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Shelley D, Cleland CM, Nguyen T, Van Devanter N, Siman N, Van M H, Nguyen NT. Effectiveness of a multicomponent strategy for implementing guidelines for treating tobacco use in Vietnam Commune Health Centers. Nicotine Tob Res 2021; 24:196-203. [PMID: 34543422 DOI: 10.1093/ntr/ntab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). METHODS We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n=26) in Vietnam. Arm 1 included training and a tool kit (e.g., reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As+R). Provider surveys were conducted at baseline, six- and 12-months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. RESULTS Adoption of the 4As increased significantly across both study arms (all p<.001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. CONCLUSION The study demonstrated the effectiveness of a multicomponent and multilevel strategy (i.e., provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. IMPLICATIONS Improving implementation of evidence-based tobacco dependence treatment (TDT) guidelines is a necessary step towards reducing the growing burden of non-communicable disease (NCDs) and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam, and offers a potentially scalable model for meeting FCTC Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a community health worker for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.
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Affiliation(s)
- D Shelley
- New York University School of Global Public Health, New York, NY
| | - C M Cleland
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
| | - N Van Devanter
- Rory Myers College of Nursing, New York University, New York, NY
| | - N Siman
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - Hoang Van M
- Minh Hoang Van, MD, Hanoi University of Public Health, Duc Thang Ward, North Tu Liem district, Hanoi, Vietnam
| | - N T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
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Quynh Mai V, Van Minh H, Truong Nam N, Thao Anh H, Minh Van N, Thi Trang N, Shelley D. Cost Analysis of Community-Based Smoking Cessation Services in Vietnam: A Cluster-Randomized Trial. Health Serv Insights 2021; 14:11786329211030932. [PMID: 34393491 PMCID: PMC8358574 DOI: 10.1177/11786329211030932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
The study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention' activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.
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Affiliation(s)
- Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Hoang Van Minh
- Hanoi University of Public Health, Hanoi, Vietnam.,National Institute of Health Sciences, Bach Mai Hospital (NIHS), Hanoi, Vietnam
| | | | | | | | | | - Donna Shelley
- New York University School of Global Public Health, New York, NY, USA
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3
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Sivaram S, Perkins S, He M, Ginsburg E, Dominguez G, Vedham V, Katz F, Parascandola M, Bogler O, Gopal S. Building Capacity for Global Cancer Research: Existing Opportunities and Future Directions. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:5-24. [PMID: 34273100 PMCID: PMC8285681 DOI: 10.1007/s13187-021-02043-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 05/21/2023]
Abstract
Cancer incidence and mortality are increasing in low- and middle-income countries (LMICs), where more than 75% of global cancer burden will occur by the year 2040. The primary drivers of cancer morbidity and mortality in LMICs are environmental and behavioral risk factors, inadequate prevention and early detection services, presence of comorbidities, and poor access to treatment and palliation. These same drivers also contribute to marked cancer health disparities in high-income countries. Studying cancer in LMICs provides opportunities to better understand and address these drivers to benefit populations worldwide, and reflecting this, global oncology as an academic discipline has grown substantially in recent years. However, sustaining this growth requires a uniquely trained workforce with the skills to pursue relevant, rigorous, and equitable global oncology research. Despite this need, dedicated global cancer research training programs remain somewhat nascent and uncoordinated. In this paper, we discuss efforts to address these gaps in global cancer research training at the US National Institutes of Health.
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Affiliation(s)
- Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Susan Perkins
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Min He
- Office of Cancer Centers, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Erika Ginsburg
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Geraldina Dominguez
- Office of HIV/AIDS Malignancy, National Cancer Institute, National Institutes of Health, 31 Center Dr, Room 3A33, Bethesda, MD 20892‑2440 USA
| | - Vidya Vedham
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Flora Katz
- Fogarty International Center, National Institutes of Health, 31 Center Drive, Building 31, Bethesda, MD 20892-2220 USA
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20892-9760 USA
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4
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Huang WC, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Freeman B, Jan S, Negin J, Marks GB, Fox GJ. Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam. BMC Public Health 2021; 21:845. [PMID: 33933063 PMCID: PMC8088640 DOI: 10.1186/s12889-021-10880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam. Methods We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit. Results Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national/provincial hospitals (30.3%) than those visiting district hospitals (11.3%, p < 0.001) and commune health centres (11.1%, p = 0.004). Conclusions Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10880-z.
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Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam. .,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. .,Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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5
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Lawrence K, Rodriguez DV, Feldthouse DM, Shelley D, Yu JL, Belli HM, Gonzalez J, Tasneem S, Fontaine J, Groom LL, Luu S, Wu Y, McTigue KM, Rockette-Wagner B, Mann DM. Effectiveness of an Integrated Engagement Support System to Facilitate Patient Use of Digital Diabetes Prevention Programs: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26750. [PMID: 33560240 PMCID: PMC7902197 DOI: 10.2196/26750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 01/16/2023] Open
Abstract
Background Digital diabetes prevention programs (dDPPs) are effective behavior change tools to prevent disease progression in patients at risk for diabetes. At present, these programs are poorly integrated into existing health information technology infrastructure and clinical workflows, resulting in barriers to provider-level knowledge of, interaction with, and support of patients who use dDPPs. Tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient engagement and adherence to these programs and improved health outcomes. Objective This study aims to use a rigorous, user-centered design (UCD) methodology to develop a theory-driven system that supports patient engagement with dDPPs and their primary care providers with their care. Methods This study will be conducted in 3 phases. In phase 1, we will use systematic UCD, Agile software development, and qualitative research methods to identify key user (patients, providers, clinical staff, digital health technologists, and content experts) requirements, constraints, and prioritization of high-impact features to design, develop, and refine a viable intervention prototype for the engagement system. In phase 2, we will conduct a single-arm feasibility pilot of the engagement system among patients with prediabetes and their primary care providers. In phase 3, we will conduct a 2-arm randomized controlled trial using the engagement system. Primary outcomes will be weight, BMI, and A1c at 6 and 12 months. Secondary outcomes will be patient engagement (use and activity) in the dDPP. The mediator variables (self-efficacy, digital health literacy, and patient-provider relationship) will be measured. Results The project was initiated in 2018 and funded in September 2019. Enrollment and data collection for phase 1 began in September 2019 under an Institutional Review Board quality improvement waiver granted in July 2019. As of December 2020, 27 patients have been enrolled and first results are expected to be submitted for publication in early 2021. The study received Institutional Review Board approval for phases 2 and 3 in December 2020, and phase 2 enrollment is expected to begin in early 2021. Conclusions Our findings will provide guidance for the design and development of technology to integrate dDPP platforms into existing clinical workflows. This will facilitate patient engagement in digital behavior change interventions and provider engagement in patients’ use of dDPPs. Integrated clinical tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient adherence to these programs and improved health outcomes by addressing barriers faced by both patients and providers. Further evaluation with pilot testing and a clinical trial will assess the effectiveness and implementation of these tools. Trial Registration ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500 International Registered Report Identifier (IRRID) DERR1-10.2196/26750
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Affiliation(s)
- Katharine Lawrence
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Danissa V Rodriguez
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Dawn M Feldthouse
- Clinical Systems & Clinical Transformation, Medical Center Information Technology Clinical Informatics Department, NYU Langone Health, New York, NY, United States
| | - Donna Shelley
- Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Jonathan L Yu
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Hayley M Belli
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Javier Gonzalez
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Sumaiya Tasneem
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Jerlisa Fontaine
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Lisa L Groom
- NYU Rory Meyers College of Nursing, New York, NY, United States
| | - Son Luu
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Yinxiang Wu
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Kathleen M McTigue
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bonny Rockette-Wagner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Devin M Mann
- Healthcare Innovation Bridging Research, Informatics, and Design Lab, Department of Population Health, NYU Langone Health, New York, NY, United States
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VanDevanter N, Vu M, Nguyen A, Nguyen T, Van Minh H, Nguyen NT, Shelley DR. A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers. Implement Sci 2020; 15:73. [PMID: 32907603 PMCID: PMC7488010 DOI: 10.1186/s13012-020-01035-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. Methods We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. Results Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. Conclusion Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users. Trial registration NCT02564653, registered September 2015
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Affiliation(s)
- Nancy VanDevanter
- Rory Myers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ann Nguyen
- Department of Population Health, NYU Langone Health, 180 Madison Ave., 17th floor, New York, NY, 10016, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Hoang Van Minh
- Hanoi University of Public Health, No 1A Duc Thang Street, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Nam Truong Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Donna R Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10012, USA.
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Jiang N, Siman N, Cleland CM, Van Devanter N, Nguyen T, Nguyen N, Shelley D. Effectiveness of Village Health Worker-Delivered Smoking Cessation Counseling in Vietnam. Nicotine Tob Res 2019; 21:1524-1530. [PMID: 30335180 PMCID: PMC6941703 DOI: 10.1093/ntr/nty216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. METHODS We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). RESULTS At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p < .001). In multivariate analyses, smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR] = 2.96, 95% confidence interval [CI] = 1.78% to 4.92%). Compared to cigarette-only smokers, water pipe-only smokers (AOR = 0.4, 95% CI = 0.26% to 0.62%) and dual users (AOR = 0.62, 95% CI = 0.45% to 0.86%) were less likely to achieve abstinence; however, the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. CONCLUSION A team approach in TDT programs that offer a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in low middle-income countries (LMICs). TDT programs may need to adapt interventions to improve outcomes for water pipe users. IMPLICATIONS The study fills literature gaps on effective models for TDT in LMICs. The addition of VHW-led cessation counseling, available through a referral from primary care providers in CHCs in Vietnam, to health care provider's brief cessation advice, increased 6-month biochemically validated abstinence rates compared to provider advice alone. The study also demonstrated the potential effectiveness of VHW counseling on reducing water pipe use. For LMICs, TDT programs in primary care settings with a referral system to VHW-led cessation counseling might be a promising and potentially scalable model for increasing access to evidence-based treatment.
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Affiliation(s)
- Nan Jiang
- Department of Population Health, New York University, New York, NY
| | - Nina Siman
- Department of Population Health, New York University, New York, NY
| | | | | | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Donna Shelley
- Department of Population Health, New York University, New York, NY
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Long H, Ma Z, Hanh TTD, Minh HV, Rawal LB, Urmi DS, Jafar TH, Tang S, Abdullah AS. Engaging village health workers in non-communicable disease (NCD) prevention and control in Vietnam: A qualitative study. Glob Public Health 2019; 15:611-625. [PMID: 31630629 DOI: 10.1080/17441692.2019.1678660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The burden of non-communicable diseases (NCDs) continues to grow in Vietnam, and reducing the burden of NCDs is a national priority. This study explored perspective of community health workers (CHWs), known as Village Health Workers (VHWs) in Vietnam, and public health leaders towards potential of expanding VHWs' role to deliver NCDs prevention and control services, and determined barriers and facilitators. We conducted focus group discussions (FGDs) with VHWs (n = 24) and in-depth interviews (IDIs) with public health administrators (n = 13). The findings show that VHWs in Vietnam deliver multiple public health services, including several NCDs related services. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Facilitators include government commitment to NCDs prevention and control, priority on capacity building, professional recognition and provision of incentives with availability of appropriate resources. While additional quantitative studies are needed to supplement the current qualitative findings, the current results inform the policy and intervention development in engaging VHWs in the delivery of community-based NCDs prevention and control initiatives in Vietnam.
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Affiliation(s)
- Hongfei Long
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Guangxi, People's Republic of China
| | | | | | - Lal B Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney Campus, Australia
| | - Dilshat S Urmi
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Tazeen H Jafar
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Nguyen N, Nguyen T, Truong V, Dang K, Siman N, Shelley D. Impact of a tobacco cessation intervention on adherence to tobacco use treatment guidelines among village health workers in Vietnam. Glob Health Promot 2019; 27:24-33. [PMID: 31319786 DOI: 10.1177/1757975919854032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers' and village health workers' adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers' adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers' adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.
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Affiliation(s)
- Nam Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Trang Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Van Truong
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Kim Dang
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Nina Siman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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10
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Alonge O, Rodriguez DC, Brandes N, Geng E, Reveiz L, Peters DH. How is implementation research applied to advance health in low-income and middle-income countries? BMJ Glob Health 2019; 4:e001257. [PMID: 30997169 PMCID: PMC6441291 DOI: 10.1136/bmjgh-2018-001257] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/30/2022] Open
Abstract
This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.
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Affiliation(s)
- Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniela Cristina Rodriguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neal Brandes
- Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, USA
| | - Elvin Geng
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ludovic Reveiz
- Knowledge Management, Bioethics, and Research Department, Pan American Health Organization, Washington, District of Columbia, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Long H, Huang W, Zheng P, Li J, Tao S, Tang S, Abdullah AS. Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006⁻2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112378. [PMID: 30373205 PMCID: PMC6266440 DOI: 10.3390/ijerph15112378] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.
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Affiliation(s)
- Hongfei Long
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Wenting Huang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Social Norms and Self-Efficacy to Quit Waterpipe Use: Findings from a Tobacco Study among Male Smokers in Rural Viet Nam. J Smok Cessat 2018. [DOI: 10.1017/jsc.2017.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction: Waterpipe use is a significant health concern in low- and middle-income countries like Viet Nam, yet there is a lack of research on factors that may influence use and self-efficacy to quit among adults.Aims: This study examined the relationship between social norms related to waterpipe use and self-efficacy to quit among male waterpipe smokers in Viet Nam.Methods: A cross-sectional survey was conducted with 214 adult male waterpipe smokers enrolled in a large cluster–randomised controlled trial conducted in a rural province in Viet Nam. Associations between social norms related to waterpipe smoking and the participants’ confidence to quit waterpipes were assessed using hierarchical regression models to account for differences among study sites and other covariates.Results: Self-efficacy to quit smoking was positively associated with immediate family members’ not minding participants smoking and with extended family's encouragement to quit smoking.Conclusions: The findings suggest the need for a more comprehensive understanding of the functions and characteristics of the social context of waterpipe smoking, including the social networks of waterpipe smokers, to inform effective cessation interventions for waterpipe smokers.
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Cole CB, Pacca J, Mehl A, Tomasulo A, van der Veken L, Viola A, Ridde V. Toward communities as systems: a sequential mixed methods study to understand factors enabling implementation of a skilled birth attendance intervention in Nampula Province, Mozambique. Reprod Health 2018; 15:132. [PMID: 30075791 PMCID: PMC6091088 DOI: 10.1186/s12978-018-0574-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skilled birth attendance, institutional deliveries, and provision of quality, respectful care are key practices to improve maternal and neonatal health outcomes. In Mozambique, the government has prioritized improved service delivery and demand for these practices, alongside "humanization of the birth process." An intervention implemented in Nampula province beginning in 2009 saw marked improvement in institutional delivery rates. This study uses a sequential explanatory mixed methods case study design to explore the contextual factors that may have contributed to the observed increase in institutional deliveries. METHODS A descriptive time series analysis was conducted using clinic register data from 2009 to 2014 to assess institutional delivery coverage rates in two primary health care facilities, in two districts of Nampula province. Site selection was based on facilities exhibiting an initial increase in institutional deliveries from 2009 to 2011, similarity of health system attributes, and accessibility for study participation. Using a modified Delphi technique, two expert panels-each composed of ten stakeholders familiar with maternal health implementation at facility, district, provincial, and national levels-were convened to formulate the "story" of the implementation and to identify contextual factors to use in developing semi-structured interview guides. Thirty-four key informant interviews with facility MCH nurses, facility managers, traditional birth attendants, community leaders, and beneficiaries were then conducted and analyzed using the Consolidated Framework for Implementation Research through inductive and deductive coding. RESULTS The two sites' skilled birth attendance coverage of estimated live births reached 80 and 100%, respectively. Eight contextual and human factors were found as dominant themes. Though both sites achieved increases, implementation context differed significantly with compelling examples of both respectful and disrespectful care. In one site, facility and community actors worked together as complementary systems to sustain improved care and institutional deliveries. In the other, community actors sustained implementation and institutional deliveries largely in absence of health system counterparts. CONCLUSION Findings support global health recommendations for combined health system and community interventions for improved MNH outcomes including delivery of respectful care, and further suggest the capacity of communities to act as systems both in partnership to and independent of the formal health system.
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Affiliation(s)
- Claire B. Cole
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Julio Pacca
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Alicia Mehl
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Anna Tomasulo
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA 02472 USA
| | - Luc van der Veken
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Adalgisa Viola
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
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Means AR, Ajjampur SSR, Bailey R, Galactionova K, Gwayi-Chore MC, Halliday K, Ibikounle M, Juvekar S, Kalua K, Kang G, Lele P, Luty AJF, Pullan R, Sarkar R, Schär F, Tediosi F, Weiner BJ, Yard E, Walson J. Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol. PLoS Negl Trop Dis 2018; 12:e0005988. [PMID: 29346376 PMCID: PMC5773078 DOI: 10.1371/journal.pntd.0005988] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022] Open
Abstract
Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | | | - Robin Bailey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katya Galactionova
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Katherine Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Moudachirou Ibikounle
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Département de Zoologie, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Pallavi Lele
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Fabian Schär
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, United States
| | - Elodie Yard
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, United States
- Division of Life Sciences, Natural History Museum, London, United Kingdom
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Nguyen N, Nguyen T, Chapman J, Nguyen L, Kumar P, VanDevanter N, Shelley D. Tobacco cessation in Vietnam: Exploring the role of village health workers. Glob Public Health 2017; 13:1265-1275. [PMID: 28776481 DOI: 10.1080/17441692.2017.1360376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre's smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.
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Affiliation(s)
- Nam Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Trang Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Jessica Chapman
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Linh Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Pritika Kumar
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Nancy VanDevanter
- c New York University Rory Meyers College of Nursing , New York , NY , USA
| | - Donna Shelley
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
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Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research. J Acquir Immune Defic Syndr 2017; 72 Suppl 2:S108-16. [PMID: 27355497 PMCID: PMC5113237 DOI: 10.1097/qai.0000000000001055] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Despite large investments to prevent mother-to-child-transmission (PMTCT), pediatric HIV elimination goals are not on track in many countries. The Systems Analysis and Improvement Approach (SAIA) study was a cluster randomized trial to test whether a package of systems engineering tools could strengthen PMTCT programs. We sought to (1) define core and adaptable components of the SAIA intervention, and (2) explain the heterogeneity in SAIA's success between facilities. Methods: The Consolidated Framework for Implementation Research (CFIR) guided all data collection efforts. CFIR constructs were assessed in focus group discussions and interviews with study and facility staff in 6 health facilities (1 high-performing and 1 low-performing site per country, identified by study staff) in December 2014 at the end of the intervention period. SAIA staff identified the intervention's core and adaptable components at an end-of-study meeting in August 2015. Two independent analysts used CFIR constructs to code transcripts before reaching consensus. Results: Flow mapping and continuous quality improvement were the core to the SAIA in all settings, whereas the PMTCT cascade analysis tool was the core in high HIV prevalence settings. Five CFIR constructs distinguished strongly between high and low performers: 2 in inner setting (networks and communication, available resources) and 3 in process (external change agents, executing, reflecting and evaluating). Discussion: The CFIR is a valuable tool to categorize elements of an intervention as core versus adaptable, and to understand heterogeneity in study implementation. Future intervention studies should apply evidence-based implementation science frameworks, like the CFIR, to provide salient data to expand implementation to other settings.
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Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system. Implement Sci 2017; 12:27. [PMID: 28241770 PMCID: PMC5330005 DOI: 10.1186/s13012-017-0558-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC. Methods We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study. Results The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting). Conclusions In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC. Trial registration NCT02564653. Registered September 2015
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Shelley D, Kumar P, Lee L, Nguyen L, Nguyen TT, VanDevanter N, Cleland CM, Nguyen NT. Health care providers' adherence to tobacco treatment for waterpipe, cigarette and dual users in Vietnam. Addict Behav 2017; 64:49-53. [PMID: 27543834 DOI: 10.1016/j.addbeh.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Almost half of adult men in Vietnam are current cigarette smokers. Recent surveys also suggest a high prevalence of water pipe use, particularly in rural areas. Yet services to treat tobacco dependence are not readily available. The purpose of this study was to characterize current tobacco use treatment patterns among Vietnamese health care providers and factors influencing adherence to recommended guidelines for tobacco use screening and cessation interventions for water pipe, cigarette and dual users. METHODS We conducted cross sectional surveys of 929 male current tobacco users immediately after they completed a primary care visit at one of 18 community health centers. RESULTS Thirty-four percent of smokers used cigarettes only, 24% water pipe only, and 42% were dual users. Overall 12% of patients reported that a provider asked them if they used tobacco products during the visit. Providers were significantly more likely to screen cigarette smokers compared with water pipe or dual users (16%, 9% and 11% respectively). Similarly, 9% of current cigarette smokers received advice to quit compared to 6% of water pipe and 5% of dual users. No patients reported that their health care provider offered them assistance to quit (e.g., self-help materials, referral). CONCLUSION Despite ratifying the Framework Convention on Tobacco Control, Vietnam has not made progress in implementing policies and systems to ensure smokers are receiving evidence-based treatment. High rates of water pipe and dual use indicate a need for health care provider training and policy changes to facilitate treatment for both cigarette and water pipe use.
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Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev 2009; 2009:CD001096. [PMID: 19588323 PMCID: PMC4171964 DOI: 10.1002/14651858.cd001096.pub2] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering 'computer reminders'. OBJECTIVES To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. SEARCH STRATEGY We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. SELECTION CRITERIA Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. MAIN RESULTS Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). AUTHORS' CONCLUSIONS Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.
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Affiliation(s)
- Kaveh G Shojania
- Director, University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Room D474, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5
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