Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings.
BACKGROUND
The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.


METHODS
The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.


RESULTS
The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.


CONCLUSIONS
Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. anna.bergstrom@kbh.uu.se.
Anna
A
Bergström
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. skeen@sun.ac.za.
Sarah
S
Skeen
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. dmd@hsph.edu.vn.|Hanoi School of Public Health, Hanoi, Vietnam. dmd@hsph.edu.vn.
Duong M
DM
Duc
Fundacion Coordinación de Hermanamientos e Iniciativas de Cooperación CHICA, León, Nicaragua. fundchica@gmail.com.
Elmer Zelaya
EZ
Blandon
Faculty of Nursing, University of Alberta, Edmonton, Canada. carole.estabrooks@ualberta.ca.
Carole
C
Estabrooks
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. petter.gustavsson@ki.se.
Petter
P
Gustavsson
Hanoi School of Public Health, Hanoi, Vietnam. phuonghoa55@yahoo.com.|Research Institute for Child Health, National Hospital of Paediatrics, Hanoi, Vietnam. phuonghoa55@yahoo.com.
Dinh Thi Phuong
DT
Hoa
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. carina.kallestal@kbh.uu.se.
Carina
C
Källestål
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. mats.malqvist@kbh.uu.se.
Mats
M
Målqvist
Research Institute for Child Health, National Hospital of Paediatrics, Hanoi, Vietnam. nga.nguyen@kbh.uu.se.
Nguyen Thu
NT
Nga
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. lars-ake.persson@kbh.uu.se.
Lars-Åke
LÅ
Persson
Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. jpervin@icddrb.org.
Jesmin
J
Pervin
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. stefan.peterson@kbh.uu.se.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. stefan.peterson@kbh.uu.se.|School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. stefan.peterson@kbh.uu.se.
Stefan
S
Peterson
Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. arahman@icddrb.org.
Anisur
A
Rahman
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. katarina.selling@kbh.uu.se.
Katarina
K
Selling
Ottawa Hospital Research Institute, Ottawa, Canada. jasquires@ohri.ca.|School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. jasquires@ohri.ca.
Janet E
JE
Squires
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. markt@sun.ac.za.
Mark
M
Tomlinson
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. pwaiswa2001@yahoo.com.|School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. pwaiswa2001@yahoo.com.
Peter
P
Waiswa
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. lars.wallin@du.se.|Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. lars.wallin@du.se.
Lars
L
Wallin
D018672:Community Health Planning / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D003906:Developing Countries; D055317:Evidence-Based Practice / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D015203:Reproducibility of Results