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7. Examining intervention design:Lessons from the development of eight related malaria health care intervention studies

Author

Chandler, Clare I.R., Burchett, Helen, Boyle, Louise, Achonduh, Olivia, Mbonye, Anthony, Diliberto, Deborah, Reyburn, Hugh, Onwujekwe, Obinna, Haaland, Ane, Roca-Feltrer, Arantxa, Baiden, Frank, Mbacham, Wilfred F., Ndyomugyenyi, Richard, Nankya, Florence, Mangham-Jefferies, Lindsay, Clarke, Sian, Mbakilwa, Hilda, Reynolds, Joanna, Lal, Sham, Leslie, Toby, Maiteki-Sebuguzi, Catherine, Webster, Jayne, Magnussen, Pascal, Ansah, Evelyn, Hansen, Kristian S., Hutchinson, Eleanor, Cundill, Bonnie, Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G., Wiseman, Virginia, Lalloo, David G., Whitty, Christopher J.M., Chandler, Clare I.R., Burchett, Helen, Boyle, Louise, Achonduh, Olivia, Mbonye, Anthony, Diliberto, Deborah, Reyburn, Hugh, Onwujekwe, Obinna, Haaland, Ane, Roca-Feltrer, Arantxa, Baiden, Frank, Mbacham, Wilfred F., Ndyomugyenyi, Richard, Nankya, Florence, Mangham-Jefferies, Lindsay, Clarke, Sian, Mbakilwa, Hilda, Reynolds, Joanna, Lal, Sham, Leslie, Toby, Maiteki-Sebuguzi, Catherine, Webster, Jayne, Magnussen, Pascal, Ansah, Evelyn, Hansen, Kristian S., Hutchinson, Eleanor, Cundill, Bonnie, Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G., Wiseman, Virginia, Lalloo, David G., and Whitty, Christopher J.M.

Abstract

—Rigorous evidence of “what works” to improve health care is in demand, but methods for the development of interventions have not been scrutinized in the same ways as methods for evaluation. This article presents and examines intervention development processes of eight malaria health care interventions in East and West Africa. A case study approach was used to draw out experiences and insights from multidisciplinary teams who undertook to design and evaluate these studies. Four steps appeared necessary for intervention design: (1) definition of scope, with reference to evaluation possibilities; (2) research to inform design, including evidence and theory reviews and empirical formative research; (3) intervention design, including consideration and selection of approaches and development of activities and materials; and (4) refining and finalizing the intervention, incorporating piloting and pretesting. Alongside these steps, projects produced theories, explicitly or implicitly, about (1) intended pathways of change and (2) how their intervention would be implemented. The work required to design interventions that meet and contribute to current standards of evidence should not be underestimated. Furthermore, the process should be recognized not only as technical but as the result of micro and macro social, political, and economic contexts, which should be acknowledged and documented in order to infer generalizability. Reporting of interventions should go beyond descriptions of final intervention components or techniques to encompass the development process. The role that evaluation possibilities play in intervention design should be brought to the fore in debates over health care improvement.

Published
2016

8. Examining Intervention Design: Lessons from the Development of Eight Related Malaria Health Care Intervention Studies

Author

Chandler, Clare I. R., primary, Burchett, Helen, additional, Boyle, Louise, additional, Achonduh, Olivia, additional, Mbonye, Anthony, additional, DiLiberto, Deborah, additional, Reyburn, Hugh, additional, Onwujekwe, Obinna, additional, Haaland, Ane, additional, Roca-Feltrer, Arantxa, additional, Baiden, Frank, additional, Mbacham, Wilfred F., additional, Ndyomugyenyi, Richard, additional, Nankya, Florence, additional, Mangham-Jefferies, Lindsay, additional, Clarke, Sian, additional, Mbakilwa, Hilda, additional, Reynolds, Joanna, additional, Lal, Sham, additional, Leslie, Toby, additional, Maiteki-Sebuguzi, Catherine, additional, Webster, Jayne, additional, Magnussen, Pascal, additional, Ansah, Evelyn, additional, Hansen, Kristian S., additional, Hutchinson, Eleanor, additional, Cundill, Bonnie, additional, Yeung, Shunmay, additional, Schellenberg, David, additional, Staedke, Sarah G., additional, Wiseman, Virginia, additional, Lalloo, David G., additional, and Whitty, Christopher J. M., additional

Published
2016
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11. Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial

Author

Cundill, Bonnie, primary, Mbakilwa, Hilda, additional, Chandler, Clare IR, additional, Mtove, George, additional, Mtei, Frank, additional, Willetts, Annie, additional, Foster, Emily, additional, Muro, Florida, additional, Mwinyishehe, Rahim, additional, Mandike, Renata, additional, Olomi, Raimos, additional, Whitty, Christopher JM, additional, and Reyburn, Hugh, additional

Published
2015
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12. Bringing the state into the clinic? Incorporating the rapid diagnostic test for malaria into routine practice in Tanzanian primary healthcare facilities.

Author

Hutchinson, Eleanor, Reyburn, Hugh, Hamlyn, Eleanor, Long, Katie, Meta, Judith, Mbakilwa, Hilda, and Chandler, Clare

Subjects
MALARIA diagnosis, ATTITUDE (Psychology), CHANGE, HEALTH services accessibility, INTERVIEWING, MEDICAL quality control, MEDICAL personnel, QUALITY assurance, RESEARCH funding, DECISION making in clinical medicine, POINT-of-care testing, HEALTH & social status
Abstract

The roles that rapid, point-of-care tests will play in healthcare in low-income settings are likely to expand over the coming years. Yet, very little is known about how they are incorporated into practice, and what it means to use and rely upon them. This paper focuses on the rapid diagnostic test for malaria (mRDT), examining its introduction into low-level public health facilities in Tanzania within an intervention to improve the targeting of costly malaria medication. We interviewed 26 health workers to explore how a participatory training programme, mobile phone messages, posters and leaflets shaped the use and interpretation of the test. Drawing on notions of biopolitics, this paper examines how technologies of the self and mechanisms of surveillance bolstered the role mRDT in clinical decision-making. It shows how the significance of the test interacted with local knowledge, the availability of other medication, and local understandings of good clinical practice. Our findings suggest that in a context in which care is reduced to the provision of medicines, strict adherence to mRDT results may be underpinned by increasing the use of other pharmaceuticals or may leave health workers with patients for whom they are unable to provide care. [ABSTRACT FROM PUBLISHER]

Published
2017
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14. The practice of ‘doing’ evaluation: lessons learned from nine complex intervention trials in action

Author

Reynolds, Joanna, primary, DiLiberto, Deborah, additional, Mangham-Jefferies, Lindsay, additional, Ansah, Evelyn K, additional, Lal, Sham, additional, Mbakilwa, Hilda, additional, Bruxvoort, Katia, additional, Webster, Jayne, additional, Vestergaard, Lasse S, additional, Yeung, Shunmay, additional, Leslie, Toby, additional, Hutchinson, Eleanor, additional, Reyburn, Hugh, additional, Lalloo, David G, additional, Schellenberg, David, additional, Cundill, Bonnie, additional, Staedke, Sarah G, additional, Wiseman, Virginia, additional, Goodman, Catherine, additional, and Chandler, Clare IR, additional

Published
2014
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15. Perceptions of mothers and hospital staff of paediatric care in 13 public hospitals in northern Tanzania

Author

Mwangi, Rose, Chandler, Clare, Nasuwa, Fortunata, Mbakilwa, Hilda, Poulsen, Anja, Bygbjerg, Ib Christian, Reyburn, Hugh, Mwangi, Rose, Chandler, Clare, Nasuwa, Fortunata, Mbakilwa, Hilda, Poulsen, Anja, Bygbjerg, Ib Christian, and Reyburn, Hugh

Abstract

Udgivelsesdato: 2008-Aug, User and provider perceptions of quality of care are likely to affect both use and provision of services. However, little is known about how health workers and mothers perceive the delivery of care in hospital paediatric wards in Africa. Paediatric staff and mothers of paediatric inpatients were interviewed to explore their opinions and experience of the admission process and conditions on the ward. Overcrowding, unsanitary conditions and lack of food were major concerns for mothers on the ward, who were deterred from seeking treatment earlier due to fears that hospital admission posed a significant risk of exposure to infection. While most staff were seen as being sympathetic and supportive to mothers, a minority were reported to be judgemental and authoritarian. Health workers identified lack of trained staff, overwork and low pay as major concerns. Staff shortages, lack of effective training and equipment are established problems but our findings also highlight a need for wards to become more parent-friendly, particularly with regard to food, hygiene and space. Training programmes focused on professional conduct and awareness of the problems that mothers face in seeking and receiving care may result in a more supportive and cooperative attitude between staff and mothers.

Published
2008

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