scholarly journals Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rawlance Ndejjo ◽  
Rhoda K. Wanyenze ◽  
Fred Nuwaha ◽  
Hilde Bastiaens ◽  
Geofrey Musinguzi
Keyword(s):  
Cardiovascular Disease ◽  
Low Income ◽  
Implementation Research ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Prevention Programme ◽  
Intervention Implementation ◽  
Design Quality ◽  
Middle Income

Abstract Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.

Development of a blended learning approach to delivering HIV assisted contact tracing in Malawi: applied theory and formative research (Preprint)

2021 ◽  
Author(s):  
Nora Ellen Rosenberg ◽  
Tapiwa A Tembo ◽  
Katherine R Simon ◽  
Katie Mollan ◽  
Sarah E Rutstein ◽  
...  
Keyword(s):  
Low Income ◽  
Cognitive Theory ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
World Health ◽  
Contact Tracing ◽  
Hiv Positive ◽  
Applied Theory ◽  
Implementation Package

UNSTRUCTURED Despite progress towards the UNAIDS “95-95-95” targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive indexes to recruit their contacts (sexual partners and children) for HIV testing, efficiently identify HIV-positive persons in need of treatment. ACT is recommended in the World Health Organization’s 2016 guidance, and although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. To bridge the gap between research and practice and support scale-up in Malawi, a set of implementation strategies (“implementation package”) was developed using frameworks and theories. First, the Consolidated Framework for Implementation Research (CFIR) guided qualitative research to identify key barriers and facilitators to intervention delivery. Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as key barriers; ongoing individual training and group problem-solving were identified as facilitators. Next, the theory of expertise, social cognitive theory and principles of continuous quality improvement informed the development of the implementation package to address these barriers and facilitators. Finally, human-centered design principles guided the translation of the implementation package from in-person to digital delivery. This trajectory highlights the key roles behavioral theories, implementation frameworks, and technology can play in bringing an evidence-based intervention, such as ACT, to scale in a low-income setting like Malawi.

scholarly journals How is implementation research applied to advance health in low-income and middle-income countries?

2019 ◽  
Vol 4 (2) ◽  
pp. e001257 ◽  
Author(s):  
Olakunle Alonge ◽  
Daniela Cristina Rodriguez ◽  
Neal Brandes ◽  
Elvin Geng ◽  
Ludovic Reveiz ◽  
...  
Keyword(s):  
Low Income ◽  
Implementation Research ◽  
Large Scale ◽  
Scale Up ◽  
Middle Income ◽  
Policy Makers ◽  
Is Implementation ◽  
Middle Income Countries ◽  
Ir Studies ◽  
Learning And Change

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.

scholarly journals Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019827 ◽  
Author(s):  
Niall Winters ◽  
Laurenz Langer ◽  
Anne Geniets
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Education And Training ◽  
Evidence Base ◽  
Mobile Technologies ◽  
Middle Income ◽  
And Training ◽  
Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

scholarly journals How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries

2017 ◽  
Vol 33 (2) ◽  
pp. 192-203 ◽  
Author(s):  
J Borghi ◽  
J Lohmann ◽  
E Dale ◽  
F Meheus ◽  
J Goudge ◽  
...  
Keyword(s):  
Health Worker ◽  
Low Income ◽  
Health Workers ◽  
Poor Quality ◽  
Validity And Reliability ◽  
High Quality Research ◽  
Quality Health Care ◽  
Middle Income ◽  
Health Worker Motivation ◽  
Worker Motivation

Abstract A health system’s ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s. This paper aims to promote high quality research that will generate policy relevant and useful evidence.

scholarly journals Accelerating access and scale-up of optimized antiretroviral therapy in low-income and middle-income countries: results of a coordinated end-to-end approach

AIDS ◽  
2021 ◽  
Vol 35 (Supplement 2) ◽  
pp. S165-S171
Author(s):  
Emily Lark Harris ◽  
Katherine Blumer ◽  
Carmen Perez Casas ◽  
Danielle Ferris ◽  
Carolyn Amole ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
Scale Up ◽  
Middle Income ◽  
Middle Income Countries ◽  
End To End

scholarly journals Implementation Research Training Framework 2.0: Making the whole greater than the parts

2021 ◽  
Author(s):  
Keyword(s):  
Implementation Research ◽  
Research Training ◽  
Scale Up ◽  
Health Impact ◽  
Routine Practice ◽  
Tropical Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Training ◽  
New Framework

Clinical innovations alone do not generate public health impact. Implementation research (IR) is a powerful tool for identifying the bottlenecks impeding scale up efforts and helping to turn scientifically tested solutions into routine practice. To enhance the ability of investigators in low- and middle-income countries (LMICs) to design, conduct and interpret IR, several actors, such as the Special Programme for Research and Training in Tropical Diseases (TDR), have sought to strengthen researchers' capacity to design and undertake IR. This report outlines the development of a new framework for IR training in LMICs to inspire thinking and discussion on how training approaches can best serve learners' needs.

scholarly journals The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study

The Lancet ◽  
2017 ◽  
Vol 390 (10113) ◽  
pp. 2643-2654 ◽  
Author(s):  
Scott A Lear ◽  
Weihong Hu ◽  
Sumathy Rangarajan ◽  
Danijela Gasevic ◽  
Darryl Leong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income

Global psychiatry

2017 ◽  
pp. 674-680
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Workers ◽  
Global Mental Health ◽  
Scale Up ◽  
Mental Health Workers ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Psychiatric Illnesses ◽  
Aids Pandemic

‘Global psychiatry’ discusses the global mental health movement. Across the globe, and especially in low- and middle-income settings, there is a high prevalence of untreated psychiatric illness. In lower resourced settings there is often the need to address the added influence of poverty. The chapter discusses the question of how to scale up services and models, including using lay mental health workers and also integration of mental health care into primary health care settings to better meet the needs of those suffering from psychiatric illnesses across the globe. Four areas are discussed in more detail—the HIV/AIDS pandemic, perinatal mental illness, child and adolescent mental health, and humanitarian emergencies.

scholarly journals How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. e002094 ◽  
Author(s):  
Chris Smith ◽  
Michelle Helena van Velthoven ◽  
Nguyen Duc Truong ◽  
Nguyen Hai Nam ◽  
Vũ Phan Anh ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Health Workers ◽  
Internet Access ◽  
Sources Of Information ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

BackgroundWe systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.MethodsWe searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.ResultsOf 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.DiscussionStudies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.PROSPERO registration numberCRD42018091088.

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