PDF(Pubmed)
Abstract：
BACKGROUND: Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi.
METHODS: The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility.
RESULTS: The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers\' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges.
CONCLUSIONS: Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention\'s fidelity, feasibility, and sustainability.
METHODS: The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility.
RESULTS: The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers\' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges.
CONCLUSIONS: Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention\'s fidelity, feasibility, and sustainability.
摘要：
背景：尽管在过去的二十年中，抗击疟疾取得了巨大的成功，疟疾控制计划仅依靠两种杀虫方法：室内残留喷洒和经过杀虫处理的蚊帐。房屋改善（HI）可以通过减少人蚊接触来补充这些干预措施，从而加强减少疾病的收益。这项研究评估了实施保真度，这是对干预与其预期设计的一致性的评估，可行性,以及马拉维南部社区主导的HI的可持续性。
方法：研究，在22个村庄(2730户)进行，采用混合方法。使用修改后的框架评估了实现保真度，纵向调查收集HI覆盖率指标的数据。定量分析,采用描述性统计数据，评估了对HI实施的依从性。定性数据来自深度访谈，关键线人采访,以及涉及项目受益者和实施者的焦点小组。使用实施保真度模型指导的内容分析来分析定性数据，以探索促进者，挑战,影响干预可行性的因素。
结果：结果表明HI按计划实施。对预期的社区主导的HI设计有很好的遵守；然而，依从性可能更高,但随着时间的推移逐渐下降.在干预实施方面，74%的房屋在2016-17年和2017-18年试图关闭屋檐，而2018-19年为70%。在2016-17年度，有42％的房屋将屋檐的所有四个侧面都关闭了，与2018-19年的33%相比。在2016-17年度，约有72％的房屋使用纱布丝进行了筛选，而2018-19年度为57％。高成本,供应短缺,劳动力需求，据报道，志愿者的恶劣生活条件和恶劣的天气阻碍了理想的HI实施。总的来说,社区将社区主导的HI描述为可行的,并且可以通过解决这些社会经济和背景挑战来维持.
结论：我们的研究发现，尽管HI最初按计划实施，它的保真度随着时间的推移而下降。使用经过培训的志愿者促进了实施干预的真实性和可行性。严格的社区教育相结合，一致的训练，信息,教育和交流，和干预修改可能是必要的，以应对挑战并增强干预的保真度，可行性,和可持续性。
方法：研究，在22个村庄(2730户)进行，采用混合方法。使用修改后的框架评估了实现保真度，纵向调查收集HI覆盖率指标的数据。定量分析,采用描述性统计数据，评估了对HI实施的依从性。定性数据来自深度访谈，关键线人采访,以及涉及项目受益者和实施者的焦点小组。使用实施保真度模型指导的内容分析来分析定性数据，以探索促进者，挑战,影响干预可行性的因素。
结果：结果表明HI按计划实施。对预期的社区主导的HI设计有很好的遵守；然而，依从性可能更高,但随着时间的推移逐渐下降.在干预实施方面，74%的房屋在2016-17年和2017-18年试图关闭屋檐，而2018-19年为70%。在2016-17年度，有42％的房屋将屋檐的所有四个侧面都关闭了，与2018-19年的33%相比。在2016-17年度，约有72％的房屋使用纱布丝进行了筛选，而2018-19年度为57％。高成本,供应短缺,劳动力需求，据报道，志愿者的恶劣生活条件和恶劣的天气阻碍了理想的HI实施。总的来说,社区将社区主导的HI描述为可行的,并且可以通过解决这些社会经济和背景挑战来维持.
结论：我们的研究发现，尽管HI最初按计划实施，它的保真度随着时间的推移而下降。使用经过培训的志愿者促进了实施干预的真实性和可行性。严格的社区教育相结合，一致的训练，信息,教育和交流，和干预修改可能是必要的，以应对挑战并增强干预的保真度，可行性,和可持续性。
