Abstract
BackgroundThe 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.MethodsThe 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.ResultsThe 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.ConclusionsAspects 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0305-2) contains supplementary material, which is available to authorized users.
Highlights
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
Findings from each phase resulted in revisions on the tested Context Assessment for Community Health (COACH) tool draft version that was assessed in the phase
Phase I: defining dimensions and developing a draft version of the COACH tool The definition of the dimensions and development of corresponding items was an iterative process whereby we initially included all eight dimensions in the Alberta Context Tool (ACT) (n = 58 items) as well as additional dimensions thought to be relevant for low- and middle-income countries (LMICs) settings
Summary
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. 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) This project aimed to develop and psychometrically validate a tool for this purpose. The 2012 World Health Report No Health Without Research emphasized the importance of implementing research into policy and practice as a means of achieving universal and equitable access to healthcare [1] This highlights the challenges to determine the most effective implementation strategies for interventions, how to understand which strategies work where and why, and in doing so, promoting the better use of research [2,3,4]. Understanding the socio-political nature of health systems, the organization’s readiness to change and the role of tailored implementation is regarded as a priority field in implementation science, including the need to systematically study the attributes of context influencing this process [9,10,11,12,13,14,15,16]
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