Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System Lessons Learned, Challenges, and Opportunities
Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System Lessons Learned, Challenges, and Opportunities
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DOI：
10.1016/j.gheart.2019.05.005
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发表时间：
2019-06-01
期刊：
影响因子：
3.7
通讯作者：
Ramirez-Zea, Manuel
中科院分区：
文献类型：
--
作者：
Fort, Meredith P.;Paniagua-Avila, Alejandra;Ramirez-Zea, Manuel
背景：迫切需要确定适当的干预策略，以控制低收入和中等收入国家的血压。2018年，一项在阿根廷被证明有效的计划被转化为危地马拉农村和主要是土著社区的公共初级卫生保健系统。Objectives：本文描述了在实施II型混合有效性-实施试验之前，用于使该计划适应危地马拉农村环境的利益相关者参与过程，并分享了经验教训。方法：我们确定了与将干预措施转化为危地马拉背景相关的两种背景下的关键差异。除了访谈和焦点小组讨论外，我们还在2018年7月和8月举办了咨询研讨会，采用参与式翻译过程，涉及患者，家庭成员，社区成员，医疗保健提供者和卫生部官员。该进程包括在危地马拉城举行的多次会议，以及在将开展研究的5个省和每个省一个区举行的会议。在研讨会期间，我们介绍了阿根廷的循证经验，然后重点介绍了参与者为干预措施的6个组成部分中的每一个确定的挑战和建议的解决方案。研究小组和卫生部官员举行了一次会议，确定了干预措施的具体细节，从而结束了这一进程。该方法考虑的挑战和建议的策略，为每6个干预components.Conclusions：我们确定了在适应过程中的经验教训，挑战和机遇。研究结果将为利益相关者在研究实施过程中的持续参与以及未来的扩大和努力提供信息，以将循证高血压控制策略转化为全球低收入和中等收入国家。
Background: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities.Objectives: This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned.Methods: We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention.Results: The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components.Conclusions: We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.