scholarly journals A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
World Health ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Public Health Systems ◽  
Factors Influencing

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

scholarly journals Qualitative Assessment of Factors Influencing Implementation Effectiveness and Sustainability of Strategies for Increasing Tobacco Use Treatment in Vietnam Health Centers

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
Health Centers ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Implementation Effectiveness ◽  
Public Health Systems

PURPOSE Effective strategies are needed to increase the implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries. Our cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in community health centers (CHCs) in Vietnam. In this paper, we present findings from a postimplementation qualitative assessment of factors that influence implementation effectiveness and program sustainability. METHODS We conducted semistructured qualitative interviews (N = 52) with 13 CHC medical directors (ie, physicians), 25 CHC health care providers, and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. RESULTS Facilitators of implementation effectiveness included training that increased confidence and skill, satisfaction with point-of-service tools, increasing patient demand for TDT, and, for the intervention arm, the value of a VHW referral system that reduced provider burden. The primary challenge to sustainability is the competing priorities driven by the Vietnam Ministry of Health, which may result in fewer resources for TDT compared with other health programs. However, providers and VHWs described several options for adapting the implementation strategies to address challenges and increase the engagement of local government committees and other sectors to sustain gains. CONCLUSION Our findings offer insight into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, these results illustrate the dynamic interplay between barriers to and facilitators of sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems, like that of Vietnam. 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, as well as planning for adaptations and subsequent resource allocations, to meet Article 14 goals.

scholarly journals Factors influencing implementation of evidence-based interventions in public health systems - a model

2019 ◽  
Vol 27 (3) ◽  
pp. 198-203 ◽  
Author(s):  
Joanne Vincenten ◽  
J. Morag MacKay ◽  
Peter Schröder-Bäck ◽  
Tamara Schloemer ◽  
Helmut Brand
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Evidence Based ◽  
Public Health Systems ◽  
Factors Influencing

scholarly journals Giants On Clay Feet – COVID-19, infection control, and public health laboratory networks in England, the US, and (West-)Germany (1945-2020)

2020 ◽  
Author(s):  
Claas Kirchhelle
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Local Level ◽  
West Germany ◽  
Robert Koch Institute ◽  
Political Autonomy ◽  
Public Health Systems ◽  
The Us ◽  
Control And Prevention ◽  
Anglo American

COVID-19 has exposed significant differences in public health systems’ ability to mount effective test and trace responses. This article analyses the historical and structural reasons behind the relative success of Germany and the problems experienced in Britain and the US during the first wave of the pandemic. It also asks why recent international surveys overestimated Anglo-American preparedness. The article argues that the answer lies in the different evolution of public health systems as well as varying public health capacities at the local level. In Germany, post-1994 reforms of the decentralised public health system managed to overcome decades of political neglect and underinvestment and strengthen federal integration without compromising public health capacity at the state and communal level. This joint strengthening of the centre and hinterland allowed the Robert Koch Institute to function as an effective coordinating hub for locally tailored COVID-19 responses. By contrast, the decades after 1970 saw world-renowned Anglo-American public health systems face increasing challenges posed by funding cuts, privatisation, overambitious reforms, and increasing loss of political autonomy. Both the US Centers for Disease Control and Prevention and Public Health England retained significant prestige, which resulted in an overestimation of capacity by international reviews. However, once centres in Atlanta and Colindale had been overwhelmed, there was little local and state public health capacity to fall back on.

scholarly journals Early Warnings: The Lessons of COVID-19 for Public Health Climate Preparedness

2020 ◽  
Vol 50 (3) ◽  
pp. 264-270 ◽  
Author(s):  
Mary C. Sheehan ◽  
Mary A. Fox
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Economic Cost ◽  
World Health ◽  
Public Health Systems ◽  
Pandemic Response ◽  
Organization Policy ◽  
Health Organization ◽  
Health Systems Governance ◽  
Early Warnings

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

Conceptualizing Dissemination Research and Activity: The Case of the Canadian Heart Health Initiative

2003 ◽  
Vol 30 (3) ◽  
pp. 267-282 ◽  
Author(s):  
Susan J. Elliott ◽  
Jennifer O'Loughlin ◽  
Kerry Robinson ◽  
John Eyles ◽  
Roy Cameron ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Evidence Based ◽  
Heart Health ◽  
Public Health Systems ◽  
Health Initiative ◽  
Premature Deaths ◽  
Key Concepts ◽  
Primary Focus ◽  
The Relationship

Cardiovascular diseases are now the world's leading cause of death. To reduce high rates of such preventable premature deaths, evidence-based approaches to heart health promotion must be disseminated across public health systems. To succeed, we must build capacity to disseminate strategies that are practical and effective. However, we know little about such dissemination, and we lack both conceptual frameworks to guide our thinking and appropriate scientific methodologies. This article presents conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems. This work is based on the Canadian Heart Health Dissemination Project, a research program examining a national heart health dissemination initiative. The primary focus is the development of a systematic protocol for measuring levels of capacity and dissemination, and determining successful conditions for, and barriers to, capacity and dissemination, as well as the nature of the relationship between these key concepts.

scholarly journals Civic programmatic participation in public health: the case of Argentina

2019 ◽  
Vol 35 (suppl 2) ◽  
Author(s):  
Tulia G. Falleti ◽  
Santiago L. Cunial
Keyword(s):  
Public Health ◽  
World Health Organization ◽  
Health Systems ◽  
Social Dynamics ◽  
National Level ◽  
World Health ◽  
Public Health Systems ◽  
The Social ◽  
The World ◽  
Health Organization

Abstract: Since the Alma Ata World Health Organization Conference in 1978, countries around the world have adopted institutions that promote the participation of citizens in their public health systems. The main objectives of this article are two-fold. First, we describe the origins and implementation of a national-level civic participatory program that was in place in Argentina in the mid-2000s: the Local Participatory Projects (Proyectos Locales Participativos). Second, we analyze the 201 local participatory projects that were carried out in Argentina between 2007 and 2008. We study health and environmental problems that prompt people’s participation in the program and the social dynamics through which such participation is executed.

Maternal health services in China’s western rural areas: uptake and correlates

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Chengfang Liu ◽  
Linxiu Zhang ◽  
Yaojiang Shi ◽  
Huan ZHOU ◽  
Alexis Medina ◽  
...  
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Services ◽  
Health Systems ◽  
Uptake Rate ◽  
Rural Areas ◽  
Design Methodology ◽  
Maternal Health Services ◽  
Western China ◽  
Public Health Systems

Purpose Many public health systems have struggled with the dual questions of (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it. The objective of this study is to assess the uptake rate of a new set of maternal health services in poor rural areas of China. Design/methodology/approach The analysis is based on the survey responses of women’s representatives and village cadres from almost 1000 villages in June 2012 as part of a wide-scale public health survey in Sichuan, Gansu and Yunnan provinces in the western part of China. Findings We find that the uptake rate of maternal health services (including in-hospital delivery, antenatal care visits and post-partum care visits) in poor rural areas of western China are far below average in China, and that the rates vary across provinces and ethnic groups. Our analyses demonstrate that distance, income, ethnicity and availability appear to be systematically correlated with low uptake rates of all maternal health services. Demand-side factors seem to be by far the most important sources of the differences between subpopulations. We also find that there is potential for creating a Conditional Cash Transfer program to improve the usage of maternal health services. Originality/value We believe that our results will contribute positively to the exploration of answers to the dual questions that many public health systems have struggled with (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it.

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