Kalolo Albino, Kapologwe Ntuli A, Samky Hendry, Kibusi Stephen M
Department of Public Health, St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania.
Department of Health, Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania.
Int J Health Plann Manage. 2022 May;37(3):1381-1401. doi: 10.1002/hpm.3402. Epub 2021 Dec 24.
Despite wide agreement that stakeholder acceptability plays a critical role in an intervention's effectiveness, gaps remain on understanding acceptability of complex health financing interventions. We aimed to understand the moderators of acceptability of the Direct Health Facility Financing (DHFF) initiative across primary health facilities in Tanzania. Employing a mixed methods approach and guided by the theoretical framework for acceptability (TFA), we collected data from implementers and their supervisors using a structured questionnaire and semi-structured interview guides. We analysed data using a chi square test, logistic regression, and thematic analysis. We recruited 238 participants, of whom 71% were females and 54% were below 37 years old. Acceptability was found to be 63% and received high rating in qualitative interviews. Moderators of acceptability included sex (AOR = 1.93, p = 006), work experience (AOR = 3.47, p = 0.001), knowledge (13.8, p = 0.00), supportive work environment (AOR = 2.28, p = 0.019), and capability to implement the programme (AOR = 0.12, p = 0.00). Moderators reported in qualitative interviews related to individual and contextual factors. This study suggests that the DHFF initiative is acceptable and influenced by factors operating at the individual level and beyond. Addressing moderators of acceptability as programs are designed and implemented is the holy grail of acceptability of complex interventions.
尽管人们普遍认为利益相关者的可接受性对干预措施的有效性起着关键作用，但在理解复杂卫生筹资干预措施的可接受性方面仍存在差距。我们旨在了解坦桑尼亚初级卫生设施中直接卫生设施筹资（DHFF）倡议可接受性的调节因素。采用混合方法，并以可接受性理论框架（TFA）为指导，我们使用结构化问卷和半结构化访谈指南从实施者及其监督者那里收集数据。我们使用卡方检验、逻辑回归和主题分析对数据进行分析。我们招募了238名参与者，其中71%为女性，54%年龄在37岁以下。可接受性为63%，在定性访谈中获得了较高评价。可接受性的调节因素包括性别（调整后比值比[AOR]=1.93，p=0.006）、工作经验（AOR=3.47，p=0.001）、知识（13.8，p=0.00）、支持性的工作环境（AOR=2.28，p=0.019）以及实施该计划的能力（AOR=0.12，p=0.00）。定性访谈中报告的调节因素与个人和背景因素有关。本研究表明，DHFF倡议是可接受的，并受到个人层面及其他层面因素的影响。在设计和实施项目时解决可接受性的调节因素是复杂干预措施可接受性的关键所在。
