Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda.
Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda.
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DOI：
10.3389/fpubh.2022.837211
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发表时间：
2022
影响因子：
5.2
通讯作者：
Katamba A
中科院分区：
文献类型：
--
作者：
Davis JL;Ayakaka I;Ggita JM;Ochom E;Babirye D;Turimumahoro P;Gupta AJ;Mugabe FR;Armstrong-Hough M;Cattamanchi A;Katamba A
自 2012 年以来，世界卫生组织建议将家庭接触调查作为一项循证干预措施，以发现和治疗活动性结核病 (TB) 患者，这是仅次于 COVID-19 的全球最常见的传染性死亡原因。不幸的是，在大多数受影响个人居住的低收入和中等收入国家，这一建议的采纳程度并不理想，而且人们对如何有效提供这项服务知之甚少。因此，我们采用 COM-B（能力-机会-动机-行为）模型和行为改变轮（BCW）框架，采用系统化流程设计了一种新颖的、基于理论的实施策略，以促进乌干达接触者调查的采用。我们系统地吸引了国家、诊所和社区的利益相关者，并集体重新审查了我们自己的形成性、平行混合方法研究的结果。我们确定了接触者调查中希望改变的三种核心行为，以及这些行为的多个前因（即障碍和促进因素）。 BCW 框架帮助确定了针对这些前因的多种干预功能，以及可能提高这些干预措施有效性的多项政策。最后，我们确定了多种行为改变技术和政策，将其纳入多组件实施策略中，并将其与家庭集群随机试验中的常规护理进行比较。我们在两个分支中引入了一些组件，包括那些旨在促进接触者调查的初步采用的组件，并相对于历史控制进行了改进。我们为促进结核病评估的完成而引入的其他组件（家庭结核病艾滋病毒评估和后续短信）由于实施失败而返回了阴性结果。总之，行为改变轮框架提供了一种可行且透明的方法来设计基于理论的实施策略。未来的研究应探索使用微观随机试验等实验方法来确定实施策略中最活跃的组成部分，以及更具创造性和创业性的方法，例如以人为本的设计，以更好地使实施策略的形式和适合最终用户的方式适应。
Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.
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影响因子：
11.3
作者：
Damschroder, Laura J.
通讯作者：
Damschroder, Laura J.
影响因子：
168.9
作者：
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DOI：
10.5588/ijtld.18.0129
发表时间：
2018-10-01
影响因子：
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作者：
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影响因子：
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作者：
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