{"title":"制定和试行实施战略,支持在四个撒哈拉以南非洲国家实施产后出血临床干预措施。","authors":"Gillian Forbes,Shahinoor Akter,Suellen Miller,Hadiza Galadanci,Zahida Qureshi,Fadhlun Alwy Al-Beity,G Justus Hofmeyr,Neil Moran,Sue Fawcus,Mandisa Singata-Madliki,Aminu Ado Wakili,Taiwo Gboluwaga Amole,Baba Maiyaki Musa,Faisal Dankishiya,Adamu Abdullahi Atterwahmie,Abubakar Shehu Muhammad,John Ekweani,Emily Nzeribe,Alfred Osoti,George Gwako,Jenipher Okore,Amani Kikula,Emmy Metta,Ard Mwampashi,Cherrie Evans,Kristie-Marie Mammoliti,Adam Devall,Arri Coomarasamy,Ioannis Gallos,Olufemi T Oladapo,Meghan A Bohren,Fabiana Lorencatto","doi":"10.9745/ghsp-d-23-00387","DOIUrl":null,"url":null,"abstract":"INTRODUCTION\r\nPostpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.\r\n\r\nMETHODS\r\nImplementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.\r\n\r\nRESULTS\r\nImplementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).\r\n\r\nCONCLUSION\r\nSystematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"5 1","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries.\",\"authors\":\"Gillian Forbes,Shahinoor Akter,Suellen Miller,Hadiza Galadanci,Zahida Qureshi,Fadhlun Alwy Al-Beity,G Justus Hofmeyr,Neil Moran,Sue Fawcus,Mandisa Singata-Madliki,Aminu Ado Wakili,Taiwo Gboluwaga Amole,Baba Maiyaki Musa,Faisal Dankishiya,Adamu Abdullahi Atterwahmie,Abubakar Shehu Muhammad,John Ekweani,Emily Nzeribe,Alfred Osoti,George Gwako,Jenipher Okore,Amani Kikula,Emmy Metta,Ard Mwampashi,Cherrie Evans,Kristie-Marie Mammoliti,Adam Devall,Arri Coomarasamy,Ioannis Gallos,Olufemi T Oladapo,Meghan A Bohren,Fabiana Lorencatto\",\"doi\":\"10.9745/ghsp-d-23-00387\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"INTRODUCTION\\r\\nPostpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.\\r\\n\\r\\nMETHODS\\r\\nImplementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.\\r\\n\\r\\nRESULTS\\r\\nImplementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).\\r\\n\\r\\nCONCLUSION\\r\\nSystematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.\",\"PeriodicalId\":12692,\"journal\":{\"name\":\"Global Health: Science and Practice\",\"volume\":\"5 1\",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Global Health: Science and Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.9745/ghsp-d-23-00387\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Health: Science and Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.9745/ghsp-d-23-00387","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries.
INTRODUCTION
Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.
METHODS
Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.
RESULTS
Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).
CONCLUSION
Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.
期刊介绍:
Global Health: Science and Practice (GHSP) is a no-fee, open-access, peer-reviewed, online journal aimed to improve health practice, especially in low- and middle-income countries. Our goal is to reach those who design, implement, manage, evaluate, and otherwise support health programs. We are especially interested in advancing knowledge on practical program implementation issues, with information on what programs entail and how they are implemented. GHSP is currently indexed in PubMed, PubMed Central, POPLINE, EBSCO, SCOPUS,. the Web of Science Emerging Sources Citation Index, and the USAID Development Experience Clearinghouse (DEC).
TOPICS:
Issued four times a year, GHSP will include articles on all global health topics, covering diverse programming models and a wide range of cross-cutting issues that impact and support health systems. Examples include but are not limited to:
Health:
Addiction and harm reduction,
Child Health,
Communicable and Emerging Diseases,
Disaster Preparedness and Response,
Environmental Health,
Family Planning/Reproductive Health,
HIV/AIDS,
Malaria,
Maternal Health,
Neglected Tropical Diseases,
Non-Communicable Diseases/Injuries,
Nutrition,
Tuberculosis,
Water and Sanitation.
Cross-Cutting Issues:
Epidemiology,
Gender,
Health Communication/Healthy Behavior,
Health Policy and Advocacy,
Health Systems,
Human Resources/Training,
Knowledge Management,
Logistics and Supply Chain Management,
Management and Governance,
mHealth/eHealth/digital health,
Monitoring and Evaluation,
Scale Up,
Youth.