Implementation Research – Practical Guides

Are you wanting to increase your knowledge about how to do Implementation Research? Well, there are 2 excellent resources available to help you out.

1.  Implementation Research in Health:  A Practical Guide David H. Peters, Nhan T. Tran, Taghreed Adam Alliance for Health Policy and Systems Research and WHO, 2013

http://who.int/alliance-hpsr/alliancehpsr_irpguide.pdf

2.  Implementation Research :  A Synthesis of the Literature, Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. and Wallace, F University of South Florida, 2005

http://nirn.fpg.unc.edu/resources/implementation-research-synthesis-literature

http://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/imce/images/nirn-monogrpah-cover-lg.png

Over the past decade, the science related to developing and identifying “evidence-based practices and programs” has improved- however the science related to implementing these programs with fidelity and good outcomes for consumers lag far behind. To this end, our intent is to describe the current state of the science of implementation, and identify what it will take to transmit innovative programs and practices to mental health, social services, juvenile justice, education, early childhood education, employment services, and substance abuse prevention and treatment. This monograph summarizes findings from the review of the research literature on implementation and proposes frameworks for understanding effective implementation processes. The results of this literature review and synthesis confirm that systematic implementation practices are essential to any national attempt to use the products of science – such as evidence-based programs – to improve the lives of its citizens.

For all list information and functions, see: http://lists.coregroup.org/lists/info/cgcommunity

(With thanks to Karen LeBan and the CORE Group cgcommunity) [Forwarded from CORE Group] Courtesy HIFA2015

I would like to add another valuable resource for implementation research. It is the Implementation Research Toolkit, which was designed to help people learn a standard process that would lead to results that could be compared across regions and countries. It is designed to help identify system bottlenecks and the stakeholders to be involved, formulate appropriate research questions, conduct the research and develop a plan for implementing the study results.

TDR, the Special Programme for Research and Training in Tropical Diseases, led this project. Over 200 researchers, academics, disease control programme managers, policy-makers, health administrators, communication scientists and journalists contributed to test and evaluate the toolkit. Major funding was provided by USAID, with additional support from the Implementation Research Platform at the World Health Organization.

Full information, including the toolkit, a facilitator’s guide, and a video are available free of charge here: http://www.who.int/tdr/publications/topics/ir-toolkit/en/

Who can use this toolkit?

  • – Health care service providers
  • – Programme staff
  • – Researchers
  • – Decision-makers
  • – Finance and administration officers
  • – Media

Learn how to:

  • – Identify barriers to implementation and formulate the research question
  • – Make your case for funding
  • – Set up a study design and appropriate methodologies
  • – Plan the project (budget, personnel, timelines, monitoring and evaluation)
  • – Collect, analyse and present research information
  • – Develop a dissemination plan
  • – Monitor and evaluate your research project

Jamie Guth

Patient Information Forum (UK)

The Patient Information Forum (PiF) is the UK association for professionals that work in the field of consumer health information. (I would be interested to learn of other similar associations, especially in low- and middle-income countries – indeed, is there a global “Patient Information Forum”?). The website is http://www.pifonline.org.uk/ PiF is creating ‘the UK’s first practical, producer-led guidance and best practice on creating great health information resources…’ The report is available here: http://www.pifonline.org.uk/wp-content/uploads/2014/06/Report-on-engagement-events-creating-health-information-that-really-works-June-2014.pdf ‘… a number of issues appeared consistently across all topics and arguably form a set of overarching principles for creating consistently good health information. These principles include (this list is not exhaustive):

  • 1. Have a clear purpose for the information and share this with all involved
  • 2. Talk to and involve potential users from the start and throughout: ‘follow the information user at all stages’
  • 3. Less is more…keep information simple and clear
  • 4. Personalise information wherever possible; one size does not fit all
  • 5. Make sure information works in the ‘real world’ for all involved or affected
  • 6. Check what’s already available and think outside your organisation: link to and share good work, knowledge and expertise across professional boundaries and across the professional/patient/public boundary
  • 7. Information shouldn’t stand alone. It needs support, so it can become knowledge, education and empowerment.’

Best wishes, Neil

Government sets 1.5-million target for homes — and then aims to exit

HUMAN Settlements Minister Lindiwe Sisulu is aiming to deliver about 1.5-million houses and “housing opportunities” over the next five years to reduce significantly the estimated backlog of 2.3-million houses. But she would then like to see the state step away from the large-scale provision of housing for the poor. This is because she believes it creates a syndrome of dependency….more

EDITORIAL: Nkwinti laws will not solve crisis

RURAL Development and Land Reform Minister Gugile Nkwinti emphasised during his budget vote speech last week that stability and conformity with the constitution are central to government land reform policy. And as proof of its determination to press on with the process, which has fallen well short of the state’s self-imposed targets, he pointed to five pieces of draft legislation his department intends passing this year….more

Mobile health and street theatre to improve maternal and child health in Bihar

Courtesy HIFA2015

(With thanks to HIFA Steering Group member John Liebhardt)

I was interested to read this article on the BBC Media Action website. The full article is freely available here:

http://www.bbc.co.uk/mediaaction/where_we_work/asia/india/india_sdp_overview_august_2012.html

As a personal comment, I am encouraged that the project will include ‘10,000 street theatre performances’ – this is a strong endorsement of the importance and continued relevance of traditional methods of health communication. Also, this combined approach to health communication (including traditional as well as new media) seems likely to be more effective than either approach used alone.

Are any HIFA members working with this project? If so, please do tell us more about it…

‘The Ananya programme, funded by the Bill & Melinda Gates Foundation, aims to reduce child mortality, improve maternal health and reduce infectious diseases in Bihar [India]. As a project partner, BBC Media Action has adopted a pioneering approach to improve the demand and uptake of life-saving family health behaviours amongst the population of 104 million.’

‘Reaching this enormous audience through traditional forms of media is difficult. Only 27% of young mothers have access to any traditional media (TV, radio, newspapers or cinema). But add mobile phones to the mix and access goes up dramatically to 90%.’

‘BBC Media Action has therefore adopted what has been called ‘a 360-degree approach’ ­ a combination of face-to-face communication, Information Communication Technology (ICT), mass media and community work ­ which is being implemented on an unprecedented scale[…]’

‘BBC Media Action has developed two innovative mobile phone services for CHWs: a training course called Mobile Academy, and an on-demand service called Mobile Kunji which is supported by a deck of cards illustrated with life-saving messages…’

‘10,000 street theatre performances and 6000 women’s listener clubs will further engage and inform families about critical family health issues. All these elements focus on the critical 33-month timeline from when a woman becomes pregnant until her child is two years old. The objective is to shift social norms and empower those who lack the information and power to make informed choices about their health.’

‘To implement this project called ?Shaping Demand and Practices, BBC Media Action leads a consortium that includes Pathfinder International, the GSMA Development Fund and Madison World. This consortium works in close partnership with the government of Bihar at all stages.’

Neil, HIFA2015

Mobile apps that help clinicians find evidence-based answers

Thanks to HIFA member Irina Ibraghimova for the July 2014 issue of the AIHA Internet Resources Digest (American International Health Alliance)

This free newsletter contains descriptions of several “free and low-cost apps that help clinicians find evidence-based answers to their questions at a point-of-care”:

  • – PubMed for Handhelds
  • – LactMed App
  • – Medscape
  • – Evidence Central
  • – 5-Minute Clinical Consult
  • – ACP Clinical Guidelines from the American College of Physicians
  • – QMDT (Quick Mobile Diagnosis & Treatment)
  • – Guideline Central
  • – EBM Rater
  • – Evidence-based Medicine Toolkit
  • – Qx Calculate
  • For further details, see http://www.healthconnect-intl.org/resources.html

Which apps have you tried and which do you find most useful?

These apps are (I think) primarily aimed at health professionals in high-income countries. I would be very interested to learn from HIFA members about their applicability in low-resource settings.

Also, the newsletter points to an interesting related article ’10 mobile applications for evidence based medicine’:

“Evidence-based medicine has quickly moved from the background to the forefront as a determiner of treatment pathways, and the mobile health app marketplace has responded in kind. Dozens of EBM apps are available in Apple’s App-Store and Google’s Android Play for smartphones and tablets, many from major medical institutions and most of them free or for a nominal fee. …When doctors are overwhelmed with data points and don’t have the time or bandwidth to read through all the journals and abstracts, these programs can separate the signal from the noise and allow them to focus on the most relevant information, as well as making sure they answer the right questions.”

http://www.mhealthnews.com/slideshow/10-mobile-apps-evidence-based-medicine

Let’s build a future where people are no longer dying for lack of healthcare knowledge: Join HIFA www.hifa2015.org

New Pathfinder Cue Cards for Counseling Adults on Contraception

I’m happy to share a new tool from Pathfinder International that may be of help to programs working in community- and facility-based contraceptive counseling and service provision: Cue Cards for Counseling Adults on Contraception: http://www.pathfinder.org/publications-tools/cue-cards-for-counseling-adults.html. The cue cards were developed to support a range of providers (such as facility-based providers, community health workers, pharmacists, outreach workers, counselors, and peer providers) in counseling adults on their contraceptive options. The cards can be adapted to meet local circumstances and contexts.

The cue cards cover the following methods:

 *   Implants

 *   Male Sterilization

 *   Female Sterilization

 *   Intrauterine Device (IUD)

 *   Lactational Amenorrhea Method (LAM)

 *   DMPA (injectables)

 *   Combined Oral Contraceptives (COCs)

 *   Progestin-Only Pills (POPs)

 *   Standard Days Method (SDM)

 *   Male Condom

 *   Female Condom

 *   Emergency Contraceptive Pills (ECPs)

A French version of the cards will be available in the coming months. I’d also like to remind you that programs targeting adolescents can use Pathfinder’s Cue Cards for Counseling Adolescents on Contraception<http://www.pathfinder.org/publications-tools/cue-cards-for-counseling-adolescents-on-contraception.html> (available in English, French, and Portuguese).

Please share widely and feel free to email me with any questions.

Apologies for cross-posting!

Best,

Olivia

Olivia Moseley

Technical Advisor for Instructional Design, Technical Services Unit

omoseley@pathfinder.org<mailto:omoseley@pathfinder.org> | skype: pathfinder.olivia.moseley

Tel: +1.617.972.1361

The Lancet: Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths?

‘Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person)’. This is one of the central messages of a 24-page paper in the Newborn Series in the current issue of The Lancet (26 July). Below is the citation and summary. The full text is freely available here (after free registration):

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60792-3/abstract

As a personal comment, it seems likely that many of the basic interventions listed by the authors are often locally available but are not provided in a timely manner for those who subsequently die. The reasons for failure to provide locally available interventions include deficits in basic healthcare knowledge among citizens and health workers. I would be interested to learn more about the gap between local availability of interventions and their actual implementation.

CITATION: Bhutta Z A et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet, Volume 384, Issue 9940, Pages 347 – 370, 26 July 2014 doi:10.1016/S0140-6736(14)60792-3

SUMMARY: ‘Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6—2·1 million]), 33% of stillbirths (0·82 million [0·60—0·93 million]), and 54% of maternal deaths (0·16 million [0·14—0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality—preterm, intrapartum, and infection-related deaths—by 58%, 79%, and 84%, respectively.’

Neil, HIFA2015

New WHO publications

Below are selected new WHO publications (with thanks to WHO Press). All are available for free download at the URLs shown.

WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention

This guideline provides recommendations for strategies for a screen-and-treat programme. It is intended primarily for policy-makers, managers, programme officers, and other professionals in the health sector who have responsibility for choosing strategies for cervical cancer prevention, at country, regional and district levels.

http://apps.who.int/iris/bitstream/10665/94830/1/9789241548694_eng.pdf

WHO Recommendations for Augmentation of Labour

The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labour and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programmes, and public health policy-makers in all settings.

http://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf

Clinical Practice Handbook for Safe Abortion

This handbook is oriented to providers who already have the requisite skills and training necessary to provide safe abortion and/or treat complications of unsafe abortion.

http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf

Psychological First Aid: Facilitator’s Manual for Orienting Field Workers

The instructions and materials in this manual are for a half-day orientation (4 hours excluding breaks) to prepare helpers to support people recently affected by very stressful events. This facilitator’s manual is to be used together with the Psychological First Aid: Guide for Field Workers.

http://apps.who.int/iris/bitstream/10665/102380/1/9789241548618_eng.pdf

eHealth and innovation in women’s and children’s health: a baseline review

This report shows how, on a daily basis, eHealth innovations are improving access to care and assisting women to take control of their own health. Advances such as these are providing pregnant women, mothers and young children with better health care services and advice.

http://www.who.int/goe/publications/baseline/en/

Atlas of eHealth Country Profiles 2013: eHealth and Innovation in Women’s and Children’s Health

This publication is based on the 2013 WHO/ITU joint survey that explored the use of eHealth for women’s and children’s health in countries that are covered by the Commission on Information and Accountability for Women’s and Children’s Health (CoIA).

http://www.who.int/goe/publications/atlas_2013/en/

Best wishes,

Neil

Toll free mobile communication for maternal and neonatal emergencies in Rural Bangladesh

A new study from Bangladesh looks at the potential for toll-free mobile telephony to reduce maternal and newborn deaths, enabling mothers and birth attendants to get help and advice in emergencies. Below is the citation and abstract. The full text is open-access.

‘There are many factors responsible for maternal death in Bangladesh; the factors are more than 80% of deliveries are conducted at home with untrained birth attendants [2], delays in recognition of maternal complications [3] and limited referral linkages and transportation for emergency obstetric care [4,5]. In addition, lack of knowledge on maternal and newborn danger signs could delay the access to health care during maternal health complications and delayed access to care affect poor birth outcomes [6]…  Health care telephonic advice is recommended as one of the possible solutions to the low income countries in order to address these gaps.’

CITATION: Huq NL et al Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh

Reproductive Health 2014, 11:52  doi:10.1186/1742-4755-11-52

http://www.reproductive-health-journal.com/content/11/1/52/abstract

ABSTRACT (provisional)

Background: Toll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications.

Methods: In-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted.

Results: Prior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with Solution Linked Group.

Conclusions: The use of mobile technology in this intervention took a leap from simply rendering information to providing more rapid services. Active participation of service providers along with mothers’ accessibility motivated both the service providers and mothers to communicate through mobile phone for maternal health issues. These altogether made the shift towards adoption of an innovation.

Condemn war in Gaza in terms of global law

THE latest outburst of aggression in the intractable conflict between Israel and Palestine inflames emotions everywhere. In the past few weeks, thousands protested in cities such as Cape Town, London, Paris and Frankfurt. Many consider the military attacks on Gaza to be in violation of international humanitarian law and international human rights law. South African public intellectuals have been particularly vocal on Israel’s treatment of Palestinians….more

Better, shorter TB treatment – thanks to SA scientists

South African scientists may be en route to developing shorter, better tuberculosis (TB) treatment, according to research released at the International AIDS Conference in Melbourne, Australia. Researchers from the universities of Cape Town, Stellenbosch and the Free State were part of the international team that recently discovered that a new combination of drugs was able to kill more TB bacteria more quickly than standard treatment…..more

10 steps to develop black professors

Xolela Mangcu has a plan to transform SA’s professoriate. Universities are arguably the most influential institutions in any society. Governments, businesses, newspapers, television and radio networks are run by university graduates. Universities produce the theories, ideas, technologies and products upon which the modern world is built…..more

 

Show leadership and respond to Nkandla report, Maimane tells Zuma

DA Parliamentary leader Mmusi Maimane has dared President Jacob Zuma to show leadership or step aside. In a speech marked by loud howls and heckling from ANC benches, Maimane advised Zuma to take the lead on critical issues facing the country such as labour unrest, the crisis at the SABC, unemployment and to encourage respect for institutions of state such as the Public Protector and the National Prosecuting Authority….1 2

ANC warns EFF not to disrupt parliamentary proceedings in the future

The Economic Freedom Fighters (EFF) rocketed into Parliament and the country’s provincial legislatures on a ticket of revolution, evolution and genuine social change. Now they’re fighting about clothes. The fighters’ insistence on wearing red overalls and domestic workers’ outfits has given their opponents yet another stick to beat them with…..1 2

The Global Health Network’s new interactive process map could help transform health research around the world

The Global Health Network has launched a brand new, interactive Global Health Research Process Map, the first digital toolkit designed to enable researchers anywhere in the world to initiate rigorous global health research studies. As the HIFA community know all too well, health research is often lacking in the regions where evidence to improve health is needed most. Crucial evidence is not being generated because doctors and nurses lack access to training, information, and support. Effort is also regularly duplicated or conducted using different criteria in different territories and studies, and sometimes it falls by the wayside from lack of simple resources and guidance on best practice. The Global Health Research Process Map (http://processmap.org/) is set to change this. It’s an open-access internationally-available online resource that guides every process and method needed to initiate a health research study. For each step researchers and their staff are provided with the information, support and training that they need to successfully run a health study. Researchers will also gain the opportunity to engage with their peers along the way, aiding collaboration and the spread of ideas.

The Process Map was released just over one week ago, and has already generated nearly 2,500 views from around the world. It is the product of four years of best practice gathered and refined by the research community who use the pioneering Global Health Network to guide and support their effort to conduct research in challenging settings. The Global Health Network works like an online science park for exchanging knowledge, sharing research methods and facilitating collaboration among global health professionals to fuel faster and better evidence to improve health. The Global Health Network facilitates global partnerships between researchers ­ allowing researchers in low-resource settings and those with more support to learn from each other ­ and conduct research studies in places where this is difficult and unusual.

The Process Map is a pioneering research tool that centralises the information and resources that researchers anywhere in the world need to develop and initiate rigorous and effective global health studies. It has the potential to revolutionise the current process, speeding the development of new drugs and vaccines, and improving how diseases are managed. With this toolkit, researchers can access the guidance, training and support that they need in order to run their own studies. This is important because there is much evidence that shows that locally-led research rarely happens in low-income settings because health workers lack research skills and any access to training and support. Therefore the Global Health Network is meeting that gap and the Global Health Research Process Map will take them through the process of conducting accurate research, step-by-step.

Visit the tool today, and click on each node to access formally written information, links to eLearning courses, guidance articles, discussions, blogs, up-to-date news, and all sorts of tools and templates which will help you complete each step. As with everything else on the Global Health Network, it’s completely free and open-access, and always will be. Your feedback is always greatly appreciated, so feel free to have a look and leave comments, either here or on the map itself.

Thank you!Tamzin

Tamzin Furtado

Project Manager

The Global Health Network

Interview with Wiley: Why we started HIFA and why it’s so important

 Dear HIFA colleagues,

I was interviewed recently by the publisher Wiley about why we started HIFA and why it’s so important:

http://exchanges.wiley.com/blog/2014/07/14/saving-lives-by-spreading-knowledge/ 

Please forward this message/link to your contacts and networks to help raise global awareness, and encourage more people to join HIFA by going to hifa2015.org

Many thanks, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge: Join HIFA www.hifa2015.org

HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info ), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru.  For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is also interested in the wider potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK. www.hifa2015.org neil.pakenham-walsh AT ghi-net.org