BMJ open · 2022
It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth.
Клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Avokpaho Euripide, Lawrence Sarah, Roll Amy, Titus Angelin, Jacob Yesudoss, Puthupalayam Kaliappan Saravanakumar, Gwayi-Chore Marie Claire, Chabi Félicien, Togbevi Comlanvi Innocent, Elijan Abiguel Belou, Nindi Providence, Walson Judd L, Ajjampur Sitara Swarna Rao, Ibikounle Moudachirou, Kalua Khumbo, Aruldas Kumudha, Means Arianna Rubin
Аннотация
OBJECTIVES: Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depends on achieving high treatment coverage and uptake. This formative analysis was conducted to evaluate the implementation climate for cMDA and to determine barriers and facilitators to launch.
SETTINGS: Prior to the launch of a cMDA trial in Benin, India and Malawi.
PARTICIPANTS: Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers.
DESIGN: We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis.
RESULTS: Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants.
CONCLUSIONS: Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation.
TRIAL REGISTRATION NUMBER: NCT03014167; Pre-results.
SETTINGS: Prior to the launch of a cMDA trial in Benin, India and Malawi.
PARTICIPANTS: Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers.
DESIGN: We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis.
RESULTS: Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants.
CONCLUSIONS: Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation.
TRIAL REGISTRATION NUMBER: NCT03014167; Pre-results.