scholarly journals Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Nyawira Mwangi ◽  
Covadonga Bascaran ◽  
Jacqueline Ramke ◽  
Mathew Kipturgo ◽  
Min Kim ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Process Evaluation ◽  
Peer Support ◽  
Scale Up ◽  
Individual Characteristics ◽  
Policy Framework ◽  
Relative Advantage ◽  
Outer Setting ◽  
Cluster Randomized ◽  
Inner Setting

Abstract Background There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR). Methods Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation. Results The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting). Conclusions The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up. Trial registration Pan African Clinical Trials Registry: PACTR201707002430195 registered 15 July 2017

scholarly journals Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Debra Morgan ◽  
Julie Kosteniuk ◽  
Megan E. O’Connell ◽  
Andrew Kirk ◽  
Norma J. Stewart ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Process Evaluation ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Small Scale ◽  
Team Members ◽  
Primary Health ◽  
Innovation Characteristics ◽  
Inner Setting

Abstract Background With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. Methods A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. Results Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. Conclusions The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.

scholarly journals Health care workers’ experiences with implementation of “screen and treat” for cervical cancer prevention in Malawi: A qualitative study

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Corrina Moucheraud ◽  
Paul Kawale ◽  
Savel Kafwafwa ◽  
Roshan Bastani ◽  
Risa M. Hoffman
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Health Workers ◽  
Structural Characteristics ◽  
Individual Characteristics ◽  
Relative Advantage ◽  
Implementation Climate ◽  
Effective Prevention ◽  
The Government ◽  
Inner Setting

Abstract Background Cervical cancer remains a major cause of mortality and morbidity in low- and middle-income countries, despite the availability of effective prevention approaches. “Screen and treat” (a single-visit strategy to identify and remove abnormal cervical cells) is the recommended secondary prevention approach in low-resource settings, but there has been relatively scarce robust implementation science evidence on barriers and facilitators to providing “screen and treat” from the provider perspective, or about thermocoagulation as a lesion removal technique. Methods Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted interviews with ten experienced “screen and treat” providers in Malawi. We asked questions based on the CFIR Guide, used the CFIR Guide codebook for a descriptive analysis in NVivo, and added recommended modifications for studies in low-income settings. Results Seven CFIR constructs were identified as positively influencing implementation, and six as negatively influencing implementation. The two strong positive influences were the relative advantage of thermocoagulation versus cryotherapy (Innovation Characteristics) and respondents’ knowledge and beliefs about providing “screen and treat” (Individual Characteristics). The two strong negative influences were the availability of ongoing refresher trainings to stay up-to-date on skills (Inner Setting, Implementation Climate) and insufficient resources (staffing, infrastructure, supplies) to provide “screen and treat” to all women who need it (Inner Setting, Readiness for Implementation). Weak positive factors included perceived scalability and access to knowledge/information, as well as compatibility, leadership engagement, and team characteristics, but these latter three were mixed in valence. Weak negative influences were structural characteristics and donor priorities; and mixed but weakly negative influences were relative priority and engaging clients. Cross-cutting themes included the importance of broad buy-in (including different cadres of health workers and leadership at the facility and in the government) and the opportunities and challenges of offering integrated care (screening plus other services). Conclusions Although “screen and treat” is viewed as effective and important, many implementation barriers remain. Our findings suggest that implementation strategies will need to be multi-level, include a diverse set of stakeholders, and explicitly address both screening and treatment.

scholarly journals Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046914
Author(s):  
Patrice Ngangue ◽  
Judith Belle Brown ◽  
Catherine Forgues ◽  
Mohamed Ali Ag Ahmed ◽  
Tu Ngoc Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Structural Characteristics ◽  
Interdisciplinary Teams ◽  
Relative Advantage ◽  
Multiple Chronic Conditions ◽  
Design Quality ◽  
Patient Centred Care ◽  
Data Coding ◽  
Inner Setting

ObjectiveA patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.DesignA descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.SettingThe study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.ParticipantsTen managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.ResultsMany key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.ConclusionThis study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.Trial registration numberNCT02789800.

Entrepreneurship, Innovation, and Economic Development: An Indian Experience

2020 ◽  
Vol 47 (3) ◽  
pp. 279-292
Author(s):  
M. Srikanth ◽  
G. Narendra Kumar ◽  
W. R. Reddy
Keyword(s):  
Economic Development ◽  
Private Sector ◽  
Scale Up ◽  
Policy Support ◽  
Policy Framework ◽  
Level Of Economic Development ◽  
The Government ◽  
Entrepreneurial Activities ◽  
Developed Nations ◽  
Innovative Culture

Entrepreneurship and innovation are considered as key drivers for economic development. In this study, we made an attempt to answer the question as to what should be the policy framework to encourage entrepreneurship and foster innovative culture in India to achieve the desired level of economic development. Entrepreneurship is built upon pillars such as institutional and policy support, availability of capital and entrepreneurial culture. In an emerging economy like India, the government should institutionalise innovation and entrepreneurship and promote commercialisation of brilliant ideas by emulating the startup ecosystems in the developed nations. Besides the government, large and well-established companies in private sector and research institutes should nurture startups by extending hand-holding support and generous funding. If India wishes to be a leader in innovation, it needs to scale up its gross expenditure on R&D, that is, on par with the advanced economies by engaging more researchers, especially in the private sector. Our article has important implications for policymakers and all key stakeholders, as it can help in identifying and implementing the appropriate measures to eliminate the obstacles that entrepreneurs face and channels to support innovative entrepreneurial activities in India.

scholarly journals “We understand our community”: implementation of the Healthy Eating Healthy Aging program among community-based organizations

2020 ◽  
Author(s):  
Judy Leong ◽  
Sou Hyun Jang ◽  
Sonia K Bishop ◽  
Emily V R Brown ◽  
Eun Jeong Lee ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Healthy Eating ◽  
Healthy Aging ◽  
Successful Implementation ◽  
Evidence Based ◽  
Semistructured Interview ◽  
Community Based ◽  
Community Based Organizations ◽  
Outer Setting ◽  
Inner Setting

Abstract Cardiovascular disease is the second leading cause of death in the USA among Asian Americans and Pacific Islanders (AAPIs) over the age of 65. Healthy Eating Healthy Aging (HEHA), an evidence-based heart health program, can provide culturally appropriate nutrition education to decrease the risk of cardiovascular disease. Community-based organizations (CBOs) are optimal settings to implement community-based programs. However, there is inadequate research on how evidence-based interventions like HEHA are implemented in CBOs. This study examined processes that facilitated the implementation of HEHA among CBOs serving older AAPIs. Twelve representatives from CBOs that implemented the HEHA program were recruited to participate in a semistructured interview. All the participants were CBO directors or senior managers. A semistructured interview guide was created and informed by the Consolidated Framework for Implementation Research (CFIR) to capture how HEHA played into the five domains of CFIR: (a) intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of the individuals, and (e) process. Data analysis captured themes under the CFIR domains. All five CFIR domains emerged from the interviews. Under intervention characteristics, three constructs emerged as facilitating the implementation of HEHA: (a) the participant’s beliefs around the quality of the HEHA program and its ability to promote healthy eating, (b) HEHA’s adaptability to different AAPI subgroups, and (c) perceptions of how successfully HEHA was bundled and assembled. Under outer setting, the participants described the community’s need for healthy eating programs and how the HEHA program meets that need. Four constructs emerged under inner setting: (a) the CBO’s structural characteristics and social standing in the community; (b) resources dedicated to the implementation and ongoing operations, including funding, training, education, physical space, and time; (c) the culture of the CBO; and (d) the participant’s commitment and involvement in marketing, promotion, and implementation of HEHA. Under characteristics of individuals, participants’ described their desire to learn the content of HEHA and deliver them successfully. Under process, participants described strategies to engage relevant individuals to facilitate HEHA implementation. The interviews with CBO representatives provided insights into CFIR domain constructs that facilitated the implementation of HEHA. CBOs are key settings for community health education. Understanding processes that lead to the successful implementation of evidence-based interventions among CBOs is critical for accelerating the dissemination and implementation of best practices.

scholarly journals Combining Effect and Process Evaluation on European Preschool Children’s Snacking Behavior in a Kindergarten-Based, Family-Involved Cluster Randomized Controlled Trial: The ToyBox Study

2020 ◽  
Vol 17 (19) ◽  
pp. 7312
Author(s):  
Marieke De Craemer ◽  
Vera Verbestel ◽  
Maïté Verloigne ◽  
Odysseas Androutsos ◽  
Luis Moreno ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Total Sample ◽  
Evaluation Score ◽  
Evaluation Scores ◽  
Total Process ◽  
Teachers And Parents ◽  
Cluster Randomized ◽  
Country Specific

This study aimed at (1) studying the effect of the standardized ToyBox intervention on European preschoolers’ snacking behavior, and (2) studying whether a higher process evaluation score from teachers and parents/caregivers was associated with a more positive result for preschoolers’ snack intake. A sample of 4970 preschoolers (51.4% boys, 4.74 ± 0.44 years) from six European countries provided information on snack intake with the use of a Food Frequency Questionnaire. To investigate the effect of the intervention, multilevel repeated measures analyses were executed for the total sample and the six country-specific samples. Furthermore, questionnaires to measure process evaluation were used to compute a total process evaluation score for teachers and parents/caregivers. No significant intervention effects on preschoolers’ snack intake were found (all p > 0.003). In general, no different effects of the intervention on snack intake were found according to kindergarten teachers’ and parents’/caregivers’ process evaluation scores. The lack of effects could be due to limited intervention duration and dose. To induce larger effects on preschoolers’ snack intake, a less standardized intervention which is more tailored to the local needs might be needed.

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