Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.
Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Hum Vaccin Immunother. 2020;16(2):465-475. doi: 10.1080/21645515.2019.1654798. Epub 2019 Sep 23.
: Although understanding implementation context is essential, there is a dearth of research on how to systematically explore it in quality improvement (QI) programs. Therefore, in this study, we used the consolidated framework for implementation research (CFIR) to guide a systematic evaluation of the implementation context of an ongoing QI program in order to generate rapid site-specific feedback that can be used to improve subsequent plan-do-study-act (PDSA) cycles.: Formative cross-case evaluation was conducted using convergent mixed methods design. The study was conducted in five primary health care (PHC) facilities (PHC 1, PHC 3, PHC 5, PHC 9 and PHC 10) implementing the QI program. Health workers in those facilities formed the study population. Quantitative data were collected using a self-administered, Likert-based rating tool, while qualitative data collection was guided by an interview guide. The interviews were transcribed verbatim, and thematic analysis was performed. Raw median score and factor scores were computed. Methodological integration occurred at the design, analysis and reporting stage.: A total of 165 health workers were included in this study with a mean age of 33.43 years (standard deviation of 7.15). Majority were females and they all had post-secondary education. Health workers in two facilities; PHC 1 and PHC 5, reported higher score for the QI program across all five domains of CFIR. Implementation facilitators included intervention flexibility, relative advantage, self-efficacy among health workers, health workers confidence in the intervention, services integration. While implementation barriers included vaccine stock out, faulty cold chain infrastructure, lack of incentives, and socio-cultural beliefs.: This study demonstrated that theory-driven formative evaluation can be integrated in QI programs in a low resource setting. It buttressed the value in conducting such assessment as they can be used to generate rapid feedback on factors that influence implementation success which can then be addressed in subsequent cycles.
: 尽管了解实施背景至关重要，但在质量改进（QI）计划中，如何系统地探索实施背景的研究却很少。因此，在本研究中，我们使用实施研究综合框架（CFIR）来指导对正在进行的 QI 计划实施背景的系统评估，以生成可用于改进后续计划-执行-研究-行动（PDSA）循环的快速特定于站点的反馈。: 采用收敛混合方法设计进行了形成性跨案例评估。该研究在五家基层医疗保健（PHC）设施（PHC1、PHC3、PHC5、PHC9 和 PHC10）中进行，这些设施正在实施 QI 计划。这些设施的卫生工作者构成了研究人群。使用基于自我管理的李克特量表收集定量数据，同时通过访谈指南指导定性数据收集。访谈逐字记录，并进行主题分析。计算原始中位数得分和因子得分。方法学整合发生在设计、分析和报告阶段。: 本研究共纳入 165 名卫生工作者，平均年龄为 33.43 岁（标准差为 7.15）。大多数是女性，都接受过中学后教育。在两个设施（PHC1 和 PHC5）中，卫生工作者报告了在 CFIR 的所有五个领域中对 QI 计划的更高评分。实施促进因素包括干预灵活性、相对优势、卫生工作者的自我效能、卫生工作者对干预的信心、服务整合。而实施障碍包括疫苗库存不足、冷链基础设施故障、缺乏激励措施以及社会文化信仰。: 本研究表明，在资源匮乏的环境中，可以将理论驱动的形成性评估纳入 QI 计划。它支持了进行此类评估的价值，因为它们可以用于生成对影响实施成功的因素的快速反馈，然后可以在后续循环中解决这些因素。
