Table 3 Implementation related to the Intervention characteristics and outer setting
From: Building an innovative Chagas disease program for primary care units, in an urban non- endemic city
Topic | Baseline and basic aspects |
|---|---|
I. Intervention Characteristics | |
A. Intervention Source | Seen as externally developed by key stakeholders |
B. Evidence Strength & quality | Few evidence supporting the belief that the intervention will have desired outcomes |
C. Relative advantage | Stakeholders’ perception of the advantage of implementing was not clear at the beginning, although no alternative solution was available |
D. Adaptability | Disposition to adapt and tailor the intervention to meet local needs |
E. Trialability | A pilot project was approved to be done by local authorities |
F. Complexity | Perceived as high by both key stakeholders |
G. Design Quality and Packaging | The project was easy to understand and accessible to users |
H. Cost | Although drugs were free of charge for the local authorities and patients, the needs to have other supplies increased costs. |
II. Outer Setting | |
A. Patient needs & resources | Barriers were analyzed, although until the pilot project implementation some were unknown |
B. Cosmopolitanism | No network with other external organizations |
C. Peer pressure | No competitive pressure |
D. External Policy & Incentives | National law and guidelines for medical treatment. No local programs or primary care guidelines for diagnosis and medical treatment |
III. Inner Setting | |
A. Structural characteristics | A governmental organization with a small and inflexible budget |
B. Networks & Communications | No social networks, informal communication channels within the organization |
C. Culture | Inflexible organizational models, no possibility of hiring human resources, low salaries, lack of incentives |
D. Implementation climate | Although perceived as a necessary intervention, many stakeholders felt that the main objectives were very difficult to achieve. Goals were clearly communicated and an intensive training program was planned to be carried on during the first years, including “hand on” practice, medical forum, and clinical coaching |
E. Readiness for Implementation | Leadership engagement, available resources, and access to knowledge and information were assured |
IV. Individuals | |
A. Knowledge & beliefs about the intervention | Scarce knowledge about public health and public policies |
B. Self-efficacy | Scarce knowledge about anti parasitic drug administration |
C. Individual Stage of change and identification with organization. Other personal attributes | Health teams perceived the municipality as a difficult organizational structure to be changed, more political focused than involved in health policies. Low salaries and lack of incentives plus bad infrastructure in the MPCF made a complex situation |
V. Process | |
A. Planning | A good and simple scheme for implementing the ChD program was performed |
B. Engaging | Some health teams were initially engaged due to their previous experience. MS worked hard in coaching health teams and solving every problem or doubt. A 24 h communication line was available for the entire centers with a MS physician |
C. Executing | The pilot project was central for latter scaling up |
D. Reflecting & evaluating | Quantitative and qualitative feedback about the progress and quality of implementation was delivered |