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Hendricks L, Uwimana-Nicol J, Young T. Decision makers perceptions and experiences of developing population-level interventions targeting risk factors for hypertension and diabetes in South Africa: a qualitative study. BMC Health Serv Res 2023; 23:146. [PMID: 36774509 PMCID: PMC9918811 DOI: 10.1186/s12913-023-09135-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND People in low- and middle-income countries are disproportionately affected by Noncommunicable diseases (NCDs). NCD's such as heart disease, cancer, chronic respiratory disease, and diabetes, are the leading cause of premature death worldwide and represent an emerging global health threat. The purpose of this qualitative study was to explore decision makers perceptions of developing population-level interventions (policies and programmes), targeting risk factors for hypertension and diabetes, in South Africa. METHODS Using purposive sampling we recruited fifteen participants, who were well informed about the policies, programs or supportive environment for prevention and management of diabetes and hypertension in South Africa. We conducted 12 individual interviews and 1 group interview (consisting of 3 participants). Data was analysed thematically in NVivo. The results were shared and discussed in two consultative stakeholder workshops, with participants, as part of a member validation process in qualitative research. All communication with participants was done virtually using MS Teams or ZOOM. RESULTS For development of population-level interventions, key enablers included, stakeholders' engagement and collaboration, contextualization of policies and programs, and evaluation and organic growth. Challenges for supportive policy and program formulation, and to enable supportive environments, included the lack of time and resources, lack of consultation with stakeholders, regulations and competing priorities, and ineffective monitoring and evaluation. The main drivers of population-level interventions for diabetes and hypertension were perceived as the current contextual realities, costs, organizational reasons, and communication between various stakeholders. CONCLUSION To address the risk factors for hypertension and diabetes in South Africa, policies and programs must account for the needs of the public and the historical and socio-economic climate. Feasibility and sustainability of programs can only be ensured when the resources are provided, and environments enabled to promote behavior change on a population-level. A holistic public health approach, which is contextually relevant, and evidence informed, is considered best practice in the formulation of population-level interventions.
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Affiliation(s)
- Lynn Hendricks
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Social Research Methodology Group, Faculty of Social Sciences, KU Leuven, Leuven, Belgium.
| | - Jeannine Uwimana-Nicol
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kicukiro- Kigali, Rwanda
| | - Taryn Young
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Implementation strategies for the patient safety reporting system using Consolidated Framework for Implementation Research: a retrospective mixed-method analysis. BMC Health Serv Res 2022; 22:409. [PMID: 35346182 PMCID: PMC8962011 DOI: 10.1186/s12913-022-07822-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background Healthcare-related adverse events occur because of complex healthcare systems. The patient safety reporting system is a core component of patient safety initiatives in hospitals. However, hospital management often encounters a cultural barrier with its implementation and struggles to overcome the same. Implementation science would be useful for analysing implementation strategies. This study determines the effects of the implemented strategy on an increase in the number of patient safety reports and the determinants of successful implementation, using the implementation framework. Methods Mixed method analysis was performed in Fujita Health University Hospital (FHUH), a large volume hospital in Japan. We identified strategies to implement the patient safety reporting system by scrutinising internal documents using the Consolidated Framework for Implementation Research (CFIR). The electronic reporting systems developed in 2004 in the FHUH and the number of reports were analysed using the staff data and hospital volumes. Results Reports (n = 110,058) issued between April 2004 and March 2020 were analysed. The number of reports increased from 2004 to 2008 and from 2013 to 2019, reaching 14,037 reports per year. Between 2009 and 2012, the FHUH experienced a stagnation period where the number of reports were not increasing. From the qualitative materials, we identified 74 strategies which contributed to the implementation of the patient safety reporting system. Among these, the domain of ‘intervention characteristics’ in the CFIR contained 12 strategies, ‘outer settings’ contained 20, ‘inner settings’ contained 21, ‘characteristics of individuals’ contained 8, and ‘process’ contained 13. There were two concentrated periods of the implemented strategies, the number was 17 in 2007 and 10 in 2016. These concentrated periods preceded a remarkable increase in the number of patient safety reports. Conclusions A safety culture had been fostered in FHUH in the study period. A relationship between number of strategies and development of a reporting culture was observed. The intensity of adequate strategies was needed for implementation of patient safety reporting system. Therefore, the implementation framework is useful for analysing patient safety initiatives for safety culture. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07822-9.
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Muhoza P, Saleem H, Faye A, Gaye I, Tine R, Diaw A, Gueye A, Kante AM, Ruff A, Marx MA. Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal. BMC Health Serv Res 2021; 21:594. [PMID: 34154578 PMCID: PMC8218491 DOI: 10.1186/s12913-021-06610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in driving decision-making in Senegal, it is imperative to understand the factors that determine their use. Methods Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data. Results Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data. Conclusions We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.
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Affiliation(s)
- Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Haneefa Saleem
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ibrahima Gaye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Roger Tine
- Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Abdoulaye Diaw
- Direction de la Planification, de la Recherche et des Statistiques/ Division du Système d'Information Sanitaire et Social, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Alioune Gueye
- Programme National de Lutte Contre le Paludisme, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Almamy Malick Kante
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Ruff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa A Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Policymaking through a knowledge lens: Using the embodied-enacted-inscribed knowledge framework to illuminate the transfer of knowledge in a mental health policy consultation process - A South African case study. PLoS One 2021; 16:e0244940. [PMID: 33439892 PMCID: PMC7806173 DOI: 10.1371/journal.pone.0244940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background Marrying principles of evidence-based policymaking, with its focus on what works, with principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs into policy decisions. Viewed through the lens of the embodied-enacted-inscribed knowledge framework, policy consultation is a site of knowledge enactment, where the embodied knowledge enacted by individuals engages with the inscribed knowledge contained in policy documents, creating new forms of embodied and inscribed knowledge that move beyond these spaces. Aim Using this knowledge framework, this study aimed to trace the movement of knowledge inputs through South Africa’s mental health policy consultation summit. Methods Breakaway group session transcripts from the national consultation summit were thematically analysed to identify the types of knowledge that participants explicitly drew on (experiential or evidence-based) during discussions and how these knowledge inputs were used, responded to, and captured. Findings Findings suggest that there was little explicit reference to either evidence-based or experiential knowledge in most of the talk. While slightly more evidence-based than experiential knowledge claims were made, this did not render these claims any more likely to be responded to or engaged with in group discussions, or to be inscribed in group recommendations. Discussion The importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces is discussed. Conclusion Attending to the specific ways in which knowledge is transformed and moved through a policy consultation process has the potential to enhance the value that consultation offers policymakers.
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Chidumwa G, Maposa I, Kowal P, Micklesfield LK, Ware LJ. Bivariate Joint Spatial Modeling to Identify Shared Risk Patterns of Hypertension and Diabetes in South Africa: Evidence from WHO SAGE South Africa Wave 2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E359. [PMID: 33466566 PMCID: PMC7796507 DOI: 10.3390/ijerph18010359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
Recent studies have suggested the common co-occurrence of hypertension and diabetes in South Africa. Given that hypertension and diabetes are known to share common socio-demographic, anthropometric and lifestyle risk factors, the aim of this study was to jointly model the shared and disease-specific geographical variation of hypertension and diabetes. The current analysis used the Study on Global Ageing and Adult Health (SAGE) South Africa Wave 2 (2014/15) data collected from 2761 participants. Of the 2761 adults (median age = 56 years), 641 (23.2%) had high blood pressure on measurement and 338 (12.3%) reported being diagnosed with diabetes. The shared component has distinct spatial patterns with higher values of odds in the eastern districts of Kwa-Zulu Natal and central Gauteng province. The shared component may represent unmeasured health behavior characteristics or the social determinants of health in our population. Our study further showed how a shared component (latent and unmeasured health behavior characteristics or the social determinants of health) is distributed across South Africa among the older adult population. Further research using similar shared joint models may focus on extending these models for multiple diseases with ecological factors and also incorporating sampling weights in the spatial analyses.
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Affiliation(s)
- Glory Chidumwa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg 2198, South Africa;
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg 2198, South Africa;
| | - Paul Kowal
- World Health Organization SAGE, CH-1211 Geneva, Switzerland;
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Lisa K. Micklesfield
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2198, South Africa; (L.K.M.); (L.J.W.)
| | - Lisa J. Ware
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2198, South Africa; (L.K.M.); (L.J.W.)
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg 2198, South Africa
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Strengthening health policy development and management systems in low- and middle- income countries: South Africa's approach. HEALTH POLICY OPEN 2020. [DOI: 10.1016/j.hpopen.2020.100010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa. Vaccines (Basel) 2020; 8:vaccines8040705. [PMID: 33255767 PMCID: PMC7712226 DOI: 10.3390/vaccines8040705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa.
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Partridge ACR, Mansilla C, Randhawa H, Lavis JN, El-Jardali F, Sewankambo NK. Lessons learned from descriptions and evaluations of knowledge translation platforms supporting evidence-informed policy-making in low- and middle-income countries: a systematic review. Health Res Policy Syst 2020; 18:127. [PMID: 33129335 PMCID: PMC7603785 DOI: 10.1186/s12961-020-00626-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) platforms are organisations, initiatives and networks that focus on supporting evidence-informed policy-making at least in part about the health-system arrangements that determine whether the right programmes, services and products get to those who need them. Many descriptions and evaluations of KT platforms in low- and middle-income countries have been produced but, to date, they have not been systematically reviewed. METHODS We identified potentially relevant studies through a search of five electronic databases and a variety of approaches to identify grey literature. We used four criteria to select eligible empirical studies. We extracted data about seven characteristics of included studies and about key findings. We used explicit criteria to assess study quality. In synthesising the findings, we gave greater attention to themes that emerged from multiple studies, higher-quality studies and different contexts. RESULTS Country was the most common jurisdictional focus of KT platforms, EVIPNet the most common name and high turnover among staff a common infrastructural feature. Evidence briefs and deliberative dialogues were the activities/outputs that were the most extensively studied and viewed as helpful, while rapid evidence services were the next most studied but only in a single jurisdiction. None of the summative evaluations used a pre-post design or a control group and, with the exception of the evaluations of the influence of briefs and dialogues on intentions to act, none of the evaluations achieved a high quality score. CONCLUSIONS A large and growing volume of research evidence suggests that KT platforms offer promise in supporting evidence-informed policy-making in low- and middle-income countries. KT platforms should consider as next steps expanding their current, relatively limited portfolio of activities and outputs, building bridges to complementary groups, and planning for evaluations that examine 'what works' for 'what types of issues' in 'what types of contexts'.
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Affiliation(s)
- Arun C R Partridge
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Cristián Mansilla
- McMaster Health Forum and Health Policy PhD Program, McMaster University, Hamilton, Canada
| | - Harkanwal Randhawa
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - John N Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center and Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Nelson K Sewankambo
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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Means AR, Kemp CG, Gwayi-Chore MC, Gimbel S, Soi C, Sherr K, Wagenaar BH, Wasserheit JN, Weiner BJ. Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implement Sci 2020; 15:17. [PMID: 32164692 PMCID: PMC7069199 DOI: 10.1186/s13012-020-0977-0] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/27/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low- and middle-income countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings. METHODS A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs. RESULTS Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a "Characteristics of Systems" domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs. CONCLUSIONS These additions provide global implementation science practitioners opportunities to account for systems-level determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments. TRIAL REGISTRATION PROSPERO, CRD42018095762.
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Affiliation(s)
| | | | | | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Judith N Wasserheit
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
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Peixoto MVDS, Chaves SCL. Analysis of the national hearing health care policy implementation in a Brazilian State. Codas 2019; 31:e20180092. [PMID: 31271577 DOI: 10.1590/2317-1782/20182018092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The present study aimed to analyze the degree of implementation of the national health care policy at the state level. METHODS This qualitative evaluation study was carried out in two stages. Firstly, the policy was modelled by means of document analysis and the application of the Delphi technique for consensus among experts. In the second stage, a qualitative, exploratory evaluative research was conducted, designed as a single case study in a Brazilian state through semi-structured interviews with health managers. RESULTS The experts reached a consensus for a logical model and an evaluation matrix of the policy implementation. The results at the state level evinced an incipient degree of implementation, as the level of government characteristics achieved 45% of the maximum score; management, 41%; and system organization, 33%. CONCLUSION The degree of implementation in the state evaluated was classified as incipient. Barriers were identified in the management and organization levels of the system, as well as in the political context.
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Lizarondo L, Lockwood C, McArthur A. Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action. Worldviews Evid Based Nurs 2019; 16:131-141. [PMID: 30977592 DOI: 10.1111/wvn.12355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Culture- and context-specific issues in African countries such as those related to language, resources, technology, infrastructure and access to available research may confound evidence implementation efforts. Understanding the factors that support or inhibit the implementation of strategies aimed at improving care and health outcomes specific to their context is important. AIMS The aim of this study was to determine barriers and facilitators to evidence implementation in African healthcare settings, based on implementation projects undertaken as part of the Joanna Briggs Institute (JBI) Clinical Fellowship program. METHODS Reports of implementation projects conducted in Africa were obtained from the JBI database and printed monographs associated with the fellowship program. A purpose-built data extraction form was used to collect data from individual reports. Data were analysed using content analysis. RESULTS Eleven published and nine unpublished implementation reports were reviewed. The most frequently reported barriers to evidence implementation operate at the health organization or health practitioner level. Health organization-level barriers relate to human resources, material resources and policy issues. Health practitioner-level barriers relate to practitioners' knowledge and skills around evidence-based practice, and attitudes to change. Barriers at the government and consumer levels were uncommon. Only a few facilitators were identified and were related to health practitioners' attitudes or support from the organization's management. LINKING EVIDENCE TO ACTION The study identified a core set of barriers and facilitators in African healthcare settings, which are common to other low- and middle-income countries. These can be used to develop a method by which implementation programs can systematically undertake barrier or facilitator analysis. Future research should aim to develop a process by which these barriers and facilitators can be prioritised so that a structured decision support procedure can be established.
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Affiliation(s)
- Lucylynn Lizarondo
- Implementation Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- Implementation Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Alexa McArthur
- Transfer Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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Young T, Shearer JC, Naude C, Kredo T, Wiysonge CS, Garner P. Researcher and policymaker dialogue: the Policy BUDDIES Project in Western Cape Province, South Africa. BMJ Glob Health 2018; 3:e001130. [PMID: 30613428 PMCID: PMC6304097 DOI: 10.1136/bmjgh-2018-001130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/28/2018] [Accepted: 11/17/2018] [Indexed: 11/16/2022] Open
Abstract
Dialogue and exchange between researchers and policy personnel may increase the use of research evidence in policy. We piloted and evaluated a programme of formalised dialogue between researchers and provincial health policymakers in South Africa, called the buddying programme. An external evaluation examined implementation and short-term impact, drawing on documents, in-depth interviews with policymakers, a researcher buddies focus group and our own reflection on what we learnt. We set up buddying with seven policymakers and five researchers on six policy questions. Researchers knew little about policymaking or needs of policymakers. Policymakers respected the contact with researchers, respected researchers’ objectivity and appreciated the formalised approach. Having policymaker champions facilitated the dialogue. Scenarios for policy questions and use were different. One topic was at problem identification stage (contraceptives and HIV risk), four at policy formulation stage (healthy lifestyles, chronic illness medication adherence, integrated care of chronic illness and maternal transmission of HIV to infants) and one at implementation stage (task shifting). Research evidence were used to identify or solve a policy problem (two scenarios), to legitimise a predetermined policy position (three scenarios) or the evidence indirectly influenced the policy (one scenario). The formalised dialogue required in this structured buddying programme took time and commitment from both sides. The programme illustrated the importance of researchers listening, and policymakers understanding what research can offer. Both parties recognised that the structured buddying made the dialogue happen. Often the evidence was helpful in supporting provincial policy decisions that were in the roll-out phase from the national government.
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Affiliation(s)
- Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jessica C Shearer
- Health Systems Innovation and Delivery, PATH, Seattle, Washington, USA
| | - Celeste Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Wu S, Legido-Quigley H, Spencer J, Coker RJ, Khan MS. Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes? Health Res Policy Syst 2018; 16:16. [PMID: 29471840 PMCID: PMC5824449 DOI: 10.1186/s12961-018-0292-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. METHODS Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. RESULTS Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. CONCLUSIONS Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Julia Spencer
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Richard James Coker
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mishal Sameer Khan
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Hsiao C, Fry D, Ward CL, Ganz G, Casey T, Zheng X, Fang X. Violence against children in South Africa: the cost of inaction to society and the economy. BMJ Glob Health 2018. [PMID: 29515918 PMCID: PMC5838395 DOI: 10.1136/bmjgh-2017-000573] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite the extent and magnitude of violence against children in South Africa, political and financial investments to prevent violence against children remain low. A recent costing study investigating the social burden and economic impact of violence against children in South Africa found notable reductions to mental and physical health outcomes in the population if children were prevented from experiencing violence, neglect and witnessing family violence. The results showed, among others, that drug abuse in the entire population could be reduced by up to 14% if sexual violence against children could be prevented, self-harm could be reduced by 23% in the population if children did not experience physical violence, anxiety could be reduced by 10% if children were not emotionally abused, alcohol abuse could be reduced by 14% in women if they did not experience neglect as children, and lastly, interpersonal violence in the population could be reduced by 16% if children did not witness family violence. The study further estimated that the cost of inaction in 2015 amounted to nearly 5% of the country’s gross domestic product. These findings show that preventing children from experiencing and witnessing violence can help to strengthen the health of a nation by ensuring children reach their full potential and drive the country’s economy and growth. The paper further discusses ways in which preventing and ending violence against children may be prioritised in South Africa through, for instance, intersectoral collaboration and improving routine monitoring data, such as through the sustainable development goals.
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Affiliation(s)
- Celia Hsiao
- Save the Children South Africa, Pretoria, South Africa.,Faculty of Health Sciences, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Fry
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa.,Safety and Violence Initiative, University of Cape Town, Cape Town, South Africa
| | - Gary Ganz
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Tabitha Casey
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Xiaodong Zheng
- College of Economics and Management, China Agricultural University, Beijing, China
| | - Xiangming Fang
- College of Economics and Management, China Agricultural University, Beijing, China.,School of Public Health, Georgia State University, Atlanta, Georgia
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15
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Tambo E, Madjou G, Khayeka-Wandabwa C, Tekwu EN, Olalubi OA, Midzi N, Bengyella L, Adedeji AA, Ngogang JY. Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa? F1000Res 2016; 5:853. [PMID: 27508058 PMCID: PMC4955019 DOI: 10.12688/f1000research.8662.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/20/2022] Open
Abstract
Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA) health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems. As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs.
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Affiliation(s)
- Ernest Tambo
- Department of Biochemistry and Pharmaceutical Sciences, Universite des Montagnes, Bangangté, Cameroon; Africa Disease Intelligence and Surveillance, Communication and Response (Africa DISCoR) Foundation, Yaoundé, Cameroon
| | - Ghislaine Madjou
- Africa Disease Intelligence and Surveillance, Communication and Response (Africa DISCoR) Foundation, Yaoundé, Cameroon
| | | | - Emmanuel N Tekwu
- Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Science, University of Ghana, Greater Accra Region, Ghana
| | - Oluwasogo A Olalubi
- Department of Public Health, Kwara State University (KWASU), Malete, Kwara State, Nigeria
| | - Nicolas Midzi
- National Institute of Health Research, Harare, Zimbabwe
| | - Louis Bengyella
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences (UHAS), Ho, Volta Region, Ghana
| | - Ahmed A Adedeji
- Department of Pharmacology and Therapeutics, Kampala International University, Kansaga, Kampala, Uganda
| | - Jeanne Y Ngogang
- Service de Biochimie, Centre Hospitalier Universitaire (CHU), Yaoundé, Cameroon
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16
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Langlois EV, Becerril Montekio V, Young T, Song K, Alcalde-Rabanal J, Tran N. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Res Policy Syst 2016; 14:20. [PMID: 26983405 PMCID: PMC4794922 DOI: 10.1186/s12961-016-0089-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. METHODS The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a 'buddying' process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. RESULTS In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. CONCLUSIONS The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.
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Affiliation(s)
- Etienne V. Langlois
- />Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - Victor Becerril Montekio
- />Center for Health Systems Research, National Institute of Public Health - Instituto Nacional de Salud Pública, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán Cerrada Los Pinos y Caminera C.P., 62100 Cuernavaca, Morelos Mexico
| | - Taryn Young
- />Centre for Evidence-based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
- />Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Kayla Song
- />Health Systems Performance Research Network, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6 Canada
| | - Jacqueline Alcalde-Rabanal
- />Center for Health Systems Research, National Institute of Public Health - Instituto Nacional de Salud Pública, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán Cerrada Los Pinos y Caminera C.P., 62100 Cuernavaca, Morelos Mexico
| | - Nhan Tran
- />Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
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