The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon

Abstract

It is essential to analyze the local context and implementation components to effectively deliver evidence-based solutions to public health problems. Tools provided by the field of implementation science can guide practitioners through a comprehensive implementation process, making innovations more adaptable, efficient, and sustainable. It is equally important to report on the design and implementation process so others can analyze, replicate, and improve on the progress made from an intervention. The current study reports on the design and implementation of an mHealth intervention to improve child health in the Amazon of Peru. The study aims to provide insight into how an implementation science tool can be used to improve implementation and reporting of an evidence-based intervention in a global health setting. Methods: Implementation of a community-based mHealth intervention is analyzed and reported through the lens of the Active Implementation Frameworks (AIF). The AIF is used to analyze the design, implementation, adaptation, and monitoring of the intervention. The implementation process is categorized in the four stages of implementation. The results of the analysis and subsequent implementation activities are reported. Results: The exploration stage was used to learn about the local context in the Amazonian communities and identify an evidence-based solution to address poor child health. Several potential solutions were combined to create an innovative mHealth tool. During the installation stage, the stakeholders worked together to improve the intervention and plan for implementation through human-centered design. The providers in the field were trained and data was gathered to monitor implementation. During initial implementation stage, electronic tablets were distributed to community health agents and continuous quality improvement activities allowed for rapid improvements to be implemented. The intervention moved on to full implementation stage as acceptance and fidelity approached 100%. Conclusion: The AIF highlighted several potential barriers to implementation that may have been overlooked without the guidance of a science-based implementation tool. Reporting on the implementation process shows how implementation science tools can Westgard and Fleming Implementation Science Tools for mHealth be used to foresee and address potential threats to successful implementation. The results of this study provide insight into the components of implementation in Amazonian communities, as well as the process of using implementation science tools in any global health setting.

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“…53 The speci c implementation activities are described in Westgard, et al, 2020. 32 Finally, the implementation outcomes, service outcomes, and clinical outcomes were de ned, monitored, evaluated, and reported, as displayed in the Implementation Research Logic Model.…”

How to Implement a Simulation-Based Education Programme: Lessons from the UK Urology Simulation Boot Camp

“…This is a common issue in surgical teaching, as many surgical departments have strong motivations to support trainees learning, but are limited in knowing how best to channel their efforts to achieve effective outcomes. Implementation science has been demonstrated to be successful in a growing number of disciplines, including medical education, novel technologies in healthcare and paediatric health in diverse settings [ 37 – 39 ]. To harness the benefits of SBE fully, we would argue that an evidence-based implementation approach is essential, and some policymakers have developed collaborative work to explore suitable methods to transform implementation evidence into practice.…”

Welcome to Global Implementation Research and Applications

“…For example, co-creation, co-learning, and co-production of solutions, led by implementation practitioners, are strengthening health systems in South Africa, Tanzania, Ghana, Uganda, and Nepal (Gilson et al 2014;Martineau et al 2018). Some propose that sound implementation of effective policies, practices, and programs produces greater impact in low-or middle-income countries (Nolte and McKee 2004;Westgard and Fleming 2020). We believe implementation lessons from these settings may also prove informative to sectors in high-income nations.…”