Beyond the Science: Advancing the "Art and Craft" of Implementation in the Training and Practice of Global Health

Eboreime, Ejemai; Banke-Thomas, Aduragbemi

doi:10.34172/ijhpm.2020.131

Cited by 11 publications

(16 citation statements)

References 40 publications

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“…As the global health landscape changes, new conceptualizations about the skills global health leaders require to pursue health goals are being debated and the image of desk-bound bureaucrats as primary decision-makers is being contested [1]. The next generation of global health leaders is emerging from various disciplines and they need to experience what is happening in the field if they are to act and react appropriately, especially during times of crisis.…”

Section: Introductionmentioning

confidence: 99%

Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe

Rodríguez

Jessani

Zunt

et al. 2021

Annals of Global Health

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Objectives:The changing global landscape of disease and public health crises, such as the current COVID-19 pandemic, call for a new generation of global health leaders. As global health leadership programs evolve, many have incorporated experiential learning and mentoring (ELM) components into their structure. However, there has been incomplete consideration on how ELM activities are deployed, what challenges they face and how programs adapt to meet those challenges. This paper builds on the co-authors' experiences as trainees, trainers, organizers and evaluators of six global health leadership programs to reflect on lessons learned regarding ELM. We also consider ethics, technology, gender, age and framing that influence how ELM activities are developed and implemented.Findings: Despite the diverse origins and funding of these programs, all six are focused on training participants from low-and middle-income countries drawing on a diversity of professions. Each program uses mixed didactic approaches, practice-based placements, competency and skills-driven curricula, and mentorship via various modalities. Main metrics for success include development of trainee networks, acquisition of skills and formation of relationships; programs that included research training had specific research metrics as well. Common challenges the programs face include ensuring clarity of expectations of all participants and mentors; maintaining connection among trainees; meeting the needs of trainee cohorts with different skill sets and starting points; and ensuring trainee cohorts capture age, gender and other forms of diversity.Conclusions: ELM activities for global health leadership are proving even more critical now as the importance of effective individual leaders in responding to crises becomes evident. Future efforts for ELM in global health leadership should emphasize local adaptation and sustainability. Practice-based learning and established mentoring relationships provide the building blocks for competent leaders to navigate complex dynamics with the flexibility and conscientiousness needed to improve the health of global populations.

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Section: Introductionmentioning

confidence: 99%

Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe

Rodríguez

Jessani

Zunt

et al. 2021

Annals of Global Health

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“…Similarly, higher implementation fidelity of intervention is achieved when a program is acceptable to the participants responsible for the implementation and recipients of the intervention [ 23 – 25 ]. There is evidence from the literature that coaching, mentorship and supportive supervision is very effective in improving fidelity, acceptability and sustainability of the intervention [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical guidelines for managing hearing loss as a complication of drug-resistant tuberculosis treatment: an evaluation of implementation fidelity in Kano, Nigeria

Muhammad

Eboreime

Ogbonna

et al. 2022

BMC Health Serv Res

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Background Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB) and hearing loss. Despite several efforts directed toward its control, many patients fail to respond to treatment, having developed DR-TB. Lack of adherence to the DR-TB guidelines/improper implementation of the guideline has been identified as one of the factors impeding on effective treatment. This study sought to measure the implementation fidelity of health workers to management guidelines for hearing loss resulting from DR-TB treatment and to identify its determinants. Method A questionnaire-based cross-sectional study was conducted at the Infectious Disease Hospital, Kano. Implementation fidelity of the Programmatic Management guidelines for the treatment of Drug-resistant Tuberculosis was measured under the four domains of content, coverage, duration and frequency. The determinants examined are intervention complexity, facilitation strategies, quality of delivery and participant responsiveness as proposed by the Carroll et al. framework. Other determinants used are age, sex, professional cadre and work experience of healthcare providers. Results The Implementation fidelity score ranged from 40 to 64% with a mean of 47.6%. Quality of delivery, intervention complexity, participants’ responsiveness, and being a medical doctor exerted a positive effect on implementation fidelity while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity. Conclusion The implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment was low. Implementation fidelity should be assessed early and at intervals in the course of implementing the Programmatic Management of Drug-resistant Tuberculosis guideline and indeed, in the implementation of any intervention.

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“…The heterogeneity in current capability, the breadth of competencies required, the scale at which capacity needs to be built, and the critical need for context-appropriate learning revealed in our interviews suggest that traditional classroom-based training models are likely to be of limited value. Rather, there is the need for what Eboreime and Banke-Thomas call the “art and craft” of implementation training, that emphasizes “relationships, supportive supervision and coaching” [ 52 ]. Our findings suggest the need for a learning approach that builds upon individual participants’ existing strengths and knowledge, facilitates generation of context-specific IS knowledge, and is taught in an interactive format, with mentoring as an integral component.…”

Section: Discussionmentioning

confidence: 99%

Learning needs assessment for multi-stakeholder implementation science training in LMIC settings: findings and recommendations

Turner

Bogdewic

Agha

et al. 2021

Implement Sci Commun

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Background Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a “knowledge-practice gap,” where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. Methods We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30–60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. Results Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. Conclusion While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

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Beyond the Science: Advancing the "Art and Craft" of Implementation in the Training and Practice of Global Health

Cited by 11 publications

References 40 publications

Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe

Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe

Clinical guidelines for managing hearing loss as a complication of drug-resistant tuberculosis treatment: an evaluation of implementation fidelity in Kano, Nigeria

Learning needs assessment for multi-stakeholder implementation science training in LMIC settings: findings and recommendations

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