Implementation Science Protocol for a participatory, theory-informed implementation research programme in the context of health system strengthening in sub-Saharan Africa (ASSET-ImplementER)
Journal – BMJ Journals
Article type – Pre-print – Other
Publication date – Jan – 2021
Authors – Nadine Seward, Jamie Murdoch, Charlotte Hanlon, Ricardo Araya, Wei Gao, Richard Harding, Crick Lund, Saba Hinrichs-Krapels, Rosie Mayston, Muralikrishnan R. Kartha, Martin Prince, Jane Sandall, Graham Thornicroft, Ruth Verhey, Nick Sevdalis
Keywords – health system, Pre-implementation, science methodologies
Open access – Yes
Speciality – Health policy
World region Central Africa, Eastern Africa, Southern Africa, Western Africa
Country: Ethiopia, Sierra Leone, South Africa, Zimbabwe
Language – English
Submitted to the One Surgery Index on January 14, 2021 at 10:49 am
Background ASSET (Health System Strengthening in Sub-Saharan Africa) is a health system strengthening (HSS) programme that aims to develop and evaluate effective and sustainable solutions that support high-quality care that involve eight work packages across four sub-Saharan African countries. Here we present the protocol for the implementation science (IS) theme within ASSET that aims to (1) understand what HSS interventions work, for whom and how; and (2) how implementation science methodologies can be adapted to improve the design and evaluation of HSS interventions within resource-poor contexts.
Pre-implementation phase The IS theme, jointly with ASSET work-packages, applies IS determinant frameworks to identify factors that influence the effectiveness of delivering evidence-informed care. Determinants are used to select a set of HSS interventions for further evaluation, where work packages also theorise selective mechanisms to achieve the expected outcomes.
Piloting phase and rolling implementation phase Work-packages pilot the HSS interventions. An iterative process then begins involving evaluation, refection and adaptation. Throughout this phase, IS determinant frameworks are applied to monitor and identify barriers and enablers to implementation in a series of workshops, surveys and interviews. Selective mechanisms of action are also investigated. In a final workshop, ASSET teams come together, to reflect and explore the utility of the selected IS methods and provide suggestions for future use.
Structured templates are used to organise and analyse common and heterogeneous patterns across work-packages. Qualitative data are analysed using thematic analysis and quantitative data is analysed using means and proportions.
Conclusions We use a novel combination of implementation science methods at a programmatic level to facilitate comparisons of determinants and mechanisms that influence the effectiveness of HSS interventions in achieving implementation outcomes across different contexts. The study will also contribute conceptual development and clarification at the underdeveloped interface of implementation science, HSS and global health.
OSI Number – 20863
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