Communities of Practice for lay health worker-delivered contact investigation for TB: Mechanisms and context

由非专业卫生工作者进行的结核病接触者调查的实践社区：机制和背景

• 批准号: 10843717
• 负责人: Rachel Hennein
• 金额: $ 5.27万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-16 至 2025-09-15
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10843717
• 关键词: Address; Behavior; Biometry; Caring; Cause of Death; Clinic; Clinical; Cluster randomized trial; Code; Communicable Diseases; Community Health Aides; Community of Practice; Consolidated Framework for Implementation Research; Country; Data; Data Analyses; Diagnosis; Disease; Effectiveness; Epidemiologist; Evaluation; Evidence based practice; Fostering; Funding; Goals; Group Practice; Health; Health Personnel; Health Services; Income; Infectious Agent; Inservice Training; Intervention; Interview; Investigation; Knowledge; Linear Regressions; Low income; Measures; Mediating; Mediation; Medicine; Mentors; Mentorship; Methods; Modeling; Nurses; Outcome; Parents; Participant; Performance; Persons; Physicians; Play; Psychometrics; Qualitative Methods; Qualitative Research; Quality of Care; Recommendation; Reduce health disparities; Research; Research Methodology; Role; Scientist; Self Efficacy; Services; Social Environment; Social support; Source; Specific qualifier value; Structure; Survey Methodology; Surveys; Testing; Training; Tuberculosis; Uganda; apprenticeship; career; collaborative environment; contextual factors; design; evidence base; experience; global health; health care delivery; health care quality; high risk; implementation research; implementation science; implementation trial; implementation/effectiveness; improved; insight; low income country; meetings; member; patient screening; prevent; programs; skills; social; social learning; systematic review; theories

Project Summary/Abstract Tuberculosis (TB) remains among the top 10 causes of death worldwide, disproportionately impacting low- income countries. Contact investigation for TB is recommended by the WHO to find and prevent additional cases. Contact investigation is often carried out by lay health workers who receive on-the-job training; however, lack of relevant in-service training is a major barrier to their delivery of high-quality health services. One approach to facilitating lay health worker training is to implement Communities of Practice (CoPs). CoPs are groups of professionals who meet regularly to support each other and share knowledge to advance their practice toward a common goal. CoPs have been used in the health field to improve the delivery of high-quality care by physicians and nurses in middle- and high-income countries. However, additional studies are needed that identify how CoPs can be used to facilitate the performance of lay health workers in low-income countries. My training proposal addresses the gaps in understanding how CoPs function in low-income countries through two scientific aims and four training aims that leverage Dr. Luke Davis’ (Sponsor) implementation trial of CoPs (5R01 AI104824-08, 2021-2023). Dr. Davis’ trial aims to address gaps in the implementation of TB contact investigation in Uganda; our research team found that only 20% of high-risk contacts completed TB evaluation in full, far below the WHO target of ≥90%. Separate from the funded trial, I will test my conceptual model of how and in what contexts CoPs can improve delivery of contact investigation. In Aim 1, I will test my hypothesis that lay health worker self-efficacy, or their confidence delivering high-quality health services, mediates the effects of CoPs on contact investigation. I will seek training and mentorship in survey methods and psychometrics to validate a widely used self-efficacy measure for use in Uganda. I will also receive training and guided mentorship in mediation analysis to assess if lay health worker self-efficacy mediates the effects of CoPs on contact investigation. In Aim 2, I will seek training and mentorship in advanced qualitative methods to identify contextual factors that impact the effectiveness of CoPs. By evaluating mechanisms of action and contextual factors pertinent to CoPs, our findings can explain why the parent trial improved, or failed to improve, outcomes. Our findings will also yield insights on how to design and implement lay health worker CoPs to improve delivery of high-quality health services, which can be applied to other low-income settings. My training plan and the collaborative environments at Yale and the Uganda TB Implementation Research Consortium will allow me to develop research, clinical, and professional skills needed for a research career as a physician-epidemiologist who uses implementation science to mitigate health disparities in low-income countries. My training plan outlines coursework, mentored research, and clinical experiences to enhance my skills in implementation trials, advanced biostatistics, qualitative methods, and infectious diseases medicine.

项目摘要/摘要 结核病(TB)仍然是全球前十大死亡原因之一，对低收入人群的影响不成比例。 收入国家。世界卫生组织建议对结核病进行接触调查，以发现和预防其他 案子。接触调查通常由接受过在职培训的非专业卫生工作者进行； 然而，缺乏相关的在职培训是他们提供高质量卫生服务的主要障碍。 促进非专业卫生工作者培训的一种方法是实施实践社区(COPS)。警察 是由专业人员组成的团体，他们定期会面，相互支持，分享知识，以促进他们的 朝着一个共同的目标练习。COPS已被用于卫生领域，以改善高质量的交付 中等收入和高收入国家的医生和护士的护理。然而，还需要进行额外的研究。 确定如何使用COPS来促进低收入国家非专业卫生工作者的业绩。 我的培训方案解决了低收入国家在理解COPS如何发挥作用方面的空白 通过两个科学目标和四个培训目标，利用Luke Davis博士(赞助商)的实施试验 COPS(5R01 AI104824-08,2021-2023)。戴维斯博士的试验旨在解决结核病实施中的差距 乌干达的接触者调查；我们的研究小组发现，只有20%的高危接触者完成了结核病 全面评估，远远低于世卫组织90%的≥目标。除了资助的试验，我将测试我的概念性 警察如何以及在什么情况下可以改进联系调查的交付的模型。在目标1中，我将测试我的 假设卫生工作者的自我效能感，或他们提供高质量卫生服务的信心， 调解警察在接触调查中的影响。我将寻求调查方法方面的培训和指导 和心理测量学，以验证在乌干达使用的广泛使用的自我效能测量。我还将接受培训 引导辅导在中介分析中评估业馀卫生工作者的自我效能感是否中介了 警察正在进行接触调查。在目标2中，我将寻求高级定性方法的培训和指导 确定影响COPS有效性的背景因素。通过评估行动机制和 与COPS相关的背景因素，我们的发现可以解释为什么父母试验改善或失败 改善，结果。我们的发现还将为如何设计和实施非专业卫生工作者提供见解 COPS以改善高质量保健服务的提供，这可适用于其他低收入环境。 我的培训计划和耶鲁大学和乌干达结核病实施研究的合作环境 财团将允许我发展研究生涯所需的研究、临床和专业技能，如 一位使用实施科学来缓解低收入人群健康差距的医生-流行病学家 国家。我的培训计划概述了课程作业、指导研究和临床经验，以增强我的 掌握实施试验、高级生物统计学、定性方法和传染病医学方面的技能。