Schriver Michael, Cubaka Vincent Kalumire, Vedsted Peter, Besigye Innocent, Kallestrup Per
a Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark.
b School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.
Glob Health Action. 2018;11(1):1445466. doi: 10.1080/16549716.2018.1445466.
External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries.
To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries.
"External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis.
We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B.
ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.
在低收入国家，对基层医疗卫生机构进行外部监督以监测和改善服务很常见。目前，这些国家尚无衡量外部监督中支持质量的工具。
开发一种由提供者报告的工具，以评估卢旺达及其他国家通过外部监督提供的支持。
“外部监督：提供者对监督支持的评价”（ExPRESS）分18个步骤开发，主要在卢旺达进行。通过系统搜索相关工具、访谈、翻译以及国际监督专家和尼日利亚、肯尼亚、乌干达及卢旺达的当地专家进行的相关性评估，优化了内容效度。在两项单独的现场测试中检验了结构效度和信度，第一次使用探索性因素分析和重测设计，第二次进行验证性因素分析。
我们在A部分（“与外部监督者的最新经历”）纳入了16个项目，在B部分（“与外部监督者的总体经历”）纳入了13个项目。项目内容效度指数可接受。在现场测试I中，重测的kappa值可接受，探索性因素分析表明A部分和B部分中的相关因素可用于模型假设。在现场测试II中，通过验证性因素分析对模型进行了测试，A部分拟合了一个4因素模型，B部分拟合了一个3因素模型。
ExPRESS是一种很有前景的工具，可用于评估资源有限环境下基层医疗卫生机构外部监督中基层医疗服务提供者的支持质量。ExPRESS可用作向外部监督者提供的具体反馈，以帮助识别和解决他们提供的监督中的差距。进一步的研究应确定分数的最佳解释以及每位监督者获得精确结果所需的受访者数量，并测试B部分的功能。
