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Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings.

Bergström A, Skeen S, Duc DM, Blandon EZ, Estabrooks C, Gustavsson P, Hoa DT, Källestål C, Målqvist M, Nga NT, Persson LÅ, Pervin J, Peterson S, Rahman A, Selling K, Squires JE, Tomlinson M, Waiswa P, Wallin L - Implement Sci (2015)

Bottom Line: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs.A supportive context is considered a key element for successful implementation of evidence-based practices (EBP).Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs.

View Article: PubMed Central - PubMed

Affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. anna.bergstrom@kbh.uu.se.

ABSTRACT

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.

Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.

Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.

Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

No MeSH data available.


Summary of the COACH tool development
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Fig1: Summary of the COACH tool development

Mentions: The COACH tool development has gone through six different phases resulting in five different versions of the COACH tool (see Fig. 1). Findings from one phase fed into the development of the next version of the tool including deletion of items, revisions of items and development of new items. Our approach was guided by the Standards for Educational and Psychological Testing [32] considered best practice in the field of psychometrics. Study sites were involved at similar stages of the project: Bangladesh (phases II, V, VI); Vietnam (phases II, V, VI); Uganda (phases II, V, VI); South Africa (phases IV, V, VI); and Nicaragua (phases II, V, VI).Fig. 1


Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings.

Bergström A, Skeen S, Duc DM, Blandon EZ, Estabrooks C, Gustavsson P, Hoa DT, Källestål C, Målqvist M, Nga NT, Persson LÅ, Pervin J, Peterson S, Rahman A, Selling K, Squires JE, Tomlinson M, Waiswa P, Wallin L - Implement Sci (2015)

Summary of the COACH tool development
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4537553&req=5

Fig1: Summary of the COACH tool development
Mentions: The COACH tool development has gone through six different phases resulting in five different versions of the COACH tool (see Fig. 1). Findings from one phase fed into the development of the next version of the tool including deletion of items, revisions of items and development of new items. Our approach was guided by the Standards for Educational and Psychological Testing [32] considered best practice in the field of psychometrics. Study sites were involved at similar stages of the project: Bangladesh (phases II, V, VI); Vietnam (phases II, V, VI); Uganda (phases II, V, VI); South Africa (phases IV, V, VI); and Nicaragua (phases II, V, VI).Fig. 1

Bottom Line: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs.A supportive context is considered a key element for successful implementation of evidence-based practices (EBP).Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs.

View Article: PubMed Central - PubMed

Affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. anna.bergstrom@kbh.uu.se.

ABSTRACT

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.

Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.

Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.

Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

No MeSH data available.