Response process and test–retest reliability of the Context Assessment for Community Health tool in Vietnam

Abstract

BackgroundThe recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low- and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items.ObjectiveThe study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam.DesignsTo investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test–retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland–Altman plots).ResultsIn general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test–retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5–0.7), demonstrating that the instrument has an acceptable level of stability.ConclusionsThis study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.

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

“…For the Sources of knowledge dimension, respondents indicate for each of five knowledge sources whether the source is available, and, where available, the frequency of its use ( never, rarely, occasionally, frequently and almost always ) [14]. In addition to the 49 original COACH items, the version used in this study contained seven demographic questions (age, gender, professional qualification, year professional qualification obtained, health facility, department (if applicable) and years working at the current facility).…”

“…Attention was paid to the participants’ level of understanding and whether they had any challenges in rating their level of agreement with the items. Identified problems were translated into English and categorized in two ways: (a) by the magnitude of their effect on the collected data (prominent vs. minor) [14]; and (b) by Conrad and Blair’s taxonomy [23] (see Table 2). All identified problems were also discussed in relation to the underlying cause of the problem, i.e.…”

“…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].…”

“…COACH has been found to have psychometrically acceptable properties amongst physicians, nurses, midwives and community health providers in the countries where it was developed [16]. However, being a relatively new tool there is a need to generate further evidence to establish reliability and validity in diverse samples and settings [14]. …”

Engaging Community Leaders in the Development of a Cardiovascular Health Behavior Survey Using Focus Group–Based Cognitive Interviewing

“… 11 Historically, cognitive interviews have been conducted via face-to-face interviews, with one individual at a time. 12 , 13 Community-based participatory research studies have evaluated community involvement in health survey development; however, there are few published studies that we are aware of describing focus group–based CI for survey development 14 – 17 and for purposes of quantitative studies. 18 …”