Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
World Child Cancer, London, United Kingdom.
JCO Glob Oncol. 2022 Sep;8:e2200151. doi: 10.1200/GO.22.00151.
PURPOSE: This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD: Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS: We identified six themes-affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement-that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION: Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.
目的:本研究旨在:(1) 评估儿童癌症预警症状和体征(EWSS)培训干预措施对医护人员(HCW)知识、态度和临床实践的感知效果;(2) 评估培训的实施难易程度,包括潜在的障碍和促进因素;(3) 为未来干预措施的迭代提供方案改进的见解。
方法:采用定性描述性研究设计,我们对 23 名接受过 EWSS 培训干预的加纳 HCW 进行了深入的半结构化访谈。我们在访谈过程中同时对数据进行迭代主题分析,并使用可接受性理论框架的修改版本来指导培训干预的评估。
结果:我们确定了六个主题——情感态度、负担、干预一致性、感知效果、自我效能和质量改进——这些主题构成了参与者对 EWSS 培训有效性的看法。参与者对培训干预措施普遍持积极态度,认为内容相对容易理解,并传达了培训对其日常实践的积极影响。然而,他们也指出了在现实世界中实施干预措施的挑战,包括患者对疾病的文化和宗教信仰、患者的经济限制以及资金不足的卫生系统。
结论:我们的研究结果表明,尽管以 HCW 为重点的培训干预措施有可能改善加纳和类似卫生系统环境中儿童癌症的及时诊断和转介,但需要针对患者和系统层面的实施挑战采取补充干预措施,将 HCW 知识的提高转化为对癌症患儿健康结果的持续影响。
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