A protocol for evaluating a multi-level implementation theory to scale up obstetric triage in referral hospitals in Ghana

2020 ◽  
Author(s):  
Caitlin Rain Williams ◽  
Stephanie Bogdewic ◽  
Medge Owen ◽  
Emmanuel K. Srofe ◽  
Rohit Ramaswamy
Keyword(s):  
Mixed Methods ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Interactive Systems ◽  
Interactive Systems Framework ◽  
Implementation Theory ◽  
Care Plans ◽  
Implementation Approach ◽  
Multi Level

Abstract Background: Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. Methods: An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions.A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability.Discussion: The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the “know-do” gap.

scholarly journals A protocol for evaluating a multi-level implementation theory to scale up obstetric triage in referral hospitals in Ghana

2020 ◽  
Author(s):  
Caitlin Rain Williams ◽  
Stephanie Bogdewic ◽  
Medge Owen ◽  
Emmanuel K. Srofe ◽  
Rohit Ramaswamy
Keyword(s):  
Mixed Methods ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Interactive Systems ◽  
Interactive Systems Framework ◽  
Implementation Theory ◽  
Care Plans ◽  
Implementation Approach ◽  
Multi Level

Abstract Background Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. Methods An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions. A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability. Discussion The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the “know-do” gap.

scholarly journals Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

2021 ◽  
Vol 13 (13) ◽  
pp. 7216
Author(s):  
Paul H. Park ◽  
Cyprien Shyirambere ◽  
Fred Kateera ◽  
Neil Gupta ◽  
Christian Rusangwa ◽  
...  
Keyword(s):  
Capacity Building ◽  
Scale Up ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Cancer Center ◽  
Health Coverage ◽  
Cancer Centers ◽  
Implementation Approach ◽  
Single Cancer

Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

Ethnography and user-centered design to inform context-driven implementation

2021 ◽  
Author(s):  
Emily R Haines ◽  
M Alexis Kirk ◽  
Lauren Lux ◽  
Andrew B Smitherman ◽  
Byron J Powell ◽  
...  
Keyword(s):  
Contextual Information ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Patient Reported Outcome ◽  
Design Approach ◽  
User Centered Design ◽  
Patient Reported ◽  
Implementation Context ◽  
User Centered

Abstract Despite pervasive findings pointing to its inextricable role in intervention implementation, context remains poorly understood in implementation science. Existing approaches for describing context (e.g., surveys, interviews) may be narrow in scope or superficial in their elicitation of contextual data. Thus, in-depth and multilevel approaches are needed to meaningfully describe the contexts into which interventions will be implemented. Moreover, many studies assess context without subsequently using contextual information to enhance implementation. To be useful for improving implementation, though, methods are needed to apply contextual information during implementation. In the case example presented in this paper, we embedded an ethnographic assessment of context within a user-centered design approach to describe implementation context and apply that information to promote implementation. We developed a patient-reported outcome measure-based clinical intervention to assess and address the pervasive unmet needs of young adults with cancer: the Needs Assessment & Service Bridge (NA-SB). In this paper, we describe the user-centered design process that we used to anticipate context modifications needed to deliver NA-SB and implementation strategies needed to facilitate its implementation. Our ethnographic contextual inquiry yielded a rich understanding of local implementation context and contextual variation across potential scale-up contexts. Other methods from user-centered design (i.e., translation tables and a design team prototyping workshop) allowed us to translate that information into specifications for NA-SB delivery and a plan for implementation. Embedding ethnographic methods within a user-centered design approach can help us to tailor interventions and implementation strategies to their contexts of use to promote implementation.

scholarly journals A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Caitlin R. Williams ◽  
Stephanie Bogdewic ◽  
Medge D. Owen ◽  
Emmanuel K. Srofenyoh ◽  
Rohit Ramaswamy
Keyword(s):  
Scale Up ◽  
Implementation Theory ◽  
Referral Hospitals ◽  
Multi Level

scholarly journals Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Janet A. Deatrick ◽  
Anne E. Kazak ◽  
Rebecca E. Madden ◽  
Glynnis A. McDonnell ◽  
Katherine Okonak ◽  
...  
Keyword(s):  
Health Equity ◽  
Pediatric Cancer ◽  
Universal Screening ◽  
Implementation Strategies ◽  
Interactive Systems ◽  
Psychosocial Risk ◽  
Care Providers ◽  
Psychosocial Screening ◽  
Universal Family ◽  
Key Stakeholders

Abstract Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020

Shared leadership and team creativity: a team level mixed-methods study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lei Xie ◽  
Soo Jeoung Han ◽  
Michael Beyerlein ◽  
Jiacheng Lu ◽  
Lillian Vukin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Shared Leadership ◽  
Structural Equation ◽  
Research Question ◽  
Self Report ◽  
Equation Modeling ◽  
Team Creativity ◽  
Content Type ◽  
Video Recordings ◽  
Multi Level

Purpose This paper aims to conduct two studies to investigate shared leadership and team creativity (TC) in leaderless short-term project teams (STPTs). Design/methodology/approach To answer the research question, this paper used a multi-level mixed-methods design. This paper analyzed video recordings, transcripts of STPTs’ collaboration and self-report surveys from an international engineering competition. In Study 1, this paper attempted to connect relation-oriented shared leadership (ROSL) and task-oriented shared leadership (TOSL) with TC by coding video recordings. In Study 2, this paper further investigated the proposed positive relationship between shared leadership and TC by surveying a sample of 166 students in 51 teams. Findings In Study 1, this paper found that shared leadership covaries with TC following a similar behavioral pattern. In Study 2, multi-level structural equation modeling results suggested that both TOSL and ROSL are positively correlated with TC. Originality/value In this mixed-methods multi-level research, this paper found that when the team’s shared leadership increases, their TC activity becomes frequent. This paper confirmed the qualitative finding by quantitatively investigated the relationship between shared leadership and creativity at the team level.

scholarly journals ‘Oh, she is just a nurse’ Re-imagining the role of the nursing workforce in Uganda after a decade of ART scale-up (2004-2014)

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Mixed Methods ◽  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

scholarly journals Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044049
Author(s):  
Mitchell N Sarkies ◽  
Emilie Francis-Auton ◽  
Janet C Long ◽  
Andrew Partington ◽  
Chiara Pomare ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Quantitative Data ◽  
Care Delivery ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Implementation Strategies ◽  
Large System ◽  
Natural Experiments ◽  
System Transformation ◽  
Delivery Models

IntroductionValue-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.Methods and analysisThis exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.Ethics and disseminationEthical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.

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