背景:综合社区病例管理(iCCM)是一项儿童健康计划,旨在为肺炎患儿提供基于社区的综合护理,疟疾,或在低收入和中等收入国家难以到达的地区腹泻。干预的基础是社区卫生工作者(CHW)提供服务,他们依靠可靠的药物和用品提供。一致的监督,综合训练,以及社区的接受和参与,以实现最佳表现。该计划的有效性还可能取决于许多其他要素,包括有利的政策环境,从国家到地方的融资机制,数据传输系统,以及适当的监测和评估。这些因素在多大程度上相互影响,影响iCCM的有效性和可行性,既是可变的,也是具有挑战性的评估,尤其是跨不同的实现上下文。
目的:在本文中,我们描述了一种基于系统的混合方法研究方案,以评估与干预效果相关的iCCM计划组成部分,并报告数据收集的初步结果.
方法:该协议使用基于系统思维方法的混合定性和定量研究设计,在马拉维的四个iCCM计划中,刚果民主共和国,尼日利亚的尼日尔州和阿比亚州。收集常规监测数据以确定干预效果,即测试,治疗,和转诊结果。CHW的调查,supervisors,护理人员被执行以收集有关其人口统计数据的定量数据,活动,以及计划中的经验,以及这些经验与干预有效性领域的关系。与这些利益相关者以及当地传统领导人进行焦点小组讨论,以了解这些数据的背景。与国家和地区级计划利益相关者和精通关键计划流程的官员进行了关键线人访谈。
结果:我们对379名CHWs参与者进行了3836次调查和45次焦点小组讨论,supervisors,看护者,和传统领导人,以及120名关键线人采访区和国家级项目经理,卫生官员,部官员。另外还收集了政策和计划文件以供审查。
结论:我们希望这项研究的证据将为低收入和中等收入环境中的儿童健康计划和实践以及iCCM干预措施中的未来政策制定提供信息。
未经批准:DERR1-10.2196/33076。
BACKGROUND: Integrated community
case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts.
OBJECTIVE: In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection.
METHODS: This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes.
RESULTS: We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review.
CONCLUSIONS: We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention.
UNASSIGNED: DERR1-10.2196/33076.