Context Matters

Gingold, Janet A.; Briccetti, Christine; Zook, Kathleen; Gillespie, Catherine W.; Gubernick, Ruth S.; Moon, Rachel Y.; Fu, Linda Y.

doi:10.1177/0009922815625874

Cited by 8 publications

(6 citation statements)

References 52 publications

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“…Others made a clear distinction between local contexts (as the implementation setting) and the broader contextual landscape [43]; for example, one study identified three distinct types of context-the setting of care context, the project-specific context and the wider general QI and implementation (QI&I) context [64]. Many studies considered and compared pre-and post-implementation contexts [38,41,46,48,67].…”

Section: Representations Of Context Within Improvement Settingsmentioning

confidence: 99%

“…This acknowledges activities often undertaken to modify improvement initiatives and implementation approaches to suit local conditions, in order to achieve 'fit' or integration with existing practices. Interactions between context and intervention were reported [54,68] and the interrelationship between intervention and context to achieve fit worked both ways: other studies reported on attempts to modify or 'improve' the local context prior to QI implementation in order to make it more supportive/receptive or to ameliorate the effects of contextual factors that impeded improvement efforts [48,51]. An example commonly mentioned was the alignment of national priorities to local work/improvement contexts or vice-versa [49,53,63].…”

Section: Managing Contextmentioning

confidence: 99%

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The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

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Background: Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? Methods: A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. Results: Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. Conclusions: This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.

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Section: Representations Of Context Within Improvement Settingsmentioning

confidence: 99%

Section: Managing Contextmentioning

confidence: 99%

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

View full text Add to dashboard Cite

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“…A simulação em ambientes virtuais, a gamificação da formação e a utilização de recursos multimídias são exemplos de alternativas para planejar processos formativos contextualizados, que dialoguem de modo estreito com a experiência profissional. Nessa mesma direção, Gingold et al (2016) reportam que o sucesso do e-learning na área da saúde tem sido associado com fatores contextuais, que [...] incluem a cultura organizacional, atitudes em direção à mudança, estrutura de poder, processos de tomada de decisão, infraestrutura de dados, experiência anterior da organização com implementação de aprimoramentos de qualidade, recursos disponíveis para apoiar a mudança e relacionamentos interpessoais dos indivíduos dentro da organização" (Tradução nossa. Gingold et al, 2016, p.2).…”

Section: Discussionunclassified

Em MarAberto: Perspectivas e desafios para uso de tecnologias digitais na educação permanente da saúde

Guizardi¹

2021

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“…The World Health Organisation recommends vaccines be stored and kept at temperatures between + 2°C and + 8°C to remain safe and potent (7). Inconsistent adherence to vaccine management guidelines might leave some communities vulnerable to outbreaks of vaccine preventable diseases and result in economic losses when vaccine potency is affected by compromised cold chain (17,18). Despite increased outreach immunization coverage in Uganda's hard to reach areas, several outbreaks of vaccine preventable diseases like measles have been reported over time leaving a lot of unanswered questions with policy makers and other stakeholders (2).…”

Section: Introductionmentioning

confidence: 99%

Gaps in vaccine management practices during Vaccination outreach sessions in rural settings in southwestern Uganda

Flavia

Eleanor

Bagenda

2023

Preprint

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Background Outreach efforts were developed to bolster people's access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. Methods For this observational descriptive study, qualitative methods were employed in 16 public health facilities across four districts of South Western Uganda (Kasese, Mitooma, Rubirizi and Rwampara). Data was gathered by means of semi-structured in-depth interviews, health facility record reviews, and observation. This enabled us to assess the vaccine management procedures prior to an immunization outreach session, the transportation means used, the set up at the outreach site, vaccine management practices during the outreach session and packing of leftover vaccines - all in relation to World Health Organization immunization practice recommendation. All interview data was transcribed and coded; categories were formed and triangulated with data from observation checklists and record reviews. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization outreach sessions and so identify any gaps in vaccine management guidelines. Results Overall, 51 individuals were interviewed - including four Assistant District Health Officers in charge of maternal and child health, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. Data collected identified several main areas of concern: insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. Issues in vaccine management were similar across immunization outreach sites regardless of whether there had been any vaccine preventable disease outbreaks in the district or not. The majority of these gaps were located at the individual level but were enabled by policy/environmental-level factors. Conclusions The research uncovered poor vaccine management procedures during outreach immunisations sessions, which were contrary to established health worker guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could significantly improve compliance with vaccine management protocols.

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Context Matters

Cited by 8 publications

References 52 publications

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

Em MarAberto: Perspectivas e desafios para uso de tecnologias digitais na educação permanente da saúde

Gaps in vaccine management practices during Vaccination outreach sessions in rural settings in southwestern Uganda

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