Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
Dodowa Health Research Centre, Dodowa, Ghana.
PLoS Negl Trop Dis. 2019 Mar 25;13(3):e0007267. doi: 10.1371/journal.pntd.0007267. eCollection 2019 Mar.
The Global Strategy to Eliminate Lymphatic Filiariasis (GFELF) through Mass Drug Administration (MDA) has been implemented in Ghana since the year 2000 and transmission has been interrupted in 76 of 98 endemic districts. To improve the MDA in the remaining districts with microfilaria (MF) prevalence above the 1% threshold for the interruption of transmission, there is a need to identify and implement appropriate quality improvement (QI) strategies. This paper describes the use of intervention mapping to select QI strategies to improve an existing evidence-based MDA program in Northern Ghana.
Due to the complexities associated with implementing evidence-based programs (EBP) such as the lymphatic filariasis MDA and variability in the context, an initial assessment to identify implementation bottlenecks associated with the quality of implementation of lymphatic filariasis MDA in the Bole District of Ghana was conducted using a mixed methods approach. Based on the findings of the initial assessment, a context specific QI strategy was designed and operationalized using intervention mapping strategy in terms of seven domains: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification.
The initial needs assessment shows that the persistent transmission of lymphatic filariasis in the Bole District is characterized by high levels of refusal to ingest the drug, high levels of reported adverse drug reactions, low MDA coverage at community level, poor adherence to the MDA protocol and non-participants' responsiveness.
This study has shown that it is feasible to develop a context specific QI strategy for an existing evidence-based intervention based on an initial needs assessment through stakeholder participation using the IM approach. However, working (towards) QI requires more time than is usually available in public health service. Sufficient theoretical knowledge of implementation research and experience with technical IM experts must be available.
自 2000 年以来，加纳一直在实施全球消灭淋巴丝虫病战略（GFELF），通过大规模药物治疗（MDA）来消灭淋巴丝虫病。目前，98 个流行地区中有 76 个地区已经阻断了传播。为了提高剩余地区的 MDA 效果，这些地区的微丝蚴（MF）流行率高于传播阻断阈值 1%，因此需要确定并实施适当的质量改进（QI）策略。本文描述了如何使用干预映射来选择 QI 策略，以改进加纳北部现有的基于证据的 MDA 项目。
由于实施基于证据的方案（EBP），如淋巴丝虫病 MDA，以及背景的复杂性，因此需要使用混合方法对实施过程中与实施质量相关的瓶颈问题进行初始评估。根据初步评估的结果，针对加纳博勒地区淋巴丝虫病 MDA 实施过程中的质量问题，设计了一个特定于该地区的 QI 策略，并使用干预映射策略从七个方面进行了实施：行动者、行动、行动目标、时间安排、剂量、实施结果以及理论依据。
初始需求评估表明，博勒地区淋巴丝虫病的持续传播主要表现为拒绝服药的比例较高、报告的药物不良反应水平较高、社区一级 MDA 覆盖率较低、对 MDA 方案的依从性较差以及非参与者的配合度较差。
本研究表明，通过利益相关者的参与，利用 IM 方法，根据初始需求评估，针对现有基于证据的干预措施制定特定于背景的 QI 策略是可行的。然而，实施 QI 需要更多的时间，而这在公共卫生服务中往往是无法实现的。因此，必须具备实施研究的充分理论知识和与技术 IM 专家合作的经验。
