Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
BMJ Open. 2021 Jul 2;11(7):e048499. doi: 10.1136/bmjopen-2020-048499.
To assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence.
Mixed-methods design including a cluster randomised controlled trial and process evaluation informed by the RE-AIM framework.
Forty-five health centres (HCs) in four districts in the south east zone of Malawi, who had an opportunity to receive cascade training.
Forty-five peer-trainers (PTs), 23 patients and 20 LHWs.
Implementation strategy employing peer-led educational outreach, a clinical support tool and peer support network to implement a TB treatment adherence intervention.
Process data were collected from study initiation to the end-of-study PT meeting, and included: LHW and patient interviews, quarterly PT meeting notes, training logs and study team observations and meeting notes. Data sources were first analysed in isolation, followed by method, data source and analyst triangulation. Analyses were conducted independently by two study team members, and themes revised through discussion and involvement of additional study team members as needed.
Forty-one HCs (91%) trained at least one LHW. Of 256 LHWs eligible to participate at study start 152 (59%) completed training, with the proportion trained per HC ranging from 0% to 100% at the end of initial cascade training. Lack of training incentives was the primary barrier to implementation, with intrinsic motivation to improve knowledge and skills, and to improve patient care and outcomes the primary facilitators of participation.
We identified important challenges to and potential facilitators of implementation, scalability and sustainability, of the TB treatment adherence intervention. Findings provide guidance to scale-up, and use of the implementation strategies employed, to address LHW training and supervision in other areas.
NCT02533089.
评估实施情况，并确定实施、可持续性和可扩展性的障碍和促进因素，以向基层卫生工作者（LHW）提供实施干预措施所需的知识、技能和工具，以支持患者结核病（TB）治疗依从性。
混合方法设计，包括一项基于 RE-AIM 框架的集群随机对照试验和过程评估。
马拉维东南部四个地区的 45 个卫生中心（HCs），有机会接受级联培训。
45 名同伴培训师（PTs）、23 名患者和 20 名 LHW。
实施策略采用同伴主导的教育外展、临床支持工具和同伴支持网络，以实施结核病治疗依从性干预措施。
从研究开始到结束，收集了过程数据PT 会议，包括：LHW 和患者访谈、季度 PT 会议记录、培训日志以及研究团队的观察和会议记录。首先对数据来源进行单独分析，然后进行方法、数据源和分析员三角分析。由两名研究团队成员独立进行分析，并根据需要通过讨论和增加研究团队成员的参与来修订主题。
41 个 HC（91%）培训了至少一名 LHW。在研究开始时有资格参加的 256 名 LHW 中，有 152 名（59%）完成了培训，每个 HC 的培训比例在初始级联培训结束时从 0%到 100%不等。缺乏培训激励是实施的主要障碍，而提高知识和技能、改善患者护理和结果的内在动机是参与的主要促进因素。
我们确定了实施、可扩展性和可持续性的重要挑战和潜在促进因素，以及结核病治疗依从性干预措施。研究结果为扩大规模以及使用所采用的实施策略提供了指导，以解决其他地区的 LHW 培训和监督问题。
NCT02533089。
