A process evaluation of the scale up of a youth-friendly health services initiative in northern Tanzania.
A process evaluation of the scale up of a youth-friendly health services initiative in northern Tanzania.
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DOI：
10.1186/1758-2652-13-32
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发表时间：
2010-08-23
影响因子：
6
通讯作者：
Obasi A
中科院分区：
文献类型：
--
作者：
Renju J;Andrew B;Nyalali K;Kishamawe C;Kato C;Changalucha J;Obasi A
虽然有一些旨在改善向年轻人提供生殖健康服务的小规模、方便青年的服务干预措施取得成功的例子，但这些项目往往是短期的，覆盖面很低。为了产生重大的长期影响，这些倡议必须在一段持续的时期内大规模实施。为了从用户和提供者的角度确定关键的促进和抑制因素，我们对坦桑尼亚姆万扎地区经评估的青年友好服务干预措施的规模扩大了10倍进行了过程评估。干预措施在持续6个月和10个月的两轮训练中逐步扩大。该过程通过多种方法的三角测量进行评估：(i)模拟患者研究；㈡焦点小组讨论和与卫生工作者和培训人员进行半结构化访谈；训练观察；（四）培训前后问卷调查。这些方法用于比较干预前和干预后组，并评估两轮训练之间的差异。2004年至2007年期间，地方政府官员培训了429名卫生工作者。培训实施得很好，随着时间的推移，培训师的信心和领导课程的能力都有所提高。地区主导的培训显著提高了有关艾滋病毒/艾滋病和青春期的知识（RR范围从1.06到2.0），对避孕套的态度，保密和年轻人获得治疗的权利（RR范围：1.23-1.36）。干预卫生单位在计划生育和要求避孕套模拟病人情景中得分较高，但在性传播感染情景中得分低于对照卫生单位。扩大规模面临着选择和留住训练有素的卫生工作者方面的挑战，并受到各种背景因素和结构限制的限制。青年友好型服务干预措施即使在通过现有系统进行扩展之后，也可以继续提供良好的服务。扩大规模的过程确实影响了干预质量的某些方面，我们的研究支持其他人强调每个设施需要培训更多的工作人员（临床和非临床），以确保提供对青年友好的服务。需要进一步的研究来确定有效的战略，以解决阻碍扩大规模的结构性限制和更广泛的社会规范。
While there are a number of examples of successful small-scale, youth-friendly services interventions aimed at improving reproductive health service provision for young people, these projects are often short term and have low coverage. In order to have a significant, long-term impact, these initiatives must be implemented over a sustained period and on a large scale. We conducted a process evaluation of the 10-fold scale up of an evaluated youth-friendly services intervention in Mwanza Region, Tanzania, in order to identify key facilitating and inhibitory factors from both user and provider perspectives. The intervention was scaled up in two training rounds lasting six and 10 months. This process was evaluated through the triangulation of multiple methods: (i) a simulated patient study; (ii) focus group discussions and semi-structured interviews with health workers and trainers; (iii) training observations; and (iv) pre- and post-training questionnaires. These methods were used to compare pre- and post-intervention groups and assess differences between the two training rounds. Between 2004 and 2007, local government officials trained 429 health workers. The training was well implemented and over time, trainers' confidence and ability to lead sessions improved. The district-led training significantly improved knowledge relating to HIV/AIDS and puberty (RR ranged from 1.06 to 2.0), attitudes towards condoms, confidentiality and young people's right to treatment (RR range: 1.23-1.36). Intervention health units scored higher in the family planning and condom request simulated patient scenarios, but lower in the sexually transmitted infection scenario than the control health units. The scale up faced challenges in the selection and retention of trained health workers and was limited by various contextual factors and structural constraints. Youth-friendly services interventions can remain well delivered, even after expansion through existing systems. The scaling-up process did affect some aspects of intervention quality, and our research supports others in emphasizing the need to train more staff (both clinical and non-clinical) per facility in order to ensure youth-friendly services delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale up.
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影响因子：
15.8
作者：
Gregson, Simon;Adamson, Saina;Anderson, Roy M.
通讯作者：
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影响因子：
120.7
作者：
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3.2
作者：
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