FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings

Cragg, Liza; Williams, Siân; Chavannes, Niels H.

doi:10.1038/npjpcrm.2016.35

Cited by 35 publications

(30 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This prospective implementation study was conducted between 2016 and 2018 within the FRESH AIR research project 56 . Reporting of this study was guided by the Standards for Reporting Implementation Studies (Supplementary Methods) 57 .…”

Section: Methodsmentioning

confidence: 99%

Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study

Brakema

Gemert

Williams³

et al. 2020

npj Prim. Care Respir. Med.

Self Cite

View full text Add to dashboard Cite

Most patients with chronic respiratory disease live in low-resource settings, where evidence is scarcest. In Kyrgyzstan and Vietnam, we studied the implementation of a Ugandan programme empowering communities to take action against biomass and tobacco smoke. Together with local stakeholders, we co-created a train-the-trainer implementation design and integrated the programme into existing local health infrastructures. Feasibility and acceptability, evaluated by the modified Conceptual Framework for Implementation Fidelity, were high: we reached ~15,000 Kyrgyz and ~10,000 Vietnamese citizens within budget (~€11,000/country). The right engaged stakeholders, high compatibility with local contexts and flexibility facilitated programme success. Scores on lung health awareness questionnaires increased significantly to an excellent level among all target groups. Behaviour change was moderately successful in Vietnam and highly successful in Kyrgyzstan. We conclude that contextualising the awareness programme to diverse low-resource settings can be feasible, acceptable and effective, and increase its sustainability. This paper provides guidance to translate lung health interventions to new contexts globally.

show abstract

Section: Methodsmentioning

confidence: 99%

Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study

Brakema

Gemert

Williams³

et al. 2020

npj Prim. Care Respir. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

“…This study was conducted as part of the FRESH AIR programme 23 in two rural provinces in Kyrgyzstan. Kyrgyzstan is a 200,000 square km mountainous country situated in Central Asia.…”

Section: Introductionmentioning

confidence: 99%

Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan: overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study

Østergaard

Kjærgaard

Kristensen

et al. 2018

npj Prim Care Resp Med

View full text Add to dashboard Cite

Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.

show abstract

“…This systematic review and meta-synthesis is part of the Horizon2020 FRESH AIR project (Free Respiratory Evaluation and Smoke-exposure reduction by primary Health cAre Integrated gRoups), addressing the implementation of prevention, diagnosis, and treatment of CRD in low-resource settings (trial registration number: NTR5759) [ 38 ]. This review is registered at PROSPERO (CRD42018088687) and follows Cochrane methodology [ 39 , 40 ] and the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting standards [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis

et al. 2020

View full text Add to dashboard Cite

The vast majority of patients with chronic respiratory disease live in low- and middle-income countries (LMICs). Paradoxically, relevant interventions often fail to be effective particularly in these settings, as LMICs lack solid evidence on how to implement interventions successfully. Therefore, we aimed to identify factors critical to the implementation of lung health interventions in LMICs, and weight their level of evidence.This systematic review followed Cochrane methodology and PRISMA reporting standards. We searched eight databases without date- or language restrictions in July 2019, and included all relevant original, peer-reviewed articles. Two researchers independently selected articles, critically appraised them (using CASP/MetaQAT), extracted data, coded factors (following CFIR), and assigned levels of confidence in the factors (via GRADE-CERQual). We meta-synthesised levels of evidence of the factors based on their frequency and the assigned level of confidence. (PROSPERO:CRD42018088687)We included 37 articles out of 9111 screened. Studies were performed across the globe in a broad range of settings. Factors identified with a high level of evidence were 1) Understanding needs of local users, 2) ensuring Compatibility of interventions with local contexts (cultures, infrastructures), 3) identifying influential stakeholders and applying Engagement strategies, 4) ensuring adequate Access to knowledge and information, and 5) addressing Resource Availability. All implementation factors and their level of evidence were synthesised in an implementation tool.To conclude, this study identified implementation factors for lung health interventions in LMICs, weighted their level of evidence, and integrated the results into an implementation tool for practice. Policymakers, non-governmental organisations, practitioners, and researchers may use this FRESH AIR Implementation tool to develop evidence-based implementation strategies for related interventions. This could increase interventions’ implementation success, thereby optimising the use of already-scarce resources and improving health outcomes.

show abstract

FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings

Cited by 35 publications

References 13 publications

Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study

Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study

Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan: overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study

Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis

Contact Info

Product

Resources

About