학술논문
Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption.
Document Type
Academic Journal
Author
Hennein R; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.; Yale School of Medicine, New Haven, CT, USA.; Ggita J; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Ssuna B; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Shelley D; Department of Public Health Policy and Management, New York University, New York, NY, United States.; Akiteng AR; Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.; Davis JL; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.; Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA.; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.; Katamba A; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.; Armstrong-Hough M; Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.; Department of Social and Behavioral Sciences, New York University, New York, NY, USA.; Department of Epidemiology, New York University, New York, NY, USA.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 101256323 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-1706 (Electronic) Linking ISSN: 17441692 NLM ISO Abbreviation: Glob Public Health Subsets: MEDLINE
Subject
Language
English
Abstract
Many implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians' opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians' beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.