Using the Implementation Research Logic Model to design and implement community-based management of possible serious bacterial infection during COVID-19 pandemic in Ethiopia

BMC Health Services Research

Research

Hema Magge¹  Tsinuel Girma Nigatu²  Lisa Ruth Hirschhorn³  Gizachew Tadele Tiruneh⁴ 

[1] Bill & Melinda Gates Foundation, Seattle, WA, USA;Department of Pediatrics and Child Health, Jimma University, Ethiopia and Fenot Project - School of Population and Public Health, University of British Columbia, Vancouver, Canada;Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL, USA;The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia;

关键词: COVID-19;    Ethiopia;    Implementation science;    Implementation research logic model;    Implementation challenges;    Implementation strategies;    Neonatal sepsis;    Newborn;    Possible serious bacterial infection;    Young infants;   

DOI  :  10.1186/s12913-022-08945-9

 received in 2022-08-29, accepted in 2022-12-08,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundCommunity-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia.MethodsThis IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation.ResultsThis IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers’ care-seeking behavior for their sick young infants.The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings.ConclusionsThe use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.

【 授权许可】

CC BY   
© The Author(s) 2022

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