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Loffreda G, Arakelyan S, Bou-Orm I, Holmer H, Allen LN, Witter S, Ager A, Diaconu K. Barriers and Opportunities for WHO "Best Buys" Non-communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review. Int J Health Policy Manag 2024; 13:7989. [PMID: 38618832 PMCID: PMC11016278 DOI: 10.34172/ijhpm.2023.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Improving the adoption and implementation of policies to curb non-communicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policy-makers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. METHODS We conducted a complex systematic review of articles discussing the adoption and implementation of World Health Organization's (WHO's) "best buys" NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. RESULTS Our CLD highlights a central feedback loop encompassing three vital variables: (1) the ability to define, (re)shape, and pass appropriate policy into law; (2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); and (3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. CONCLUSION To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.
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Affiliation(s)
- Giulia Loffreda
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Musselburgh, UK
| | - Ibrahim Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
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Moosan H, Thakor M, Sharma AK, Mohanty SS, Panigrahi A, Dhikav V, Yadav S, Huda RK, Parmar M, Singh P, John D. Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India. F1000Res 2024; 12:100. [PMID: 38434648 PMCID: PMC10904959 DOI: 10.12688/f1000research.128549.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.
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Affiliation(s)
- Hisham Moosan
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Mahendra Thakor
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Arun Kumar Sharma
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - S. S. Mohanty
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Ansuman Panigrahi
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Vikas Dhikav
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Suresh Yadav
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Ramesh Kumar Huda
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Mukesh Parmar
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Poonam Singh
- Department of Health Research, ICMR-National Institute for Implementation Research on Non-Communicable Diseases,, Jodhpur, Rajasthan, 342005, India
| | - Denny John
- Professor, Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, Karnataka, 560054, India
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Rawat A, Ameha A, Karlström J, Taddesse L, Negeri EL, Detjen A, Gandrup-Marino K, Mataruse N, Källander K, Tariku A. Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study. Int J Health Policy Manag 2023; 12:7385. [PMID: 38618793 PMCID: PMC10699823 DOI: 10.34172/ijhpm.2023.7385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children's Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). METHODS Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. RESULTS All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. CONCLUSION Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.
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Affiliation(s)
- Angeli Rawat
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Agazi Ameha
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Jonas Karlström
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- Global Programmes and Research, SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore
| | - Lisanu Taddesse
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | | | - Anne Detjen
- Child and Community Health Unit, Health Programme Group, UNICEF, New York City, NY, USA
| | | | | | - Karin Källander
- Digital Health and Health Information Systems Unit, Health Programme Group, UNICEF, New York City, NY, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abraham Tariku
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
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Young J, Ablona A, Klassen BJ, Higgins R, Kim J, Lavoie S, Knight R, Lachowsky NJ. Implementing community-based Dried Blood Spot (DBS) testing for HIV and hepatitis C: a qualitative analysis of key facilitators and ongoing challenges. BMC Public Health 2022; 22:1085. [PMID: 35642034 PMCID: PMC9158154 DOI: 10.1186/s12889-022-13525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2018, the Community-Based Research Centre (CBRC) invited gay, bisexual, trans, queer men and Two-Spirit and non-binary people (GBT2Q) at Pride Festivals across Canada to complete in-person Sex Now surveys and provide optional dried blood spot (DBS) samples screening for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). As there is a lack of research evaluating the implementation of DBS sampling for GBT2Q in community settings, we aimed to evaluate this intervention, identifying key facilitators and ongoing challenges to implementing community-based DBS screening for HIV/HCV among GBT2Q. Methods We conducted sixteen one-on-one interviews with individuals involved with the community-based DBS collection protocol, including research staff, site coordinators, and volunteer DBS collectors. Most individuals involved with DBS collection were “peers” (GBT2Q-identified). The Consolidated Framework for Implementation Research (CFIR) guided our data collection and analysis. Results Interviewees felt that DBS collection was a low-barrier, cost-effective, and simple way for peers to quickly screen a large number of Sex Now respondents. Interviewees also noted that the community and peer-based aspects of the research helped drive recruitment of Sex Now respondents. Most interviewees felt that the provision of results took too long, and that some Sex Now respondents would have preferred to receive their test results immediately (e.g., rapid or point-of-care testing). Conclusion Peer-based DBS sampling can be an effective and relatively simple way to screen GBT2Q at Pride Festivals for more than one sexually transmitted and blood borne infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13525-x.
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Affiliation(s)
- James Young
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Aidan Ablona
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Benjamin J Klassen
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Rob Higgins
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada.,School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - John Kim
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - Stephanie Lavoie
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - Rod Knight
- British Columbia Centre On Substance Use, Providence Health Care, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nathan J Lachowsky
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada. .,School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
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Mancuso A, Ahmed Malm S, Sharkey A, Shahabuddin ASM, Shroff ZC. Cross-cutting lessons from the Decision-Maker Led Implementation Research initiative. Health Res Policy Syst 2021; 19:83. [PMID: 34380519 PMCID: PMC8356374 DOI: 10.1186/s12961-021-00706-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Almost 20 million children under one year of age did not receive basic vaccines in 2019, and most of these children lived in low- and middle-income countries. Implementation research has been recognized as an emerging area that is critical to strengthen the implementation of interventions proven to be effective. As a component of strengthening implementation, WHO has called for greater embedding of research within decision-making processes. One strategy to facilitate the embedding of research is to engage decision-makers as Principal Investigators of the research. Since 2015, the Alliance for Health Policy and Systems Research within the WHO and the United Nations Children's Fund have supported decision-maker led research by partnering with Gavi, the Vaccine Alliance, in an initiative called "Decision-Maker Led Implementation Research". This synthesis paper describes the cross-cutting lessons from the initiative to further understand and develop future use of the decision-maker led strategy. METHODS This study used qualitative methods of data collection, including a document review and in-depth interviews with decision-makers and researchers engaged in the initiative. Document extraction and thematic content analysis were applied. The individual project was the unit of analysis and the results were summarized across projects. RESULTS Research teams from 11 of the 14 projects participated in this study, for an overall response rate of 78.6%. Most projects were carried out in countries in Africa and conducted at the sub-state or sub-district level. Seven enablers and five barriers to the process of conducting the studies or bringing about changes were identified. Key enablers were the relevance, acceptability, and integration of the research, while key barriers included unclear results, limited planning and support, and the limited role of a single study in informing changes to strengthen implementation. CONCLUSIONS Decision-maker led research is a promising strategy to facilitate the embedding of research into decision-making processes and contribute to greater use of research to strengthen implementation of proven-effective interventions, such as immunization. We identified several lessons for consideration in the future design and use of the decision-maker led strategy.
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Affiliation(s)
- Arielle Mancuso
- Alliance for Health Policy and Systems Research, WHO headquarters, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Shahira Ahmed Malm
- Nutrition Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - Alyssa Sharkey
- Implementation Research and Delivery Science Unit, Health Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - A S M Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, WHO headquarters, Avenue Appia 20, 1211, Geneva, Switzerland
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6
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Abstract
Ethn Dis. 2021;31(1):1-4
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Affiliation(s)
- George A. Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William T. Riley
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD, USA
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7
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Binagwaho A. We Need Compassionate Leadership Management Based on Evidence to Defeat COVID-19. Int J Health Policy Manag 2020; 9:413-414. [PMID: 32610733 PMCID: PMC7719216 DOI: 10.34172/ijhpm.2020.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
The current pandemic of coronavirus disease 2019 (COVID-19) has had unprecedented reach and shown the need for strong, compassionate and evidence-based decisions to effectively stop the spread of the disease and save lives. While aggressive in its response, Rwanda prioritized the lives of its people - a human right that some governments forget to focus on. The country took significant steps, before the first case and to limit the spread of the disease, rolled out a complete nationwide lockdown within one week of the first confirmed case, while also providing social support to vulnerable populations. This pandemic highlights the need for leaders to be educated on implementation science principles to be able to make evidence-based decisions through a multi-sectoral, integrated response, with consideration for contextual factors that affect implementation. This approach is critical in developing appropriate preparedness and response strategies and save lives during the current threat and those to come.
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Binagwaho A, Frisch MF, Udoh K, Drown L, Ntawukuriryayo JT, Nkurunziza D, Donahoe KB, Hirschhorn LR. Implementation Research: An Efficient and Effective Tool to Accelerate Universal Health Coverage. Int J Health Policy Manag 2020; 9:182-184. [PMID: 32563218 PMCID: PMC7306110 DOI: 10.15171/ijhpm.2019.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022] Open
Abstract
Success in the implementation of evidence-based interventions (EBIs) in different settings has had variable success. Implementation research offers the approach needed to understand the variability of health outcomes from implementation strategies in different settings and why interventions were successful in some countries and failed in others. When mastered and embedded into a policy and implementation framework, the application of implementation research by countries can provide policy-makers and implementers with the knowledge necessary to work towards universal health coverage (UHC) with the effectiveness, efficiency, sustainability, and fidelity needed to achieve sustainable positive health outcomes for all. To achieve this goal however, work is needed by the communities of research producers and consumers to create more clarity on implementation research methodologies and to build capacity to apply them as a critical tool for countries on their path to achieving UHC.
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Affiliation(s)
| | | | - Kelechi Udoh
- University of Global Health Equity, Kigali, Rwanda
| | - Laura Drown
- University of Global Health Equity, Kigali, Rwanda
| | | | | | | | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Shelley KD, Frumence G, Mpembeni R, Mwinnyaa G, Joachim J, Kisusi HK, Killewo J, Baqui AH, Peters DH, George AS. "Because Even the Person Living With HIV/AIDS Might Need to Make Babies" - Perspectives on the Drivers of Feasibility and Acceptability of an Integrated Community Health Worker Model in Iringa, Tanzania. Int J Health Policy Manag 2019; 8:538-549. [PMID: 31657176 PMCID: PMC6815988 DOI: 10.15171/ijhpm.2019.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 05/20/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model. Methods: To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n=67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings. Results: Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability. Conclusions: Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.
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Affiliation(s)
- Katharine D Shelley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Mwinnyaa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juliana Joachim
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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10
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Abstract
Health inequities are well-documented, but their economic dimensions have received less attention. In this report, we describe four economic dimensions of health inequities in the United States. First, we describe an economic conceptual framework that connects poverty and health inequities at both individual and population levels and conveys the concept of reverse causality, where poverty worsens health inequities and health inequities worsen poverty. This framework can help us understand the key elements of health inequity and its drivers. Second, we describe economic measurements used for quantifying the economic burden of health inequalities and summarize the empirical findings from studies. Third, we review the evidence on the return-on-investment of economic interventions that are aimed at reducing health inequities. Finally, we highlight the importance of cross disciplinary perspectives from economics and implementation research in effectively delivering interventions that can mitigate health inequities.
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Affiliation(s)
- Michael M Engelgau
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ping Zhang
- National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
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11
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Makasa EM. Universal Access to Surgical Care and Sustainable Development in Sub-Saharan Africa: A Case for Surgical Systems Research Comment on "Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa". Int J Health Policy Manag 2019; 8:58-60. [PMID: 30709105 PMCID: PMC6358643 DOI: 10.15171/ijhpm.2018.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/27/2018] [Indexed: 11/09/2022] Open
Abstract
National level experiences, lessons learnt from the Millennium Development Goal (MDG) era coupled with the academic evidence and proposals generated by the Lancet Commission on Global Surgery (LCoGS) together with the economic arguments and recommendations from the World Bank Group’s "Essential Surgery" Disease Control Priorities (DCP3) publication, provided the impetus for political commitments to improve surgical care capacity at the primary level of the healthcare system in low- and middle-income countries (LMICs) as part of their drive towards universal health coverage (UHC) in the form of World Health Organization (WHO) Resolution A68.15. This global commitment from governments must be followed up with development of a Global Action Plan and a global coordination mechanism supported by regional implementation frameworks on the part of the WHO in order for the organisation to better coordinate all stakeholders and sustain the technical support needed to develop and implement national surgical health policy in the form of National Surgical Obstetric and Anaesthesia Plans (NSOAPs). As expounded by Gajewski et al, data and research output on surgical care is essential to informing policy development and programme implementation. This area still remains a challenge in sub-Saharan Africa (SSA) but it is envisaged that countries will include this key component in their ongoing national surgical healthcare policy development and programme implementation. In the Zambian case study, research in the area of Global Surgery investment-the surgical workforce scale-up is used to demonstrate the important role of implementation research in the development and implementation of the Zambian NSOAP as well as the need for international collaborations to this end. Scale-up reviews informed by implementation research to evaluate progress on the commitments contained in Resolution A68.15 and Decision A70.22 are essential to sustain the momentum and to help maintain focus on the gaps in all countries. There are opportunities for non-state actors especially local sub-regional academic institutions, non-governmental organizations (NGOs) and private sector to play a key role in surgical healthcare policy development and implementation research. Collection of and better information management of standardised surgical care indicators is essential for such research, for bi-annual WHO progress reporting and for demonstration of impact to justify and encourage further investments in surgical care.
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Affiliation(s)
- Emmanuel M Makasa
- Republic of Zambia, Ministry of Foreign Affairs, Lusaka, Zambia.,School of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Semitala FC, Camlin CS, Wallenta J, Kampiire L, Katuramu R, Amanyire G, Namusobya J, Chang W, Kahn JG, Charlebois ED, Havlir DV, Kamya MR, Geng EH. Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry. J Int AIDS Soc 2018; 20. [PMID: 29206357 PMCID: PMC5810312 DOI: 10.1002/jia2.25033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/10/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction The Streamlined Antiretroviral Therapy Initiation Strategy (START‐ART) study found that a theory‐based intervention using opinion leaders to inform and coach health care providers about the risks of treatment delay, provision of point of care (POC) CD4 testing machines (PIMA) and reputational incentives, led to rapid rise in ART initiation. We used qualitative research methods to explore mechanisms of provider behaviour change. Methods We conducted in‐depth interviews (IDIs) with 24 health care providers and nine study staff to understand perceptions, attitudes and the context of changes in ART initiation practices. Analyses were informed by the Theoretical Domains Framework. Results Rapid dissemination of new practices was enabled in the environmental context of an existing relationship based on communication, implementation and accountability between Makerere University Joint AIDS Program (MJAP), a Ugandan University‐affiliated organization that provided technical oversight for HIV service delivery at the health facilities where the intervention was implemented, and a network of health facilities operated by the Uganda Ministry of Health. Coaching carried out by field coordinators from MJAP strengthened influence and informal accountability for carrying out the intervention. Frontline health workers held a pre‐existing strong sense of professional identity. They were proud of attainment of new knowledge and skills and gratified by providing what they perceived to be higher quality care. Peer counsellors, who were not explicitly targeted in the intervention design, effectively substituted some functions of health care providers; as role models for successful ART uptake, they played a crucial role in creating demand for rapid ART initiation through interactions with patients. Point of care (POC) CD4 testing enabled immediate action and relieved providers from frustrations of lost or delayed laboratory results, and led to higher patient satisfaction (due to reduced costs because of ability to initiate ART right away, requiring fewer return trips to clinic). Conclusions Qualitative data revealed that a multicomponent intervention to change provider behaviour succeeded in the context of strong institutional and individual relationships between a University‐affiliated organization, government facilities, and peer health workers (who acted as a crucial link between stakeholders) and the community. Fostering stable institutional relationships between institutional actors (non‐governmental organization (NGOs) and ministry‐operated facilities) as well as between facilities and the community (through peer health workers) can enhance uptake of innovations targeting the HIV cascade in similar clinical settings.
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Affiliation(s)
- Fred C Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Makerere University Joint AIDS Program (MJAP), Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Carol S Camlin
- Division of HIV, ID and Global Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeanna Wallenta
- Philip R. Lee Institute for Health Policy Studies, Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, CA, USA
| | | | | | - Gideon Amanyire
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Wei Chang
- Philip R. Lee Institute for Health Policy Studies, Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, CA, USA
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, CA, USA
| | - Edwin D Charlebois
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Diane V Havlir
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Makerere University Joint AIDS Program (MJAP), Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Elvin H Geng
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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Dean L, Page S, Hawkins K, Stothard R, Thomson R, Wanji S, Gyapong M, Anagbogu I, Molyneux D, Theobald S. Tailoring mass drug administration to context: implementation research is critical in achieving equitable progress in the control and elimination of helminth neglected tropical diseases in sub-Saharan Africa. Int Health 2017; 8:233-4. [PMID: 27481833 DOI: 10.1093/inthealth/ihw031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
The concept of a technological quick fix or 'magic-bullet' for control and elimination of Neglected Tropical Diseases (NTDs) is flawed. NTDs are embedded within complex biological and social systems that are shaped by ecological and political contexts. This commentary emphasises the need for implementation research to address implementation gaps in the control of NTDs. With a specific focus on sub-Saharan Africa and helminth diseases amenable to preventive chemotherapy through mass drug administration, we explore the important role of context, programme partnerships and community in achieving equitable and effective NTD control.
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Affiliation(s)
- Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA;
| | - Samantha Page
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA
| | | | - Russell Stothard
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA
| | - Rachael Thomson
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA
| | - Samuel Wanji
- Research Foundation in Tropical Diseases and Environment, University of Buea, P.O. Box 63, Buea, Cameroon
| | | | | | - David Molyneux
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA
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14
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Martinez C, Bacigalupe G, Cortada JM, Grandes G, Sanchez A, Pombo H, Bully P. The implementation of health promotion in primary and community care: a qualitative analysis of the 'Prescribe Vida Saludable' strategy. BMC Fam Pract 2017; 18:23. [PMID: 28212606 PMCID: PMC5316200 DOI: 10.1186/s12875-017-0584-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The impact of lifestyle on health is undeniable and effective healthy lifestyle promotion interventions do exist. However, this is not a fundamental part of routine primary care clinical practice. We describe factors that determine changes in performance of primary health care centers involved in piloting the health promotion innovation 'Prescribe Vida Saludable' (PVS) phase II. METHODS We engaged four primary health care centers of the Basque Healthcare Service in an action research project aimed at changing preventive health practices. Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable) is focused on designing, planning, implementing and evaluating innovative programs to promote multiple healthy habits, feasible to be performed in routine primary health care conditions. After 2 years of piloting, centers were categorized as having high, medium, or low implementation effectiveness. We completed qualitative inductive and deductive analysis of five focus groups with the staff of the centers. Themes generated through consensual grounded qualitative analysis were compared between centers to identify the dimensions that explain the variation in actual implementation of PVS, and retrospectively organized and assessed against the Consolidated Framework for Implementation Research (CFIR). RESULTS Of the 36 CFIR constructs, 11 were directly related to the level of implementation performance: intervention source, evidence strength and quality, adaptability, design quality and packaging, tension for change, learning climate, self-efficacy, planning, champions, executing, and reflecting and evaluating, with -organizational tracking added as a new sub-construct. Additionally, another seven constructs emerged in the participants' discourse but were not related to center performance: relative advantage, complexity, patients' needs and resources, external policy and incentives, structural characteristics, available resources, and formally appointed internal implementation leaders. Our findings indicate that the success of the implementation seems to be associated with the following components: the context, the implementation process, and the collaborative modelling. CONCLUSIONS Identifying barriers and enablers is useful for designing implementation strategies for health promotion in primary health care centers that are essential for innovation success. An implementation model is proposed to highlight the relationships between the CFIR constructs in the context of health promotion in primary care.
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Affiliation(s)
- Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Gonzalo Bacigalupe
- University of Massachusetts Boston, College of Education and Human Development, 100 Morrissey Bvld, Boston, MA, 02125, USA
| | - Josep M Cortada
- Deusto Primary Health Care Center. Bilbao-Basurto Integrated Care Organisation. Basque Healthcare Service - Osakidetza. BioCruces Health Research Institute, Luis Power 18, Bilbao, 48014, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain.
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
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Liddle HA. Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings. Fam Process 2016; 55:558-576. [PMID: 27565445 DOI: 10.1111/famp.12243] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings.
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Affiliation(s)
- Howard A Liddle
- Departments of Public Health Sciences and Psychology, Center for Treatment Research on Adolescent Drug Abuse, University of Miami Miller School of Medicine, Miami, FL.
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16
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Peprah E, Lopez-Class M, Shero S, John-Sowah J, Engelgau M. A Global Perspective on Using Implementation Research to Address Hypertension-Associated Target Organ Damage. Ethn Dis 2016; 26:395-8. [PMID: 27440980 DOI: 10.18865/ed.26.3.395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypertension, a major risk factor for cardiovascular disease, imposes a significant public health burden and challenge to address it worldwide. Scaling up delivery of proven, effective interventions for hypertension could significantly advance the goal of reducing the global burden. Although significant progress has been made in many countries, some lament that large-scale initiatives focused on reducing blood pressure in global populations have not effectively addressed this challenge. Late-stage implementation research plays a critical role in determining effective and sustainable scale-up of these initiatives. In this article, we briefly discuss some of the global initiatives that have been funded by the National Heart, Lung, and Blood Institute of the US National Institutes of Health. Intervention delivery strategies in low resource settings must have demonstrated effectiveness and consideration for the social, cultural and physical context (eg, access, affordability, and availability of medications) in which a program is being delivered in order to be sustainable nationally and globally. Hence, the use of implementation research is central to determining sustainable delivery of evidence-based and tailored interventions focused on hypertension control. The sustained control of hypertension in global populations holds tremendous potential for reducing morbidity, premature mortality, and the adverse economic impact of cardiovascular disease in all regions.
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Affiliation(s)
- Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Maria Lopez-Class
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Susan Shero
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Joylene John-Sowah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
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Rao KD, Nagulapalli S, Arora R, Madhavi M, Andersson E, Ingabire MG. An Implementation Research Approach to Evaluating Health Insurance Programs: Insights from India. Int J Health Policy Manag 2016; 5:295-9. [PMID: 27239878 DOI: 10.15171/ijhpm.2016.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 03/09/2016] [Indexed: 11/09/2022] Open
Abstract
One of the distinguishing features of implementation research is the importance given to involve implementers in all aspects of research, and as users of research. We report on a recent implementation research effort in India, in which researchers worked together with program implementers from one of the longest serving government funded insurance schemes in India, the Rajiv Aarogyasri Scheme (RAS) in the state of undivided Andhra Pradesh, that covers around 70 million people. This paper aims to both inform on the process of the collaborative research, as well as, how the nature of questions that emerged out of the collaborative exercise differed in scope from those typically asked of insurance program evaluations. Starting in 2012, and over the course of a year, staff from the Aarogyasri Health Care Trust (AHCT), and researchers held a series of meetings to identify research questions that could serve as a guide for an evaluation of the RAS. The research questions were derived from the application of a Logical Framework Approach ("log frame") to the RAS. The types of questions that emerged from this collaborative effort were compared with those seen in the published literature on evaluations of insurance programs in low- and middle-income countries (LMICs). In the published literature, 60% of the questions pertained to output/outcome of the program and the remaining 40%, relate to processes and inputs. In contrast, questions generated from the RAS participatory research process between implementers and researchers had a remarkably different distribution - 81% of questions looked at program input/processes, and 19% on outputs and outcomes. An implementation research approach can lead to a substantively different emphasis of research questions. While there are several challenges in collaborative research between implementers and researchers, an implementation research approach can lead to incorporating tacit knowledge of program implementers into the research process, research questions that are more relevant to the research needs of policy-makers, and greater knowledge translation of the research findings.
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Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Elin Andersson
- The Graduate Institute of International and Development Studies, Geneva, Switzerland
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Davis M, Balasubramanian BA, Waller E, Miller BF, Green LA, Cohen DJ. Integrating behavioral and physical health care in the real world: early lessons from advancing care together. J Am Board Fam Med 2013; 26:588-602. [PMID: 24004711 DOI: 10.3122/jabfm.2013.05.130028] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. METHODS To study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. RESULTS Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. CONCLUSION Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
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Knowles V, Kaljee L, Deveaux L, Lunn S, Rolle G, Stanton B. National Implementation of an Evidence-Based HIV Prevention and Reproductive Health Program for Bahamian Youth. Int Electron J Health Educ 2012; 15:173-190. [PMID: 25197265 PMCID: PMC4153366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A wide range of behavioral prevention interventions have been demonstrated through longitudinal, randomized controlled trials to reduce sexual risk behaviors. Many of these interventions have been made available at little cost for implementation on a public health scale. However, efforts to utilize such programs typically have been met with a range of problems to be addressed, leading to the recognition that new processes must be identified and integrated into the emerging field of implementation science. A randomized, controlled trial conducted among Bahamian grade six students attending fifteen elementary schools found the sexual risk-reduction intervention "Focus on Youth in the Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT)" to be effective through three years of follow-up. Based on these results, the Bahamian Ministry of Education decided to implement FOYC-CImPACT throughout all government grade six classes in The Bahamas. This manuscript describes the considerations, approaches, and actions taken regarding national implementation of this evidence-based intervention. The implementation process included active data-gathering, observation and feedback components to inform subsequent intervention phases. This manuscript reviewed the success and challenges to date within this framework and described changes made to enable next stages of the national implementation effort.
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Affiliation(s)
- Valerie Knowles
- the Office of HIV and AIDS Research, Ministry of Health, Nassau, the Bahamas
| | - Linda Kaljee
- the Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, US, 48201
| | - Lynette Deveaux
- the Office of HIV and AIDS Research, Ministry of Health, Nassau, the Bahamas
| | - Sonja Lunn
- the Office of HIV and AIDS Research, Ministry of Health, Nassau, the Bahamas
| | - Glenda Rolle
- the Health and Family Life Education, Ministry of Education, Nassau, the Bahamas
| | - Bonita Stanton
- the Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, US, 48201
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