Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya

BMC Health Services Research

Juliet Miheso¹  Agneta Chepchumba¹  Josephine Andesia¹  Eunice Mwangi¹  Sonak D. Pastakia²  Violet Naanyu³  Mc Kinsey M. Pillsbury⁴  Rajesh Vedanthan⁵  Tim Mercer⁶  Gerald S. Bloomfield⁷  Aarti Thakkar⁷  Shravani Pathak⁸  Benson Njuguna⁹  Constantine Akwanalo⁹  Jemima Kamano^1,10 

[1] Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;Center for Health Equity and Innovation, Purdue University, West Lafayette, IN, USA;College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya;Department of Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, 10016, New York, NY, USA;Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA;Duke University School of Medicine, Durham, NC, USA;Icahn School of Medicine, Mount Sinai, New York, NY, USA;Moi Teaching and Referral Hospital, Eldoret, Kenya;Moi Teaching and Referral Hospital, Eldoret, Kenya;College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya;

关键词: Human-centered design;    Implementation research;    Hypertension;    Referral networks;    Peer interventions;    Health information technology;   

DOI  :  10.1186/s12913-021-06930-2

来源: Springer

【 摘 要 】

BackgroundHuman-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial.MethodsWe organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey.ResultsThe design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions.ConclusionsThe adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings.Trial registrationClinicaltrials.gov, NCT02501746, registration date: July 17, 2015,

【 授权许可】

CC BY