Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study

Abstract

BackgroundIn the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention.MethodsA secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis.ResultsThe three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups.ConclusionsThis study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

“…Rather, we found that engaging leaders and other key stakeholders is vital to sustain change; although the NeoKIP trial was established in collaboration with representatives from various levels of the health system, those representatives were not sufficiently involved throughout the project’s lifetime. Again, this emphasizes the importance of assessing the needs before initiating a project, that is, by connecting to potential stakeholders and trying to understand which contextual factors might influence implementation already from the beginning [ 23 , 36 ]. Also, to tailor an intervention to include more health system representatives, particularly those in principal positions, is beneficial for achieving success and sustainability [ 37 ].…”

“…The facilitation strategy led to a reduction of neonatal mortality by almost 50% [ 22 ]. The reduction was detected during the third intervention year, indicating that facilitation is a time-consuming process, requiring substantial commitment and recognition of contextual factors [ 14 , 23 , 24 ].…”

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

“…Qualitative efforts to understand the healthcare context have previously yielded a more diverse description of context [18,19,32]. One strategy might thus be to use mixed-methods (quantitative and qualitative combined) when aiming to understand context in LMICs.…”

“…Consequently, the Context Assessment for Community Health (COACH) tool was developed in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua to assess modifiable aspects of the healthcare context that may influence the implementation of interventions and the integration of EBPs into clinical routines in LMICs [14–16]. The COACH concept originated from the context element of the PARIHS framework [10,17–19] and the interconnected health system building blocks presented by the World Health Organization (WHO) [20]. The tool evaluates health providers’ perceptions of the building blocks of the local health system.…”

Evaluating the implementation and sustainability of an evidence-based intervention: delivering Triple P within Indigenous child welfare agencies

“…The professionals who work with families living with the most disadvantage have a difficult task when implementing an EBP due to the demands of integrating often complex programs with their full workload and sometimes inadequate health systems (Haines, Kuruvilla, & Borchert, 2004). When implementing a program with disadvantaged communities, the practical aspects of program delivery must be taken into consideration, including the needs and capacity of the community and provider, intergenerational trauma in the community, level of complexity for the provider when moving from training to delivery in their workplace, the barriers to provider and community engagement, the availability and nature of the workforce, and the importance of community partnerships (Duong et al, 2015;Zhou et al, 2015).…”