Abstract
ABSTRACTBackground: 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.
Highlights
Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique
The concept of the ‘know-do gap’ has emerged from the field of implementation science, wherein the methods to promote the systemic uptake of research findings and other evidence-based practices (EBPs) in routine healthcare practices are studied, which aims to improve the quality and effectiveness of healthcare [7]
This study revealed that health providers involved in maternal and neonatal care in the study area rated all the dimensions high, with lower scores in Organizational resources, as ‘supportive of change’ when seen in a continuum
Summary
Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. The poor quality of care is due to constraints on human and financial resources, and weak-functioning health systems [3], and to the failure to adopt appropriate strategies to implement evidence-based practices (EBPs) [4,5]. Policymakers must recognize the importance of the healthcare context, as an influence on the adoption of appropriate implementation strategies, and as a modifier of the effectiveness of interventions aimed at increasing health providers’ performance and improving quality of care [6]. The concept of the ‘know-do gap’ has emerged from the field of implementation science, wherein the methods to promote the systemic uptake of research findings and other EBPs in routine healthcare practices are studied, which aims to improve the quality and effectiveness of healthcare [7] Theoretical frameworks within this field have been developed over the last
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