Gilmore Brynne, Vallières Frédérique, McAuliffe Eilish, Tumwesigye Nazarius Mbona, Muyambi Gilbert
Implement Sci. 2014 Sep 26;9:137. doi: 10.1186/s13012-014-0137-5.
The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle. Understanding how positive and negative feedbacks obtained from communities can subsequently be used to inform and iterate existing programmes is an important step towards ensuring the success of community health workers for maternal and child health programming and, ultimately, for improving health outcomes.
The study took place over a period of 4 weeks in North Rukiga, Kabale District of southwestern Uganda. Using a cross-sectional qualitative study that employed an epistemological approach of phenomenology, nine focus group discussions and eight in-depth interviews were conducted with a total of 76 female participants across six different sites. Women were identified as either users or non-users of the maternal and child health programme. Purposeful sampling was employed to recruit women from six different locations within the programme catchment area. Translated and transcribed transcripts were subjected to a bottom-up thematic analysis using NVivo 10 Software, whereby themes were arrived at inductively.
Predominant themes emerging from the focus groups and key informant interviews identified early trends in programme strengths. Beneficiaries reported confidence in both the programme and the relationships they had forged with community health workers, exhibited pride in the knowledge they had received, and described improved spousal involvement. Beneficiaries also identified a number of programme challenges including barriers to adopting the behaviours promoted by the programme, and highlighted issues with programme dependency and perceived ownership. It also emerged that community health workers were not reaching the entire population of intended programme beneficiaries.
This research provides support for the importance of an early-stage participatory evaluation of beneficiaries' perceptions of newly initiated health programmes. Our results support how evaluations conducted in the early phases of programme implementation can provide valuable, timely feedback as well as yield recommendations for programme adjustment or re-alignment, and in turn, better meet end-user expectations. Potential reasons for the observed lack of community participation in early stages of programme implementation are considered.
项目受益者对社区妇幼保健项目的系统性参与程度仍然很低且有限，尤其是在项目周期的形成阶段。了解从社区获得的正面和负面反馈如何随后用于为现有项目提供信息并进行迭代，是确保社区卫生工作者在妇幼保健规划中取得成功以及最终改善健康结果的重要一步。
该研究在乌干达西南部卡巴莱区的北鲁基加进行，为期4周。采用横断面定性研究，运用现象学的认识论方法，在六个不同地点对76名女性参与者进行了九次焦点小组讨论和八次深入访谈。这些女性被确定为妇幼保健项目的使用者或非使用者。采用目的抽样法从项目覆盖区域内的六个不同地点招募女性。翻译并转录的访谈记录使用NVivo 10软件进行自下而上的主题分析，通过归纳得出主题。
焦点小组和关键信息访谈中出现的主要主题确定了项目优势的早期趋势。受益者对项目以及他们与社区卫生工作者建立的关系表示有信心，对所获得的知识感到自豪，并描述了配偶参与度的提高。受益者还指出了一些项目挑战，包括采纳项目所倡导行为方面的障碍，并强调了项目依赖性和感知所有权方面的问题。还发现社区卫生工作者并未覆盖到项目所有预期受益者群体。
本研究支持对受益者对新启动的卫生项目的看法进行早期参与式评估的重要性。我们的结果支持了在项目实施早期阶段进行的评估如何能够提供有价值、及时的反馈，并产生项目调整或重新调整的建议，进而更好地满足最终用户的期望。研究还考虑了观察到的项目实施早期社区参与度不足的潜在原因。
