Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa.
Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa.
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DOI：
10.1371/journal.pone.0161790
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
van Wyk B
中科院分区：
文献类型：
--
作者：
Mukumbang FC;van Belle S;Marchal B;van Wyk B
在南非西开普省的初级保健设施中推出了抗逆转录病毒坚持治疗俱乐部干预措施，以缓解诊所拥挤的状况，并在病人负担不断增加的情况下提高护理的保留率和治疗坚持率。我们采用现实主义的评估方法来评估抗逆转录病毒俱乐部干预措施的哪些方面有效，针对患者人群的哪些部分，以及在哪些社区和卫生系统背景下，为扩大干预措施提供指导。在这篇文章中，我们报告的一个步骤的发展计划理论的假设方案设计者和卫生服务管理人员如何以及为什么坚持俱乐部的干预预计将实现其目标和看法，它是如何做到的（或不）。我们采用了探索性的定性研究设计。我们对12份关于坚持俱乐部干预的设计和实施的文件进行了文件审查，并对12名有目的地选择的项目设计者和管理者进行了关键线人访谈。专题内容分析被用来确定归属于方案行为者、背景、机制和成果的专题。使用情境-机制-结果配置工具，我们提供了一个解释性的焦点，如何坚持俱乐部的干预是推出和工程指导的现实主义的观点。我们将坚持俱乐部设计者和管理者的假设分类为坚持俱乐部计划的推出，实施和利用，分别围绕提供者，管理/运营人员和患者构建。两个竞争对手的理论被确定在病人的角度来看。我们使用这些观点来开发一个初始的程序理论的坚持俱乐部的干预，这将在稍后阶段进行测试。方案设计者和管理人员的观点为制定初步方案理论迈出了重要一步，这将指导我们对南非的坚持俱乐部方案进行现实主义的评价。
The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. The perspectives of the programme designers and managers provided an important step towards developing an initial programme theory, which will guide our realist evaluation of the adherence club programme in South Africa.