Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

Bergström, Anna; Peterson, Stefan; Namusoko, Sarah; Waiswa, Peter; Wallin, Lars

doi:10.1186/1748-5908-7-117

Cited by 46 publications

(76 citation statements)

References 57 publications

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“…Informal payments in our study were defined as payments to individuals or to institutions, in cash or in kind, that should have been covered by the health system [39]. Informal payments for health services were reported in another Ugandan district [38] and were cited as a barrier to immunisation especially for FGD participants in our study. Financial barriers could reduce vaccination rates by 10 to 15% [40].…”

Section: Discussionmentioning

confidence: 99%

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda

Babirye

Engebretsen

Rutebemberwa

et al. 2014

BMC Health Serv Res

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BackgroundPrevious studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda.MethodsMixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Survey data underwent descriptive statistical analysis. Latent content analysis was used for qualitative data.ResultsOf the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years (95% CI 24–27). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents (24%, 95% CI 21–27). This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% (95% CI 30–37) of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% (95% CI 27–34) of the survey respondents utilised these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. Charges ranged from US$ 0.2 to US$4 and these were more commonly reported at private (70%, 95% CI 65–76) than at public (58%, 95% CI 54–63) facilities. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities.ConclusionsComplex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, governments should strengthen health systems to cater for increasing urban populations.

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Section: Discussionmentioning

confidence: 99%

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda

Babirye

Engebretsen

Rutebemberwa

et al. 2014

BMC Health Serv Res

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“…Twenty papers referred to nine different existing frameworks and five to the development of frameworks for evaluation of specific initiatives. Studies came from a wide range of locations: seven from the UK (Adegoke, Hofman, Kongnyuy, & van den Broek, ; Byng, Norman, Redfern, & Jones, ; Dickerson, Green, & Blass, ; Froggatt & Hockley, ; Furness et al., ; MacArthur, ; Themessl‐Huber, Lazenbatt, & Taylor, ), six from USA (Bahr et al., ; Eisenbise, ; Hill et al., ; Hundley, ; Serowoky, George, & Yarandi, ; Sockolow, ), three from Australia (Gardner, Gardner, & O'Connell, ; Hungerford, Prosser, & Davey, ; Wand, White, & Patching, ), two from Canada (Bainbridge, Brazil, Ploeg, Krueger, & Taniguchi, ; Yonge, Myrick, & Ferguson, ), two from Switzerland (Bryant‐Lukosius et al., ; Chmiel, Shaha, & Schneider, ) and one each from Africa (Bergstrom et al., ), Norway (Varsi, Ekstedt, Gammon, & Ruland, ), Spain (Oroviogoicoechea & Watson, ), Sweden (Frykman, von Thiele Schwarz, Muntlin Athlin, Hasson, & Mazzocato, ) and Thailand (Jaipakdee, Jiamjarasrangsi, Lohsoonthorn, & Lertmaharit, ). A broad range of nursing and midwifery interventions and programs represented community settings and hospitals in rural and metropolitan locations.…”

Section: Resultsmentioning

confidence: 99%

“…The Consolidation Framework for Implementation Research (CFIR) (Damschroder et al., ) was useful for formative evaluations including developing interviews as well as organising findings (Bahr et al., ) and managing the breadth and depth of complex interventions (Varsi et al., ). The Promoting Action on Research Implementation in Health Service (PARIHS) framework (Rycroft‐Malone, ) was used to provide structure to describe a health system (Bergstrom et al., ).…”

Section: Resultsmentioning

confidence: 99%

Evaluation frameworks in health services: An integrative review of use, attributes and elements

Bradford

Chambers

Hudson

et al. 2019

Journal of Clinical Nursing

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Aims and objective To synthesise the evidence on the use of evaluation frameworks by nurses and midwives in research designed to improve healthcare services and practice. A secondary aim was to identify the attributes and elements of evaluation frameworks. Background Evaluation is an integral component of any initiative to improve outcomes or change clinical practice. Yet often an evaluation may not yield the information required to sustain or integrate an initiative into practice. Evaluation frameworks can support effective evaluations, but there is a lack of consensus regarding elements and attributes of frameworks that support use. Methods We undertook an integrative review to synthesise the use of evaluation frameworks in practice guided by the Preferred Reporting Items for Systematic review and Meta‐Analysis flow diagram and checklist 2009 (Supporting Information File 4). The protocol was registered with PROSPERO (CRD42018087033). A broad range of electronic databases were systematically searched using keywords. Findings Twenty‐five papers were included from a diverse range of clinical areas and across high‐, middle‐ and low‐income nations. Twenty of the research projects had used nine existing frameworks, and five had developed an evaluation specific to an initiative. Frameworks supported the processes of evaluation and made them more meaningful by simplifying a complex process (providing structure and guidance for the evaluation processes); identifying and including stakeholders; explaining reasons for outcomes; generating transferable lessons; and identifying the mechanisms driving or inhibiting change. Conclusion Nurses and midwives reported that frameworks were useful in undertaking evaluations. Each framework had positive attributes and missing or confusing elements. When undertaking an evaluation, it is pertinent to review the elements and attributes of a framework to ensure it includes evaluation measures that are relevant to specific projects. Relevance to clinical practice Nurses are actively involved in evaluation of clinical practice. This review identifies important elements to consider when choosing a framework for evaluation.

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“…Qualitative efforts to understand the healthcare context have previously yielded a more diverse description of context [18,19,32]. One strategy might thus be to use mixed-methods (quantitative and qualitative combined) when aiming to understand context in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Mocumbi

McKee

Munguambe

et al. 2018

Global Health Action

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Background: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence. Objectives: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. Methods: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach’s α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Results: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed. Conclusions: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants’ responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.

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Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

Cited by 46 publications

References 57 publications

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda

Evaluation frameworks in health services: An integrative review of use, attributes and elements

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

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