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Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

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

Authors: Anna Bergström, Sarah Skeen, Duong M. Duc, Elmer Zelaya Blandon, Carole Estabrooks, Petter Gustavsson, Dinh Thi Phuong Hoa, Carina Källestål, Mats Målqvist, Nguyen Thu Nga, Lars-Åke Persson, Jesmin Pervin, Stefan Peterson, Anisur Rahman, Katarina Selling, Janet E. Squires, Mark Tomlinson, Peter Waiswa, Lars Wallin

Published in: Implementation Science | Issue 1/2015

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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 high-income 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.
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Metadata
Title
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
Authors
Anna Bergström
Sarah Skeen
Duong M. Duc
Elmer Zelaya Blandon
Carole Estabrooks
Petter Gustavsson
Dinh Thi Phuong Hoa
Carina Källestål
Mats Målqvist
Nguyen Thu Nga
Lars-Åke Persson
Jesmin Pervin
Stefan Peterson
Anisur Rahman
Katarina Selling
Janet E. Squires
Mark Tomlinson
Peter Waiswa
Lars Wallin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-015-0305-2

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