I-RREACH: an engagement and assessment tool for improving implementation readiness of researchers, organizations and communities in complex interventions.
BACKGROUND
Non-communicable chronic diseases are the leading causes of mortality globally, and nearly 80% of these deaths occur in low- and middle-income countries (LMICs). In high-income countries (HICs), inequitable distribution of resources affects poorer and otherwise disadvantaged groups including Aboriginal peoples. Cardiovascular mortality in high-income countries has recently begun to fall; however, these improvements are not realized among citizens in LMICs or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Aboriginal people. It is critical to develop multi-faceted, affordable and realistic health interventions in collaboration with groups who experience health inequalities. Based on community-based participatory research (CBPR), we aimed to develop implementation tools to guide complex interventions to ensure that health gains can be realized in low-resource environments.


METHODS
We developed the I-RREACH (Intervention and Research Readiness Engagement and Assessment of Community Health Care) tool to guide implementation of interventions in low-resource environments. We employed CBPR and a consensus methodology to (1) develop the theoretical basis of the tool and (2) to identify key implementation factor domains; then, we (3) collected participant evaluation data to validate the tool during implementation.


RESULTS
The I-RREACH tool was successfully developed using a community-based consensus method and is rooted in participatory principles, equalizing the importance of the knowledge and perspectives of researchers and community stakeholders while encouraging respectful dialogue. The I-RREACH tool consists of three phases: fact finding, stakeholder dialogue and community member/patient dialogue. The evaluation for our first implementation of I-RREACH by participants was overwhelmingly positive, with 95% or more of participants indicating comfort with and support for the process and the dialogue it creates.


CONCLUSIONS
The I-RREACH tool was designed to (1) pinpoint key domains required for dialogue between the community and the research team to facilitate implementation of complex health interventions and research projects and (2) to identify existing strengths and areas requiring further development for effective implementation. I-RREACH has been found to be easily adaptable to diverse geographical and cultural settings and can be further adapted to other complex interventions. Further research should include the potential use of the I-RREACH tool in the development of blue prints for scale-up of successful interventions, particularly in low-resource environments.
Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada. mmaar@nosm.ca.
Marion
M
Maar
Department of Medicine, Queens University, Kingston, ON, Canada. yeatesk@queensu.ca.
Karen
K
Yeates
Riverstone Research Consulting, Guelph, ON, Canada. marcbarron12@gmail.com.
Marcia
M
Barron
Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada. Diane.Hua@sunnybrook.ca.
Diane
D
Hua
University of Ottawa Heart Institute, Ottawa, ON, Canada. PLiu@ottawaheart.ca.
Peter
P
Liu
Department of Research, Advocacy and Health Promotion, Heart and Stroke Foundation of Ontario, Toronto, ON, Canada. mmoylumkwong@gmail.com.
Margaret
M
Moy Lum-Kwong
Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada. Nancy.Perkins@sunnybrook.ca.
Nancy
N
Perkins
Department of Medicine, Queens University, Kingston, ON, Canada. jessica.sleeth@queensu.ca.
Jessica
J
Sleeth
Department of Medicine, Western University, London, ON, Canada. joshuasamueltobe@gmail.com.
Joshua
J
Tobe
Wikwemikong Health Centre, Wikwemikong, ON, Canada. mjwabano@wikyhealth.ca.
Mary Jo
MJ
Wabano
Noojmowin Teg Health Centre, Little Current, ON, Canada. p.williamson@noojmowin-teg.ca.
Pamela
P
Williamson
Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada. Sheldon.Tobe@sunnybrook.ca.|Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada. Sheldon.Tobe@sunnybrook.ca.
Sheldon W
SW
Tobe
D002170:Canada / Q000453:epidemiology; D003150:Community Health Workers / Q000458:organization & administration; D055812:Community-Based Participatory Research / Q000458:organization & administration*; D003661:Decision Support Techniques; D003906:Developing Countries; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D007198:Indians, North American; D011204:Poverty Areas; D012107:Research Design; D012111:Residence Characteristics; D012307:Risk Factors; D064890:Social Determinants of Health; D013636:Tanzania / Q000453:epidemiology