vivian Lin
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - William Summerskill
- Consulting Editor, The Lancet, 125 London Wall, London EC2Y 5AS, United Kingdom
| | - Yong Luo
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Tinghai Wu
- School of Architecture, Tsinghua University, Beijing, China
| | - Changhong Yang
- Division for Business Management and Quality Control of Sichuan Centre for Diseases Control and Prevention, Chengdu 610041, China
| | - Jing Li
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen; National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, Beijing, China
| | - Yixiong Xiao
- Business Intelligence Lab, Baidu Research, Beijing, China
| | - Jingbo Zhou
- Business Intelligence Lab, Baidu Research, Beijing, China
| | - Dejing Dou
- Business Intelligence Lab, Baidu Research, Beijing, China
| | - Hui Xiong
- Artificial Intelligence Thrust, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, China and The Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | | | - Lan Wang
- College of Architecture and Urban Planning, Tongji University, Shanghai, China
| | - Shu Tao
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Bojie Fu
- State Key Laboratory of Urban and Regional Ecology, Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Yong Zhang
- Cancer Hospital Chinese Academy of Medical Science, Beijing, China
| | - Bing Xu
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Jun Yang
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Key Laboratory for Earth System Modelling, Tsinghua University, Beijing, China
| | - Peng Gong
- Department of Earth Sciences and Geography, University of Hong Kong, Hong Kong Special Administrative Region, China
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Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200061. [PMID: 36109054 PMCID: PMC9476480 DOI: 10.9745/ghsp-d-22-00061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
Achieving universal health care coverage requires the adoption of primary health care policies and delivery strategies that are evidence based. Although this has been confronted by manifold challenges, particularly in the health systems of sub-Saharan Africa, there are promising approaches for accomplishing this objective. Salient among these is embedding implementation research (i.e., the study of methods to promote the systematic uptake of evidence-based interventions (EBIs) into routine practice) into policy making and implementation processes. Since 2007, the African Health Initiative of the Doris Duke Charitable Foundation supported partnerships that strengthened primary health systems and policy implementation in 7 countries in sub-Saharan Africa using the embedded implementation research as a core strategy. This programmatic review and analysis aims to identify the core features and processes that characterized how the partnerships operationalized the embedded implementation research approach and understand the factors that helped and constrained partnerships' effective use of this approach. For this, we drew upon findings from a desk review that consisted of 30 examples of embedded implementation research conducted by 3 African Health Initiative partnerships between 2016 and 2021 in Ethiopia, Ghana, and Mozambique. In addition, we conducted and analyzed 13 in-depth interviews with embedded implementation research stakeholders of the 3 projects. Core features and processes of embedded implementation research were: (1) the leadership role of policy decision makers and implementation leaders; (2) positioning research with program implementation at multiple levels of health systems; (3) multidisciplinary and multisectoral partnerships; (4) focus on research capacity building; and (5) real-time feedback loops and knowledge translation. Factors influencing the effectiveness of the embedded implementation research experiences involved: (1) the implementation climate and leadership; (2) opportunities and capacities to circulate and absorb new information; and (3) stakeholders' baseline knowledge and embedded scientists' identification within their organizations.
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27
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Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Bartels SM, Haider S, Williams CR, Mazumder Y, Ibisomi L, Alonge O, Theobald S, Bärnighausen T, Escallon JV, Vahedi M, Ramaswamy R, Sarker M. Diversifying Implementation Science: A Global Perspective. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00757. [PMID: 36041849 PMCID: PMC9426981 DOI: 10.9745/ghsp-d-21-00757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
We present a joint global perspective about the urgent need to diversify the loci of knowledge creation and sharing in global implementation science. We underscore the imperative of addressing implementation research questions relevant to practitioners, policy makers, and researchers from low- and middle-income countries.
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Affiliation(s)
- Sophia M Bartels
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Shabab Haider
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Caitlin R Williams
- Department of Maternal and Child Health, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yameen Mazumder
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Latifat Ibisomi
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sally Theobald
- Social Science and International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg, Germany
| | | | | | - Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg, Germany
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Jarrett C, Baxter YC, Boch J, Carrasco C, Cobos Muñoz D, Mauro Dib K, Pessoa L, Saric J, Silveira M, Steinmann P. Deconstructing design thinking as a tool for the implementation of a population health initiative. Health Res Policy Syst 2022; 20:91. [PMID: 35986365 PMCID: PMC9389775 DOI: 10.1186/s12961-022-00892-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background The translation of evidence-based practices and rapid uptake of innovations into global health practice is challenging. Design thinking is a consultative process involving multiple stakeholders and has been identified as a promising solution to create and apply implementation strategies in complex environments like health systems. Methods We conducted a process evaluation of a real-world example, namely an initiative to innovate hypertension screening, diagnosis and care in São Paulo, Brazil. The parameters of the evaluation were informed by a specification rubric and categorization system, recommended for the investigation of implementation strategies, and the double-diamond conceptual framework to describe and examine the strategic architecture and nature of the design thinking approach, with particular emphasis on identifying potential areas of “value-add” particular to the approach. The retrospective evaluation was performed by an independent partner who had not been involved in the setting up and implementation of the design thinking process. Results The evaluation unveiled a dense catalogue of strategically driven, mostly theoretically based, activities involving all identified health system stakeholders including patients. Narrative reconstruction illuminated the systematic and coherent nature of this approach, with different resulting actions progressively accounting for all relevant layers of the health system to engineer a broad selection of specific implementation solutions. The relevance of the identified features and the mechanics used to promote more successful implementation practices was manifested in several distinct ways: design thinking offered a clear direction on which innovations really mattered and when, as well as several new dimensions for consideration in the development of an innovation mindset amongst stakeholders. It thereby promoted relationship quality in terms of familiarity and trust, and commitment to evidence-based enquiry and action. Design thinking was also able to navigate the territory between the need for intervention “fidelity” versus “adaptation” and provide the operational know-how to face familiar implementation hurdles. Lastly, it brought a new kind of skill set to the public health stakeholders that incorporated diplomacy, multidisciplinary approaches and management sciences—skills that are considered necessary but not yet widely taught as part of public health training. Conclusions Design thinking is a sound and viable tool to use as part of an implementation strategy for engaging with health system stakeholders and successfully translating evidence-based practices and new innovations into routine practice, thereby addressing an important knowledge—practice gap and, more broadly, contributing to the strategic repertoire available to implementation science. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00892-5.
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Parascandola M, Neta G, Salloum RG, Shelley D, Rositch AF. Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control. JCO Glob Oncol 2022; 8:e2200054. [PMID: 35960906 PMCID: PMC9812451 DOI: 10.1200/go.22.00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting? METHODS We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening. RESULTS These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors. CONCLUSION Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge.
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Affiliation(s)
- Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, MD,Mark Parascandola, PhD, MPH, Research and Training Branch, Center for Global Health, National Cancer Institute, 9609 Medical Center Dr, Room 3W564, Bethesda, MD 20892; Twitter: @parafoto; e-mail:
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Donna Shelley
- Department of Policy and Public Health Management, NYU School of Global Public Health, New York, NY
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Gagnon MP. Context Matters in Evidence Implementation Globally Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis". Int J Health Policy Manag 2022; 11:1580-1583. [PMID: 35021616 PMCID: PMC9808333 DOI: 10.34172/ijhpm.2021.179] [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: 10/22/2021] [Accepted: 12/26/2021] [Indexed: 01/12/2023] Open
Abstract
Context influences the effectiveness of healthcare interventions and should be considered to inform their implementation. However, context remains poorly defined in the knowledge translation (KT) literature. The paper by Squires and colleagues constitutes a valuable contribution to the field of KT as it provides the basis for a comprehensive framework to assess the influence of context on implementation success. In their study, Squires et al identified 66 context features, grouped into 16 attributes. Their findings highlight a great convergence in the context features mentioned by stakeholders across countries, experience levels and roles in KT. Thus, the proposed framework could eventually transfer to several implementation settings. However, all study participants were from high-income countries. It would therefore be important to replicate this research in low- and middle-income countries (LMICs). A common understanding of what context means is essential to assessing its influence on the implementation of healthcare interventions globally.
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Massazza A, May CR, Roberts B, Tol WA, Bogdanov S, Nadkarni A, Fuhr DC. Process evaluations of mental health and psychosocial support interventions for populations affected by humanitarian crises. Soc Sci Med 2022; 303:114994. [PMID: 35561423 DOI: 10.1016/j.socscimed.2022.114994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Randomised controlled trials (RCTs) have been increasingly used to test the effectiveness of mental health and psychosocial support(MHPSS) interventions for populations affected by humanitarian crises. Process evaluations are often integrated within RCTs of psychological interventions to investigate the implementation of the intervention, the impact of context, and possible mechanisms of action. We aimed to explore limitations and strengths of how process evaluations are currently conceptualised and implemented within MHPSS RCTs specifically. METHODS In April-June 2021 we conducted semi-structured interviews with 24 researchers involved in RCTs of MHPSS interventions in 23 different countries. Participants were selected based on systematic reviews of MHPSS interventions, funders' databases, and personal networks. Data were analysed using codebook thematic analysis. RESULTS The conduct of process evaluations was characterized by high heterogeneity in perceived function, implementation outcomes assessed, and methods used. While process evaluations were overwhelmingly considered as an important component of an RCT, there were different opinions on their perceived quality. This could be explained by the varying prioritization of effectiveness data over implementation data, confusion around the nature of process evaluations, and challenges in the collection and analysis of process data in humanitarian settings. Various practical recommendations were made by participants to improve future process evaluations in relation to: (i) study design (e.g., embedding process evaluations in study protocol and overall study objectives); (ii) methods (e.g., use of mixed methods); and (iii) increased financial and human resources dedicated to process evaluations. CONCLUSION The current state of process evaluations in MHPSS RCTs is heterogeneous. The quality of process evaluations should be improved to strengthen implementation science of the growing number of evidence-informed MHPSS interventions.
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Affiliation(s)
- Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Carl R May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; NIHR North Thames Applied Research Collaborative, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Ross B, Penkunas MJ, Maher D, Certain E, Launois P. Evaluating results of the implementation research MOOC using Kirkpatrick's four-level model: a cross-sectional mixed-methods study. BMJ Open 2022; 12:e054719. [PMID: 35504633 PMCID: PMC9066485 DOI: 10.1136/bmjopen-2021-054719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION An implementation research (IR) massive open online course (MOOC) was developed by the Special Programme for Research and Training in Tropical Diseases, to address the scarcity of training in low-income and middle-income countries in the field of IR. The Kirkpatrick model was used to evaluate the IR MOOC as it is widely applied for evaluation of training and educational programmes. The Kirkpatrick model evaluates training programmes on four levels: reaction, learning, behaviour and results. This paper addresses the impact of the IR MOOC on participants' professional practice. METHODS Findings are based on analysis of survey and interview data collected 1.5-2 years after the conclusion of the two 2018 IR MOOC offerings. Of the 3858 MOC participants, 748 responded to the anonymous online survey and seven of these respondents were interviewed. All data are self-reported. RESULTS The IR MOOC was successful in enhancing the professional practice of participants and for their organisations. Over 40% reported modifying or implementing changes in their professional work. Respondents reported that participation in the MOOC had improved their ability to conduct IR, enhanced their professional profiles and increased their opportunities for collaboration, research and job promotion. Respondents stated that the MOOC had improved their work quality and productivity, and allowed them to contribute to research, initiate and develop professional collaborations and train others in IR. Respondents reported an increase in applying for grants and scholarships and presenting and publishing work on IR after participating in the MOOC. Barriers applying the knowledge gained from the IR MOOC were experienced, for example, due to a lack of funding and lack of support from colleagues, managers and organisations. CONCLUSION Participants perceived that the IR MOOC was successful in its aims of delivering medium-term and long-term results in relation to their own and their organisations' professional outcomes.
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Affiliation(s)
- Bella Ross
- Monash College, Docklands, Victoria, Australia
| | - Michael J Penkunas
- United Nations University International Institute for Global Health (UNU-IIGH), Cheras, Kuala Lumpur, Malaysia
| | - Dermot Maher
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Edith Certain
- Consultant - Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Pascal Launois
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Cardoso-Weinberg A, Alley C, Kupfer LE, Aslanyan G, Makanga M, Zicker F, Olesen OF. Funders' Perspectives on Supporting Implementation Research in Low- and Middle-Income Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00497. [PMID: 35487544 PMCID: PMC9053148 DOI: 10.9745/ghsp-d-21-00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022]
Abstract
We identify and discuss 7 approaches for funders to contemplate when considering support for implementation research in low- and middle-income countries.
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Affiliation(s)
- Ana Cardoso-Weinberg
- European & Developing Countries Clinical Trials Partnership, EDCTP, The Hague, The Netherlands.
| | - Chris Alley
- Hunter College, City University of New York, New York, NY, USA
| | - Linda E Kupfer
- Fogarty International Center - National Institutes of Health (NIH), Bethesda, MD, USA
| | - Garry Aslanyan
- TDR, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
| | - Michael Makanga
- European & Developing Countries Clinical Trials Partnership, EDCTP, The Hague, Netherlands
| | - Fabio Zicker
- Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Ole F Olesen
- European Vaccine Initiative (EVI), Heidelberg, Germany & Global Health Section, Department of Public Health, University of Copenhagen, Denmark
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Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S, Ilbawi A, Kapambwe S, Kingham P, Kutluk T, Lamichhane N, Mutebi M, Orem J, Parham G, Ranganathan P, Sengar M, Sullivan R, Swaminathan S, Tannock IF, Tomar V, Vanderpuye V, Varghese C, Weiderpass E. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med 2022; 28:649-657. [PMID: 35440716 PMCID: PMC9108683 DOI: 10.1038/s41591-022-01738-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra A Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Satish Gopal
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Peter Kingham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tezer Kutluk
- Faculty of Medicine and Cancer Institute, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Accra, Ghana
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Johnson SE, Jayasekar Zurn S, Anderson BO, Vetter BN, Katz ZB, Milner DA. International perspectives on the development, application, and evaluation of a multicancer early detection strategy. Cancer 2022; 128 Suppl 4:875-882. [PMID: 35133661 DOI: 10.1002/cncr.33927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
The development and implementation of a multicancer early detection (MCED) test that is effective and affordable has the potential to change cancer care systems around the world. However, careful consideration is needed within the context of different health care settings (both low- and middle-income countries and high-income countries) to roll out an MCED test and promote equity in access.
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Affiliation(s)
| | | | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
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Michaud-Létourneau I, Gayard M, Njoroge B, Agabiirwe CN, Luwangula AK, McGough L, Mwangi A, Pelto G, Tumilowicz A, Pelletier DL. Operationalizing Implementation Science in Nutrition: The Implementation Science Initiative in Kenya and Uganda. Curr Dev Nutr 2022; 6:nzab146. [PMID: 35047720 PMCID: PMC8760423 DOI: 10.1093/cdn/nzab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Implementation science (IS) has the potential to improve the implementation and impact of policies, programs, and interventions. Most of the training, guidance, and experience has focused on implementation research, which is only 1 part of the broader field of IS. In 2018, the Society for Implementation Science in Nutrition borrowed concepts from IS in health to develop a broader and more integrated conceptual framework, adapted to the particular case of nutrition and with language and concepts more familiar to the nutrition community: it is called the IS in Nutrition (ISN) framework. OBJECTIVE The purpose of this research was to generate knowledge concerning challenges and strategies in operationalizing the ISN framework in low- and middle-income country (LMIC) settings. METHODS The ISN framework was operationalized in partnership with country teams in Kenya and Uganda over a 3-y period as part of the Implementation Science Initiative. An action research methodology (developmental evaluation) was used to provide timely feedback to the country teams, facilitate adaptations and adjustments, and generate the data presented in this article concerning challenges and strategies. RESULTS Operationalization of the ISN framework proceeded by first articulating a set of guiding principles as touchstones for the country teams and further articulating 6 components of an IS system to facilitate development of work streams. Challenges and strategies in implementing these 6 components were then documented. The knowledge gained through this experience led to the development of an IS system operational model to assist the application of IS in other LMIC settings. CONCLUSIONS Future investments in IS should prioritize a system- and capacity-building approach in order to realize its full potential and become institutionalized at country level. The operational model can guide others to improve the implementation of IS within a broad range of programs.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- The Society for Implementation Science in Nutrition,
NY, USA
- Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Marion Gayard
- The Society for Implementation Science in Nutrition,
NY, USA
| | | | | | | | | | | | - Gretel Pelto
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | | | - David L Pelletier
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
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Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, Donahoe K, Mathewos K, Sayinzoga F, Binagwaho A. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021; 5:72. [PMID: 35079696 PMCID: PMC8688814 DOI: 10.12688/gatesopenres.13214.3] [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] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) - in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification, and testing of strategies, work to achieve sustainability at scale, and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and to extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda's actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country's success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
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Affiliation(s)
- Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Miriam Frisch
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | | | - Kateri Donahoe
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, 7162, Rwanda
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Kumar M, Chu W, Gellatly R, Wambua GN, Becker KD, Chorpita BF. Identified needs of peripartum adolescents in Sub-Saharan Africa from 2013 to 2021: a mapping of domains for strengthening psychosocial interventions. Curr Opin Psychol 2021; 45:101291. [PMID: 35016086 DOI: 10.1016/j.copsyc.2021.12.003] [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: 07/31/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Adolescent pregnancy and early motherhood pose significant socioeconomic and health risks in Sub-Saharan Africa, leading to considerable morbidity and mortality. To learn more about the needs of this population, we reviewed 24 articles featuring 21 samples covering 12,490 adolescents from 14 countries. Our coding revealed that adolescent mothers were studied more (85.7% of samples) than pregnant adolescents (61.9%). We summarized needs as per six categories. Resource needs were most prevalent, reported by 100% of samples, followed by ecology (85.7%), mental health (76.2%), medical (61.9%), other (61.9%), and education (33.3%). The most frequently reported resource needs were low income and unemployment. Low social support, low family functioning, and exposure to negative cultural norms were ecological needs prevalent in most samples. Among mental health concerns, depression was the most commonly reported problem, whereas other problems, such as anxiety, substance use, and suicidality, were reported much less frequently. HIV-positive status was the most frequently reported medical concern. Intervention developers should consider the range of challenges when designing psychosocial services for this population.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Kenya.
| | - Wendy Chu
- Department of Psychology, University of South Carolina, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
| | - Grace Nduku Wambua
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, Vrije Universiteit, Netherlands
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA
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Ezumah N, Manzano A, Ezenwaka U, Obi U, Ensor T, Etiaba E, Onwujekwe O, Ebenso B, Uzochukwu B, Huss R, Mirzoev T. Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria. Soc Sci Med 2021; 293:114644. [PMID: 34923352 PMCID: PMC8819156 DOI: 10.1016/j.socscimed.2021.114644] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/29/2022]
Abstract
Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users and healthcare providers in Nigeria. Key documents were reviewed, and initial programme theories of how context triggers mechanisms to produce intended and unintended outcomes were developed. These were tested, consolidated and refined through iterative cycles of data collection and analysis. Testing and validation of the trust theory utilized eight in-depth interviews with health workers, four focus group discussions with service users and a household survey of 713 pregnant women and analysed retroductively. The conceptual framework adopted Hurley's perspective on 'decision to trust' and Straten et al.'s framework on public trust and social capital theory. Incentives offered by the programme triggered confidence and satisfaction among service users, contributing to their trust in healthcare providers, increased service uptake, motivated healthcare providers to have a positive attitude to work, and facilitated their trust in the health system. Termination of the programme led to most service users' dissatisfaction, and distrust reflected in the reduction in utilization of MCH services, increased staff workloads leading to their decreased performance although residual trust remained. Understanding the role of trust in a programme's short and long-term outcomes can help policymakers and other key actors in the planning and implementation of sustainable and effective health programmes. We call for more theory-driven approaches such as realist evaluation to advance understanding of the implementation of health programmes in LMICs.
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Affiliation(s)
- Nkoli Ezumah
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Ana Manzano
- Nuffield Centre for International Health and Development, University of Leeds, United Kingdom.
| | - Uchenna Ezenwaka
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Uche Obi
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, United Kingdom.
| | - Enyi Etiaba
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Obinna Onwujekwe
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, United Kingdom.
| | - Benjamin Uzochukwu
- Health Policy Research Group (HPRG) College of Medicine, University of Nigeria Enugu Campus, Nigeria.
| | - Reinhard Huss
- Nuffield Centre for International Health and Development, University of Leeds, United Kingdom.
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, United Kingdom; Department of Global Health and Development, London School of Hygiene and Tropical Medicine.
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Husson O, Reeve BB, Darlington AS, Cheung CK, Sodergren S, van der Graaf WTA, Salsman JM. Next Step for Global Adolescent and Young Adult Oncology: A Core Patient-Centered Outcome Set. J Natl Cancer Inst 2021; 114:496-502. [PMID: 34865066 DOI: 10.1093/jnci/djab217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
The relatively small number of cancers in the adolescent and young adult (AYA) age group, those aged 15-39 years, does not appropriately reflect the personal and societal costs of cancer in this population, as reflected in the potential years of life lost or saved; the decreased productivity and health-related quality of life due to the impact of the disease during formative years and long-term complications or disabilities. Improvements in care and outcomes for AYAs with cancer require collaboration among different stakeholders at different levels (patients, caregivers, healthcare professionals, researchers, industry, and policymakers). Development of a Core Outcome Set (COS), an agreed minimum set of outcomes that should be measured globally in research, routine clinical practice, specifically for AYAs with cancer, with outcomes that are well defined based on the perspective of those who are affected and assessed with validated measures is highly required. A globally implemented COS for AYAs with cancer will facilitate better pooling of research data and the implementation of high-quality healthcare registries, which by benchmarking not only nationally, but also internationally, may ultimately improve the value of the care given to these underserved young cancer patients. We reflect on the need to develop a COS for AYA with cancer, the arenas of application and the challenges of implementing an age-specific COS in research and clinical practice.
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Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Clinical Studies; Institute of Cancer Research, London, UK.,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bryce B Reeve
- Department of Population Health Sciences; Duke University School of Medicine; Durham, NC, USA
| | | | | | | | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John M Salsman
- Department of Social Sciences & Health Policy; Wake Forest School of Medicine; Wake Forest Baptist Comprehensive Cancer Center; Winston Salem, NC, USA
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Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, Verhey R, Shidhaye R, Thornicroft G, Araya R, Sevdalis N. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health 2021; 6:e005365. [PMID: 34969685 PMCID: PMC8718460 DOI: 10.1136/bmjgh-2021-005365] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022] Open
Abstract
Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Department of Health Service and Population Research, King's College London, London, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Rondebosch, South Africa
| | - Jamie Murdoch
- University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | | | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | | | | | - Nick Sevdalis
- Health Service & Population Research Department, King's College London, London, UK
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Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, Donahoe K, Mathewos K, Sayinzoga F, Binagwaho A. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021; 5:72. [PMID: 35079696 PMCID: PMC8688814 DOI: 10.12688/gatesopenres.13214.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/09/2023] Open
Abstract
Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) - in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification, and testing of strategies, work to achieve sustainability at scale, and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and to extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda's actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country's success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
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Affiliation(s)
- Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Miriam Frisch
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | | | - Kateri Donahoe
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, 7162, Rwanda
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Jackson D, Shahabuddin ASM, Sharkey AB, Källander K, Muñiz M, Mwamba R, Nyankesha E, Scherpbier RW, Hasman A, Balarajan Y, Albright K, Idele P, Peterson SS. Closing the know-do gap for child health: UNICEF's experiences from embedding implementation research in child health and nutrition programming. Implement Sci Commun 2021; 2:112. [PMID: 34588002 PMCID: PMC8479889 DOI: 10.1186/s43058-021-00207-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition. This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work. From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods. UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.
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Affiliation(s)
- Debra Jackson
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA. .,Takeda Chair in Global Child Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. .,School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - A S M Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Alyssa B Sharkey
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Karin Källander
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Maria Muñiz
- Health Section, East and Southern Africa Regional Office, UNICEF, Nairobi, Nairobi, Kenya
| | - Remy Mwamba
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Elevanie Nyankesha
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Robert W Scherpbier
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Andreas Hasman
- Nutrition Section, Programme Division, UNICEF, New York, New York, USA
| | - Yarlini Balarajan
- Nutrition Section, Programme Division, UNICEF, New York, New York, USA
| | - Kerry Albright
- Office of Research Innocenti, UNICEF, Florence, Florence, Italy
| | - Priscilla Idele
- Office of Research Innocenti, UNICEF, Florence, Florence, Italy
| | - Stefan Swartling Peterson
- Office of the Associate Director for Health, Programme Division, UNICEF, New York, New York, USA.,Uppsala University, Women's and Children's Health (IMCH) and Karolinska Institutet, Uppsala, Sweden.,Makerere University School of Public Health, Kampala, Uganda
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46
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Lazo-Porras M, Liu H, Miranda JJ, Moore G, Burri M, Chappuis F, Perel P, Beran D. Process evaluation of complex interventions in chronic and neglected tropical diseases in low- and middle-income countries-a scoping review protocol. Syst Rev 2021; 10:244. [PMID: 34488877 PMCID: PMC8422627 DOI: 10.1186/s13643-021-01801-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of process evaluations is a growing area of interest in research groups working on complex interventions. This methodology tries to understand how the intervention was implemented to inform policy and practice. A recent systematic review by Liu et al. on process evaluations of complex interventions addressing non-communicable diseases found few studies in low- and middle- income countries (LMIC) because it was restricted to randomized controlled trials, primary healthcare level and non-communicable diseases. Yet, LMICs face different barriers to implement interventions in comparison to high-income countries such as limited human resources, access to health care and skills of health workers to treat chronic conditions especially at primary health care level. Therefore, understanding the challenges of interventions for non-communicable diseases and neglected tropical diseases (diseases that affect poor populations and have chronic sequelae) will be important to improve how process evaluation is designed, conducted and used in research projects in LMICs. For these reasons, in comparison to the study of Liu et al., the current study will expand the search strategy to include different study designs, languages and settings. OBJECTIVE Map research using process evaluation in the areas of non-communicable diseases and neglected tropical diseases to inform the gaps in the design and conduct of this type of research in LMICs. METHODS Scoping review of process evaluation studies of randomized controlled trials (RCTs) and non-RCTs of complex interventions implemented in LMICs including participants with non-communicable diseases or neglected tropical diseases and their health care providers (physicians, nurses, technicians and others) related to achieve better health for all through reforms in universal coverage, public policy, service delivery and leadership. The aspects that will be evaluated are as follows: (i) available evidence of process evaluation in the areas of non-communicable diseases and neglected tropical diseases such as frameworks and theories, (ii) methods applied to conduct process evaluations and (iii) gaps between the design of the intervention and its implementation that were identified through the process evaluation. Studies published from January 2008. Exclusion criteria are as follows: not peer reviewed articles, not a report based on empirical research, not reported in English or Spanish or Portuguese or French, reviews and non-human research. DISCUSSION This scoping review will map the evidence of process evaluations conducted in LMICs. It will also identify the methods they used to collect and interpret data, how different theories and frameworks were used and lessons from the implementation of complex interventions. This information will allow researchers to conduct better process evaluations considering special characteristics from countries with limited human resources, scarce data available and limited access to health care.
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Affiliation(s)
- María Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 455, Miraflores, Lima, Peru
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 455, Miraflores, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Graham Moore
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Mafalda Burri
- Library, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
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Patel K, Say S, Leng D, Prak M, Lo K, Mukaka M, Riedel A, Turner C. Saving babies' lives (SBL) - a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial. BMC Pediatr 2021; 21:390. [PMID: 34493225 PMCID: PMC8421466 DOI: 10.1186/s12887-021-02833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. METHODS This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. DISCUSSION Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. TRIAL REGISTRATION ClinicalTrials.gov: NCT04663620 . Registered on 11th December 2020, retrospectively registered.
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Affiliation(s)
- Kaajal Patel
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia.
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia.
| | - Sopheakneary Say
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
| | - Daly Leng
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
| | - Manila Prak
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
| | - Koung Lo
- Preah Vihear Provincial Health Department, Preah Vihear, Cambodia
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Arthur Riedel
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
| | - Claudia Turner
- Saving Babies' Lives Programme, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
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Ishaku SM, van der Harst M, Warren CE, Franx A, Kayode GA, Grobbee D, Browne JL. Research within international non-governmental organisation programmes in low and middle-income countries: challenges amid opportunities. BMJ Glob Health 2021; 6:bmjgh-2021-006210. [PMID: 34389627 PMCID: PMC8365794 DOI: 10.1136/bmjgh-2021-006210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Salisu Mohammed Ishaku
- Julius Global Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Maria van der Harst
- Faculty of Law, Economics and Governance, Center for Global Challenges, Utrecht University, Utrecht, The Netherlands
| | | | - Arie Franx
- Obstetrics and Gynaecology, Erasmus MC, Zeist, The Netherlands
| | - Gbenga Ayodele Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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Seward N, Murdoch J, Hanlon C, Araya R, Gao W, Harding R, Lund C, Hinrichs-Krapels S, Mayston R, Kartha M, Prince M, Sandall J, Thornicroft G, Verhey R, Sevdalis N. Implementation science protocol for a participatory, theory-informed implementation research programme in the context of health system strengthening in sub-Saharan Africa (ASSET-ImplementER). BMJ Open 2021; 11:e048742. [PMID: 34244274 PMCID: PMC8268893 DOI: 10.1136/bmjopen-2021-048742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES ASSET (Health System Strengthening in sub-Saharan Africa) is a health system strengthening (HSS) programme involving eight work-packages (ie, a research study that addresses a specific need for HSS) that aims to develop solutions that support high-quality care. Here we present the protocol for the implementation science (IS) theme within ASSET (ASSET-ImplmentER) that aims to understand what HSS interventions work, for whom and how, and how IS methodologies can be adapted to improve the HSS interventions within resource-poor contexts. SETTINGS Publicly funded health facilities in rural and urban areas in in Ethiopia, South Africa, Sierra Leone, and Zimbabwe. PARTICIPANTS Research staff including principal investigators, coinvestigators, field staff, PhD students, and research assistants. INTERVENTIONS Work-packages use a mixed-methods effectiveness-effectiveness hybrid designs. At the end of the pre-implementation phase, a workshop is held whereby the IS theme, jointly with ASSET work-packages apply IS determinant frameworks to research findings to identify factors that influence the effectiveness of delivering evidence-informed care. Determinants are used to select a set of HSS interventions for further evaluation, where work-packages also theorise selective mechanisms.In the piloting and rolling implementation phase, work-packages pilot the HSS interventions. An iterative process then begins involving evaluation, reflection and adaptation. Throughout this phase, IS determinant frameworks are applied to monitor and identify barriers/enablers to implementation. Selective mechanisms of action are also investigated. Implementation outcomes are evaluated using qualitative and quantitative methods. The psychometric properties of outcome measures including acceptability, appropriateness and feasibility are also evaluated. In a final workshop, work-packages come together, to reflect and explore the utility of the selected IS methods and provide suggestions for future use.Structured templates are used to organise and analyse common and heterogeneous patterns across work-packages. Qualitative data are analysed using thematic analysis and quantitative data are analysed using means and proportions. CONCLUSIONS We use a novel combination of IS methods at a programmatic level to facilitate comparisons of determinants and mechanisms that influence the effectiveness of HSS interventions in achieving implementation outcomes across different contexts. The study also contributes conceptual development and clarification at the underdeveloped interface of IS, HSS and global health.The ASSET-ImplementER theme is considered minimal risk as we only interview researchers involved in the different work-packages. To this effect we have received approval from King's College London Ethics Committee for research that is considered minimal risk (Reference number: MRA-20/21-21772).
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
| | - Jamie Murdoch
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care and Policy, King's College London, London, UK
| | - Richard Harding
- Department of Palliative Care and Policy, King's College London, London, UK
| | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Saba Hinrichs-Krapels
- The Policy Institute, King's College London, London, UK
- King's Global Health Institute, King's College London, London, UK
| | - Rosie Mayston
- King's Global Health Institute, King's College London, London, UK
- Global Health and Social Medicine, King's College London, London, UK
| | | | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Jane Sandall
- Dept of Women and Children's Health, School of Life Course Sciences, FoLSM, King's College London, London, UK
| | - Graham Thornicroft
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
| | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nick Sevdalis
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
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Haque SS, Freeman MC. The Applications of Implementation Science in Water, Sanitation, and Hygiene (WASH) Research and Practice. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:65002. [PMID: 34132602 PMCID: PMC8207965 DOI: 10.1289/ehp7762] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Delivery of high quality, at-scale, and sustained services is a major challenge in the water, sanitation, and hygiene (WASH) sector, made more challenging by a dearth of evidence-based models for adaption across contexts in low- and middle-income countries. OBJECTIVE We aim to describe the value of implementation science (IS) for the WASH sector and provide recommendations for its application. METHODS We review concepts from the growing field of IS-defined as the "scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services"-and we translate their relevance to WASH research, learning, and delivery. DISCUSSION IS provides a suite of methods and theories to systematically develop, evaluate, and scale evidence-based interventions. Though IS thinking has been applied most notably in health services delivery in high-income countries, there have been applications in low-income settings in fields such as HIV/AIDS and nutrition. Expanding the application of IS to environmental health, specifically WASH interventions, would respond to the complexity of sustainable service delivery. WASH researchers may want to consider applying IS guidelines to their work, including adapting pragmatic research models, using established IS frameworks, and cocreating knowledge with local stakeholders. https://doi.org/10.1289/EHP7762.
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Affiliation(s)
- Sabrina S. Haque
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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