Health system context and implementation of evidence-based practices—development and validation of the context assessment for community health (COACH) tool for low- and middle-income settings
Date
2015-08-15
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
ENGLISH ABSTRACT: Background: The gap between what is known and what is practiced results in health service users not benefitting
from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful
implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects
of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus,
this project aimed to develop and psychometrically validate a tool for this purpose.
Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the
context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a
derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda,
South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity
amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5)
translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.
Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six
phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its
psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community
engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and
Sources of knowledge.
Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in highincome
settings were also found to be relevant in LMICs. However, there were additional aspects of context of
relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use
of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare
interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare
interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Description
CITATION: Bergstrom, A., et al. 2015. Health system context and implementation of evidence-based practices—development and validation of the context assessment for community health (COACH) tool for low- and middle-income settings. Implementation Science, 10:120, doi:10.1186/s13012-015-0305-2.
The original publication is available at http://implementationscience.biomedcentral.com
The original publication is available at http://implementationscience.biomedcentral.com
Keywords
Health system, Medical care, Health planning, Community health
Citation
Bergstrom, A., et al. 2015. Health system context and implementation of evidence-based practices—development and validation of the context assessment for community health (COACH) tool for low- and middle-income settings. Implementation Science, 10:120, doi:10.1186/s13012-015-0305-2