An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context
An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context
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DOI：
10.1186/1748-5908-4-42
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发表时间：
2009-07-23
影响因子：
7.2
通讯作者：
Irimu, Grace
中科院分区：
文献类型：
--
作者：
English, Mike;Ntoburi, Stephen;Irimu, Grace
背景：人们越来越认识到，对研究背景和干预过程的详细描述极大地促进了对卫生系统研究的解释。我们在肯尼亚开展了一项为期18个月的以医院为基础的干预研究，旨在改善对住院儿童和新生儿的护理。在这里，我们描述了八家医院作为接受干预的环境的基线特征，以及一般和地方卫生系统背景及其在18个月内的演变。方法：使用先前开发的评估儿童和新生儿卫生服务提供的广泛结构、过程和结果的工具评估医院特征。通过监测政府政策公告、媒体以及通过与决策者的非正式接触，前瞻性地记录了干预期间国家一级卫生系统或政策的主要发展情况。在医院一级，每六个月与医院高级工作人员举行面对面会议，使用一份结构化的开放式问卷，以确定可能影响实施的主要地方发展情况。这些数据为那些试图理解描述干预效果的报告的普遍性，以及干预是否合理地导致了这些效果的人提供了重要的背景。结果：医院在基础设施、设备、物资和人力资源方面的能力有限，无法在基线时提供高质量的护理。例如，医院缺少30%至56%被认为是向重病儿童或新生儿提供护理所必需的物品。医院翻修支出的增加、为保健工作者实行绩效合同的尝试以及选举后的暴力行为被记录为可能影响执行工作总体成功的国家一级因素的例子。可能影响在当地取得成功的因素包括工作人员的频繁变动，有时是大量的变动，高级部门或行政工作人员的调动，以及具有其他优先事项的当地“捐助”伙伴的存在。结论：在实现变革的实际需要期间，医院层面的干预措施的有效性可能受到国家和地方层面各种因素的影响。我们已经证明了这样的环境是多么动态，因此在解释干预措施的有效性时需要考虑环境。
Background: It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months.Methods: Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects.Results: Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors that might influence success locally included frequent and sometimes numerous staff changes, movements of senior departmental or administrative staff, and the presence of local 'donor' partners with alternative priorities.Conclusion: The effectiveness of interventions delivered at hospital level over periods realistically required to achieve change may be influenced by a wide variety of factors at national and local levels. We have demonstrated how dynamic such contexts are, and therefore the need to consider context when interpreting an intervention's effectiveness.