Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals.
Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals.
复制标题
DOI：
10.1186/1748-5908-8-39
复制
发表时间：
2013-03-28
期刊：
影响因子：
--
通讯作者：
English M
中科院分区：
文献类型：
--
作者：
English M
肯尼亚和许多低收入国家的地区医院服务应提供行之有效的干预措施，大幅降低儿童和新生儿死亡率。然而，这类服务的质量往往很差。因此，研究人员面临的挑战是确定超越知识、技能或资源不足的干预战略，以支持卫生系统大规模提供更好的服务。描述了根据当地需要和背景并利用理论制定以系统为导向的干预措施的努力。一项旨在改善地区医院儿童服务的干预措施基于四个主要战略：一个反思过程，以提炼出所观察到的服务提供问题的根本原因；制定一套可能的干预方法，以解决这些问题；搜索文献，寻找为干预设计提供最适当基础的理论；反复在已确定的原因、拟议的干预措施、已确定的理论和现有背景知识之间来回移动，以制定似乎可行、可能可接受和潜在可持续的总体干预措施。除人力和资源限制外，主要问题包括相关专业人员未能对提供儿科服务的挑战负起责任或当家作主；服务单位领导人(中层管理人员)准备不足、支助不足，往往在专业和地理上与世隔绝；几乎完全缺乏有用的信息来定期监测或了解提供服务的做法或成果。以系统为导向的干预措施承认服务单位领导人的关键作用，但涉及医院的外部和内部环境，旨在帮助塑造和支持这些专业人员的适当作用。它旨在培养一种主人翁意识，同时为中层管理人员提供必要的了解、知识和技能，以便与高级管理人员和前线工作人员有效地合作，以改善服务。干预措施将包括开发信息系统、反馈机制和促进积极变化的讨论论坛。这种干预的工具是一个由政府和国家专业协会组成的合作网络。提出这一案例是为了促进关于制定适合背景的干预措施的方法的讨论，特别是在国际卫生方面。
District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while providing the necessary understanding, knowledge, and skills for mid-level managers to work effectively with senior managers and frontline staff to improve services. The intervention will include development of an information system, feedback mechanisms, and discussion fora that promote positive change. The vehicle for such an intervention is a collaborative network partnering government and national professional associations. This case is presented to promote discussion on approaches to developing context appropriate interventions particularly in international health.
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.4
作者：
Agweyu, Ambrose;Opiyo, Newton;English, Mike
通讯作者：
English, Mike
影响因子：
7.2
作者：
Birken, Sarah A.;Lee, Shoou-Yih Daniel;Weiner, Bryan J.
通讯作者：
Weiner, Bryan J.
影响因子：
3.7
作者：
Bolton, SC
通讯作者：
Bolton, SC
影响因子：
5.5
作者：
Dopson, Sue;Fitzgerald, Louise
通讯作者：
Fitzgerald, Louise