The Role of Implementation Science in Advancing Resource Generation for Health Interventions in Low- and Middle-Income Countries

Ojo, Temitope; Kabasele, Laetitia; Boyd, Bethanny; Enechukwu, Scholastica; Ryan, Nessa; Gyamfi, Joyce; Peprah, Emmanuel

doi:10.1177/1178632921999652

Cited by 25 publications

(30 citation statements)

References 26 publications

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“…Correct use of any evidence-based practice is integral to assuring impact, and quality of use must be measured and iteratively improved over time. Process evaluation is a strategy to identify and address gaps at each level of an intervention to maximize implementation success and address barriers to successful use ( 19 , 20 ). Understanding how PEWS impacts are interrelated helps explain how they are achieved.…”

Section: Discussionmentioning

confidence: 99%

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

et al. 2022

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BackgroundPediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers.MethodsWe conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution.ResultsPEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use.ConclusionsIn resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.

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Section: Discussionmentioning

confidence: 99%

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

et al. 2022

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“…When evidence discourse includes experience, researchers seem to present it as the need to understand the power dynamics of policymaking, politicians' needs, and the political landscape. Some implementation researchers note that to ensure the adoption of evidence-based policies, researchers and implementers must intentionally incorporate elements for successful implementation into the planning and formulation of policies (Bullock et al, 2021;Ojo et al, 2021;Proctor et al, 2011).…”

Section: Understanding Evidence-based Policymakingmentioning

confidence: 99%

“…This determinant framework incorporates contextual and determinant factors influencing the success or failure of policy implementations. Although other existing frameworks might adequately reveal and explain contextual issues, the CFIR appears to be the most common among LMICs (Means et al, 2020;Ojo et al, 2021). There are five CFIR domains: Intervention Characteristics, Characteristics of Individuals, Outer Setting, Inner Setting, and Process.…”

Section: Applying Consolidated Framework For Implementation Research ...mentioning

confidence: 99%

“…For instance, a systematic review by Means et al (2020) and Nnaji et al (2021) found that some researchers in LMICs applied the framework before implementing evidence-based interventions to identify barriers. Other researchers like Ojo et al (2021) and Gimbel et al (2016) applied CFIR to existing health services to map contextual factors influencing the implementation.…”

Section: Applying Consolidated Framework For Implementation Research ...mentioning

confidence: 99%

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The People-Centred Approach to Policymaking: Re-Imagining Evidence-Based Policy in Nigeria

Ndu

Ariba

Ohuruogu

2022

Glob Implement Res Appl

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The discourse on evidence-based policymaking in healthcare continues to explore sustainable solutions to current and emerging challenges. However, what constitutes evidence in health policymaking needs to be defined and agreed upon, especially in places with several forms of knowledge and ways of knowing. Researchers, policymakers, and other stakeholders must understand the value of people-centred approaches to health policies, given the increased focus on equitable distribution of power and resources for sustained health outcomes. This paper argues that people's values, lived experiences, and opinions are not always adequately considered when formulating health policies, especially in countries with diverse cultural and social norms. A country, like Nigeria, with many health challenges requires health policies based on contextual knowledge, given the country's diverse lived experiences and values. Implementation researchers note that to ensure the adoption of evidence-based policies, researchers and implementers must intentionally incorporate elements for successful implementation into the planning and formulation of policies. Evidence shows that the policy development process in public health does not always adequately capture informal knowledge in the policy formulation process. With the lack of data on the role of informal knowledge in policymaking, Nigerian researchers could begin to examine the potential benefits these types of knowledge could have on policies. Future research could explore, and document experiences and lessons learned from other fields to apply these to public health.

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“…Lessons from the treatment of HIV have demonstrated that even complex and expensive treatments are possible when accompanied by innovative treatment models and new investments [ 12 ]. Therefore, facilitating the successful adoption of medications like blinatumomab in LMICs requires an approach that addresses cost but also an implementation approach to maximize existing resources and address therapeutic challenges and barriers related to organizational context [ 19 ]. Currently, there is no implementation framework for novel pediatric cancer interventions in a global setting.…”

Section: Introductionmentioning

confidence: 99%

Evaluating blinatumomab implementation in low- and middle-income countries: a study protocol

Duffy

Santana

Inaba

et al. 2022

Implement Sci Commun

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Background The recent implementation of novel therapies has accelerated progress in pediatric cancer care. Despite the significantly poorer survival of patients in low- and middle-income countries (LMICs), administation complexities and other significant resource barriers have limited the translation of these novel therapies in these regions. This study aims to develop a model that can be used to support the implementation of novel therapies, such as blinatumomab (bispecific antibody therapy for B-cell acute lymphoblastic leukemia [B-ALL]) in LMIC centers, with the long-term goal of developing an implementation framework for similar future efforts. Methods In this study, mixed methods will be applied to understand the key contextual considerations that can be accounted for through a training program and prospectively designed implementation activities. The Consolidated Framework for Implementation Research will guide the activities related to implementation evaluation in parallel with a drug donation program. A multidisciplinary research team comprising high- and low-middle income healthcare professionals, industry, and implementation scientists has been assembled with the common goal of improving safe access to blinatumomab. To assess the factors affecting blinatumomab administration, semi-structured interviews with diverse collaborators and quantitative assessments of organizational characteristics will be conducted, together with quantitative and qualitative assessments of feasibility, acceptability, appropriateness, and cost of blinatumomab implementation. A quantitative assessment of stakeholder perceptions of different implementation strategies used as part of the multifaceted approach will also be performed. Finally, we will examine the key domains and processes used and construct the implementation roadmap for translation of novel therapies. Discussion This study will rigorously develop an implementation roadmap for translation of novel therapies in low-resource settings. The knowledge gained in the formative assessment will reveal the priority areas and key implementation strategies. Thereby, the resultant roadmap will facilitate future scale-out strategies for novel therapies in LMICs, thus increasing access, building capacity for management, and ultimately improving the care for children in LMICs.

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The Role of Implementation Science in Advancing Resource Generation for Health Interventions in Low- and Middle-Income Countries

Cited by 25 publications

References 26 publications

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

The People-Centred Approach to Policymaking: Re-Imagining Evidence-Based Policy in Nigeria

Evaluating blinatumomab implementation in low- and middle-income countries: a study protocol

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