Suchergebnisse

Background: The use of process evaluations is a growing area of interest in research groups working on complex interventions. This methodology tries to understand how the intervention was implemented to inform policy and practice. A recent systematic review by Liu et al. on process evaluations of complex interventions addressing non-communicable diseases found few studies in low- and middle- income countries (LMIC) because it was restricted to randomized controlled trials, primary healthcare level and non-communicable diseases. Yet, LMICs face different barriers to implement interventions in comparison to high-income countries such as limited human resources, access to health care and skills of health workers to treat chronic conditions especially at primary health care level. Therefore, understanding the challenges of interventions for non-communicable diseases and neglected tropical diseases (diseases that affect poor populations and have chronic sequelae) will be important to improve how process evaluation is designed, conducted and used in research projects in LMICs. For these reasons, in comparison to the study of Liu et al., the current study will expand the search strategy to include different study designs, languages and settings. Objective: Map research using process evaluation in the areas of non-communicable diseases and neglected tropical diseases to inform the gaps in the design and conduct of this type of research in LMICs. Methods: Scoping review of process evaluation studies of randomized controlled trials (RCTs) and non-RCTs of complex interventions implemented in LMICs including participants with non-communicable diseases or neglected tropical diseases and their health care providers (physicians, nurses, technicians and others) related to achieve better health for all through reforms in universal coverage, public policy, service delivery and leadership. The aspects that will be evaluated are as follows: (i) available evidence of process evaluation in the areas of non-communicable diseases and neglected tropical diseases such as frameworks and theories, (ii) methods applied to conduct process evaluations and (iii) gaps between the design of the intervention and its implementation that were identified through the process evaluation. Studies published from January 2008. Exclusion criteria are as follows: not peer reviewed articles, not a report based on empirical research, not reported in English or Spanish or Portuguese or French, reviews and non-human research. Discussion: This scoping review will map the evidence of process evaluations conducted in LMICs. It will also identify the methods they used to collect and interpret data, how different theories and frameworks were used and lessons from the implementation of complex interventions. This information will allow researchers to conduct better process evaluations considering special characteristics from countries with limited human resources, scarce data available and limited access to health care. © 2021, The Author(s). ; The COHESION (COmmunity HEalth System InnovatiON) Project was funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development. M.L.-P. receives funding from the Swiss Excellence Government Scholarship (2018.0698). JJM acknowledges having received support from the Alliance for Health Policy and Systems Research (HQHSR1206660), the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T.H. Chan School of Public Health (BLSCHP-1902), Bloomberg Philanthropies, FONDECYT via CIENCIACTIVA/CONCYTEC, British Council, British Embassy and the Newton-Paulet Fund (223-2018, 224-2018), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877), Grand Challenges Canada (0335-04), International Development Research Center Canada (IDRC 106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), Medical Research Council (MR/P008984/1, MR/P024408/1, MR/P02386X/1), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), Wellcome Trust (074833/Z/04/Z, 093541/Z/10/Z, 107435/Z/15/Z, 103994/Z/14/Z, 205177/Z/16/Z, 214185/Z/18/Z) and the World Diabetes Foundation (WDF15-1224).

AbstractThe Mini-ICF-APP is an established instrument in social medicine, especially in the context of work ability assessment. In this study, the 13 capacity dimensions of Mini-ICF-APP were tested for its inter-rater reliability in the context of a vocational training program for persons with chronic and mental health problems in Switzerland. Also, the development of capacity impairments was investigated over the course of the long-term vocational training programs.61 training reports on chronically ill persons with mental health impairments were collected within a vocational training program in 2018–2019. Capacity impairment of the trainees were assessed at the beginning of the intervention (t0), after three months (t1) and after 6 to 9 months (t2) by a job attendant and a consultant at each of the three time points. Inter-rater reliabilities for each time point have been calculated. Development of capacity impairment over the course of the vocational training were investigated by variance analysis with repeated measurements.The inter-rater reliability increased in all 13 Mini-ICF-APP capacity dimensions over the course from t0 to t2. Spearman correlation in each capacity dimension reached sufficient values (r = 0.55*–0.97**). There was no statistically significant change of capacity impairment over the course of the vocational training. Ten capacity dimensions showed a decreasing tendency, three showed a tendency to improve capacity levels.Through repeated application and training programs the capacity raters seem to be able to improve reliability of their assessments. The phenomenon of slight increase of capacity impairments over the time may be due to the fact that context and rater's knowledge on participants and context demands changed over the time.