Institute of Tropical Medicine Pedro Kouri, Havana City, Cuba.
Health Policy Plan. 2011 Sep;26(5):413-22. doi: 10.1093/heapol/czq077. Epub 2010 Dec 12.
Fidelity research can help to answer essential questions about the diffusion process of innovative health interventions and provide insights for further scaling-up and institutionalization. This study assessed fidelity and reinvention in the implementation of a community-based control strategy for Aedes aegypti control. The intervention was implemented in 16 study areas in La Lisa, a municipality of Havana, Cuba. Its major components were: organization & management, capacity-building, community work and surveillance. A participatory assessment of process data was performed to determine whether the components and subcomponents were implemented, not-implemented or modified. Frequencies were tabulated over all circumscriptions (lowest level of local government) and the average was calculated for the four components. Spearman Rank correlation coefficients were calculated to explore the relationships between components. In addition, semi-structured interviews were conducted with co-ordinators of the strategy at different levels to identify difficulties encountered in the strategy's implementation. Surveillance was the most implemented component (72.9%) followed by capacity-building (54.7%). Community work and organization & management were less implemented or modified (50% and 45%, respectively). Apart from surveillance and capacity-building, all components are significantly and strongly correlated (Spearman Rank correlation coefficient > 0.70, P < 0.01). If one component is implemented in a circumscription, the other components are also likely to be implemented. It is noticeable that areas which did not undergo organizational changes commonly did not implement community work activities. Within the whole strategy, few activities were added. Scarcely implemented subcomponents were the most innovative. The difficulties encountered during implementation were related to appropriate training and skills, available time, lack of support and commitment to the strategy, lack of motivation of local leadership, and integration of actors and resources. The study showed a wide variability of fidelity in the implementation of the intervention and highlighted challenges for scaling-up and institutionalization of the community-based intervention.
信度研究有助于回答关于创新卫生干预措施传播过程的基本问题，并为进一步扩大规模和制度化提供见解。本研究评估了基于社区的登革热控制策略实施中的信度和再创新。该干预措施在古巴哈瓦那市拉利萨的 16 个研究区域实施。其主要组成部分是：组织和管理、能力建设、社区工作和监测。对过程数据进行了参与式评估，以确定是否实施、未实施或修改了组成部分和子组成部分。对所有行政区（地方政府的最低级别）进行了频率制表，并计算了四个组成部分的平均值。计算了斯皮尔曼秩相关系数以探索组成部分之间的关系。此外，还对不同层次的战略协调员进行了半结构化访谈，以确定战略实施中遇到的困难。监测是实施最多的组成部分（72.9%），其次是能力建设（54.7%）。社区工作和组织与管理的实施或修改较少（分别为 50%和 45%）。除了监测和能力建设外，所有组成部分都具有显著且强相关性（斯皮尔曼秩相关系数> 0.70，P <0.01）。如果一个行政区实施了一个组成部分，其他组成部分也很可能会实施。值得注意的是，没有进行组织变革的地区通常不开展社区工作活动。在整个战略中，增加的活动很少。实施较少的子组成部分最具创新性。实施过程中遇到的困难与适当的培训和技能、可用时间、缺乏对战略的支持和承诺、地方领导层缺乏动力以及行动者和资源的整合有关。研究表明，干预措施实施中的信度存在很大差异，并强调了扩大规模和使基于社区的干预措施制度化的挑战。
