Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings
Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings
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DOI：
10.1186/s13012-015-0305-2
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发表时间：
2015-08-15
影响因子：
7.2
通讯作者：
Wallin, Lars
中科院分区：
文献类型：
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作者：
Bergstrom, Anna;Skeen, Sarah;Wallin, Lars
背景：已知与实践之间的差距导致医疗服务使用者无法从医疗保健的进步中受益，并产生不必要的成本。支持性环境被认为是成功实施循证实践（EBP）的关键要素。没有可用的工具来系统地绘制影响低收入和中等收入国家 (LMIC) 实施 EBP 的组织环境的各个方面。因此，该项目旨在为此目的开发和心理测量验证工具。方法：社区健康情境评估（COACH）工具的开发是以促进卫生服务研究实施行动框架中的情境维度为前提的，并且是阿尔伯塔情境工具的衍生产品。它的开发在孟加拉国、越南、乌干达、南非和尼加拉瓜分六个阶段进行：(1) 定义维度和草案工具开发，(2) 国内专家小组的内容有效性，(3) 国际专家的内容有效性，(4) 响应过程有效性，(5) 翻译和 (6) 对五个国家 690 名卫生工作者的心理测量特性进行评估。 结果：该工具经过验证，可供医生、护士/助产士和社区卫生工作者使用。六个开发阶段使 COACH 工具的理论维度与其心理测量特性完美契合。该工具有 49 个项目，衡量环境的八个方面：资源、社区参与、工作承诺、非正式薪酬、领导力、工作文化、行动监测服务和知识来源。结论：被确定为影响高收入环境中 EBP 实施的组织环境方面也被发现与中低收入国家相关。然而，中低收入国家还有其他相关背景，特别是资源、社区参与、工作承诺和非正式支付。使用 COACH 工具将允许在实施医疗保健干预措施之前系统地描述当地医疗保健环境，以便调整实施策略或作为实施医疗保健干预措施评估的一部分，从而更深入地了解中低收入国家实施 EBP 的过程。
Background: 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. 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.Methods: The 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.Results: The 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.Conclusions: Aspects 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.