Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis
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Le résumé fourni par la source
Background Rheumatic heart disease is a high‐burden condition in Australian Aboriginal communities. We evaluated a stepped‐wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed‐methods evaluation, designed a priori , aimed to determine the association between methodological approaches and outcomes. Methods and Results An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health‐center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health‐center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project‐level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self‐management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study. Conclusions The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis
- Date Crossref
- 17/07/2018
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The Kids Research Institute Australia pays non établi dans la noticeOrganisation à but non lucratif
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The University of Western Australia Clancy Read Telethon Kids Institute pays non établi dans la noticeUniversité ou école supérieure
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Charles Darwin University pays non établi dans la noticeUniversité ou école supérieure
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The University of Sydney pays non établi dans la noticeUniversité ou école supérieure
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Lismore Base Hospital pays non établi dans la noticeÉtablissement de santé
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Australian National University pays non établi dans la noticeUniversité ou école supérieure
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Menzies School of Health Research pays non établi dans la noticeOrganisation à but non lucratif
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Baker Heart and Diabetes Institute pays non établi dans la noticeOrganisation à but non lucratif
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Centre for Remote Health pays non établi dans la noticeUniversité ou école supérieure
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Princess Margaret Hospital for Children pays non établi dans la noticeÉtablissement de santé
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Perth Children's Hospital pays non établi dans la noticeÉtablissement de santé
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Royal Darwin Hospital pays non établi dans la noticeÉtablissement de santé
The Kids Research Institute Australia, Clancy Read Telethon Kids Institute — The University of Western Australia et Charles Darwin University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.