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BackgroundApproximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. ObjectiveOur objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. MethodsThis study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. ResultsConsensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. ConclusionsThis study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. International Registered Report Identifier (IRRID)DERR1-10.2196/17263

ObjectivesThe overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts.DesignA comparative case study approach, analysing variation in outcomes across different settings.SettingStudies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case.Participants28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria.InterventionsThe interventions included different mRDT training packages, supervision, supplies and community sensitisation.Outcome measuresAnalysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial).ResultsOutcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs.ConclusionsBasic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.

Qualitative comparative analysis (QCA) was originally developed as a tool for cross-national comparisons in macrosociology, but its use in evaluation and evidence synthesis of complex interventions is rapidly developing. QCA is theory-driven and relies on Boolean logic to identify pathways to an outcome (e.g., is the intervention effective or not?). We use the example of two linked systematic reviews on weight management programs (WMPs) for adults--one focusing on user views (a "views synthesis") and one focusing on the effectiveness of WMPs incorporating dietary and physical activity--to demonstrate how a synthesis of user views can supply a working theory to structure a QCA. We discuss how a views synthesis is especially apt to supply this working theory because user views can (a) represent a "middle-range theory" of the intervention; (b) bring a participatory, democratic perspective; and (c) provide an idiographic understanding of how the intervention works that external taxonomies may not be able to furnish. We then discuss the practical role that the views synthesis played in our QCA examining pathways to effectiveness: (a) by suggesting specific intervention features and sharpening the focus on the most salient features to be examined, (b) by supporting interpretation of findings, and (c) by bounding data analysis to prevent data dredging.

Background: Theories of change explaining how interventions work are increasingly important, yet the methods/data to develop these are less advanced than for evaluating effects. Methods: We conducted a systematic evidence synthesis to develop a theory of change for structural adolescent contraception interventions. We reflect on the utility of the information provided in evaluation reports. Findings/discussion: Few of the included evaluations presented their theory of change, or included rich, qualitative process data. Authors' descriptions of context and implementation, typically in introduction and discussion sections, were very useful. These helped to understand the intervention's context, how it was experienced and why or how it had the effect that it did. We recommend incorporating rich process evaluations into studies, and reporting contextual insights into the intervention's development, implementation and experience. We also recommend including these data and insights within syntheses that aim to develop theories of change. [ABSTRACT FROM AUTHOR]

This article explores the perceived value of public health research and the types of research considered useful in Ghana. Sixty-nine decision makers, researchers and stakeholders were interviewed. A broad range of research was highly valued. Two traits were important: an applied, relevant topic and quickly produced findings. Interviewees valued research which explored implementation issues or identified and increased understanding of health problems. Effectiveness research often lacked these traits and was not generally considered as important because it was implicitly assumed that as long as interventions (that were based on a good understanding of the situation) were implemented well, they would be effective.

Semi-structured interviews in Ghana and England explored perceptions of the usefulness and use of foreign research (ie, beyond the original study country) compared to locally conducted research (ie, conducted in Ghana). There was a preference for locally conducted studies, although interviewees generally recognised the potential usefulness of foreign research. Various factors affected whether foreign research was considered useful or used; it was not used automatically or indiscriminately. Researchers should recognise the potential usefulness of their research beyond the original study country. Further work is needed to explore how to maximise the utility of foreign research, as a means of enabling evidence-informed decision making where locally conducted research is not available.