title: Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam.
abstract: BACKGROUND
  Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention.
  
  
  METHODS
  Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models.
  
  
  RESULTS
  To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46).
  
  
  CONCLUSIONS
  This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.
  
  
  BACKGROUND
  ISRCTN ISRCTN44599712 .
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. leif.eriksson@kbh.uu.se.
authors.forename: Leif
authors.initials: L
authors.lastname: Eriksson
authors.affiliation: Nursing office, Department of Medical Services Administration, Ministry of Health, Hanoi, Vietnam. huyub@yahoo.com.
authors.forename: Tran Q
authors.initials: TQ
authors.lastname: Huy
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. duong_duc2002@yahoo.com.|Hanoi School of Public Health, Hanoi, Vietnam. duong_duc2002@yahoo.com.
authors.forename: Duong M
authors.initials: DM
authors.lastname: Duc
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. katarina.selling@kbh.uu.se.
authors.forename: Katarina
authors.initials: K
authors.lastname: Ekholm Selling
authors.affiliation: Hanoi School of Public Health, Hanoi, Vietnam. phuonghoa55@yahoo.com.
authors.forename: Dinh P
authors.initials: DP
authors.lastname: Hoa
authors.affiliation: Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam. nguyenthuyubh@gmail.com.
authors.forename: Nguyen T
authors.initials: NT
authors.lastname: Thuy
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. nga.nguyen@kbh.uu.se.|Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam. nga.nguyen@kbh.uu.se.
authors.forename: Nguyen T
authors.initials: NT
authors.lastname: Nga
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. lars-ake.persson@kbh.uu.se.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Persson
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. lars.wallin@du.se.|School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. lars.wallin@du.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
mesh_terms: D003266:Continuity of Patient Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018743:Perinatal Care; D015397:Program Evaluation; D012932:Social Facilitation; D057170:Translational Research, Biomedical; D014744:Vietnam