What do we think we are doing? How might a clinical information network be promoting implementation of recommended paediatric care practices in Kenyan hospitals?
What do we think we are doing? How might a clinical information network be promoting implementation of recommended paediatric care practices in Kenyan hospitals?
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DOI：
10.1186/s12961-017-0172-1
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发表时间：
2017-02-02
影响因子：
4
通讯作者：
Irimu G
中科院分区：
文献类型：
--
作者：
English M;Ayieko P;Nyamai R;Were F;Githanga D;Irimu G
建议建立一个临床网络，以促进实施一套针对肯尼亚住院儿科护理的推荐临床做法。选择网络作为策略的基本原理已经在前面描述过。在这里，我们的目标是描述网络活动实际上进行了第一个2.5年，解构其实施到特定的组件，并提供我们的“内部”的解释网络是如何作为一种干预。我们阐明了关键活动，共同构成了网络过程超过2.5年，然后利用最近公布的实施组件的类型，从提供干预措施的角度来提供更大的粒度。然后，我们使用行为改变轮来建议网络如何运作以实现改变，并在努力以现实主义的情境-机制-结果配置的形式综合我们的理解之前提供改变的例子。我们建议，我们的网络可能包括22个从总共73个可识别的干预组件，其中12个和10个，我们认为主要和次要组件，分别。在政策层面，我们采用了临床指南、营销和沟通策略，通过激励、说服、教育、授权、建模和环境重组等方式进行干预。这些可能会通过提高心理能力，创造社会机会和主要通过反思途径增加动机来影响行为。我们以前提出了一个临床网络作为解决方案的挑战，实施建议的做法在肯尼亚医院的基础上，我们对理论和背景的理解。在这里，我们报告我们如何制定了什么是建议，并使用最近的类型解构干预到它的元素，并阐明我们认为网络可能会产生变化。我们提供了一个更一般化的声明，我们的理论变化的上下文机制的结果配置。我们希望这将补充计划中的对“事情如何运作”的独立评估，将帮助其他人解释未来更正式报告的变化结果，并鼓励其他人考虑进一步审查网络，作为扩大低收入国家健康改善实践的手段。
The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our ‘insider’ interpretation of how the network is functioning as an intervention. We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context–mechanism–outcome configuration. We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway. We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised statement of our theory of change in a context–mechanism–outcome configuration. We hope this will complement a planned independent evaluation of ‘how things work’, will help others interpret results of change reported more formally in the future and encourage others to consider further examination of networks as means to scale up improvement practices in health in lower income countries.