Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Global Public Health
Abstract
Many implementation efforts experience interruptions, especially in
settings with developing health systems. Approaches for evaluating
interruptions are needed to inform re-implementation strategies. We
sought to devise an approach for evaluating interruptions by exploring
the sustainability of a programme that implemented diabetes mellitus
(DM) screening within tuberculosis clinics in Uganda in 2017. In 2019,
we conducted nine interviews with clinic staff and observed clinic visits
to determine their views and practices on providing integrated care. We
mapped themes to a social ecological model with three levels derived
from the Consolidated Framework for Implementation Research (CFIR):
outer setting (i.e. community), inner setting (i.e. clinic), and individuals
(i.e. clinicians). Respondents explained that DM screening ceased due to
disruptions in the national supply chain for glucose test strips, which
had cascading effects on clinics and clinicians. Lack of screening
supplies in clinics limited clinicians’ opportunities to perform DM
screening, which contributed to diminished self-efficacy. However,
culture, compatibility and clinicians’ beliefs about DM screening
sustained throughout the interruption. We propose an approach for
evaluating interruptions using the CFIR and social ecological model;
other programmes can adapt this approach to identify cascading effects
of interruptions and target them for re-implementation.
Description
Keywords
Non-communicable diseases, Tuberculosis, Diabetes mellitus, Interruption, Qualitative methods
Citation
Rachel Hennein, Joseph Ggita, Bashir Ssuna, Donna Shelley, Ann R. Akiteng, J. Lucian Davis, Achilles Katamba & Mari Armstrong-Hough (2022) Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption, Global Public Health, 17:9, 1868-1882, DOI: 10.1080/17441692.2021.2003838