Department of Health Systems, Management and Policy, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Aurora, CO, USA; Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
Glob Heart. 2019 Jun;14(2):155-163. doi: 10.1016/j.gheart.2019.05.005.
There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities.
This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned.
We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention.
The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components.
We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.
迫切需要定义适当的干预策略来控制中低收入国家的血压。2018 年，在阿根廷证明有效的一个项目被翻译成了危地马拉农村和主要是土著社区的公共初级卫生保健系统。
本文描述了在实施 II 型混合有效性实施试验之前，用于根据危地马拉农村背景调整该项目的利益相关者参与过程，并分享所获得的经验教训。
我们确定了 2 个背景中与将干预措施转化为危地马拉背景相关的关键差异。除了访谈和焦点小组讨论外，我们还于 2018 年 7 月和 8 月举行了咨询研讨会，采用了一种参与式翻译过程，涉及患者、家属、社区成员、卫生保健提供者和卫生部官员。该过程包括在危地马拉城举行的多次会议，以及在研究实施的 5 个部门中的每一个部门以及每个部门的 1 个区举行的会议。在研讨会上，我们展示了来自阿根廷的基于证据的经验，然后重点关注参与者为干预的 6 个组成部分中的每一个确定的挑战和建议解决方案。该过程以研究团队和卫生部官员定义干预措施具体细节的会议结束。
该过程的结果是一种适合于在试验阶段纳入危地马拉公共初级卫生保健系统的适应方法。该方法考虑了 6 个干预组成部分中的每一个的挑战和建议策略。
我们在适应过程中确定了经验教训、挑战和机遇。调查结果将为研究实施期间正在进行的利益相关者参与以及未来在全球中低收入国家推广和实施基于证据的高血压控制策略提供信息。
