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1. A qualitative evaluation of the short and long-term impacts of an implementation science training program in South Africa

Author

Oludoyinmola Ojifinni, Nosipho Shangase, Kristin Reed, Kathryn Salisbury, Tobias F. Chirwa, Juliana Kagura, Latifat Ibisomi, Audrey E. Pettifor, Rohit Ramaswamy, and Sophia M. Bartels

Subjects
Capacity building, Implementation science, South Africa, Medicine (General), R5-920
Abstract

Abstract Background As implementation science (IS) in low and middle-income country settings continues to grow and generate interest, there is continual demand for capacity building in the field. Training programs have proliferated, but evaluations of these efforts are sparse and primarily from high-income countries. There is little knowledge about the impact of IS training on students’ careers post-graduation. This evaluation of the first cohort of students who graduated from the 18-month implementation science concentration in HIV/AIDS within the Master of Science program at University of the Witwatersrand in South Africa addresses this gap. Methods We conducted two rounds of virtual interviews with the students, who were from eight African countries, immediately after the training program ended (n = 10 participants) and again five years later (n = 9 participants). The first survey captured student perceptions of IS before they entered the program and their opinions just after graduation. The follow-up evaluated their perceptions five years after graduation. Interviews were recorded, transcribed, and coded in ATLAS.ti (first round) and MAXQDA (second round), using the framework method and thematic analysis. Results Prior to the training, all students, even those with no knowledge of the field, perceived that the IS training program would help them develop skills to address critical public health priorities. These expectations were generally met by the training program, and most students reported satisfaction despite what they felt was a limited timeframe of the program and insufficient mentorship to complete their dissertation projects at their home institutions across the African continent. Five years post-graduation, most of the students did not have jobs in IS but continued applying their training in their roles and had subsequently pursued further education, some in IS-related programs. Conclusions IS training in Africa was clearly seen as valuable by trainees but IS job opportunities remain scarce. Training programs need to be more closely tied to local government priorities, and training for in-country policy and decision-makers is needed to increase demand for qualified IS researchers and practitioners.

Published
2024
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2. Learning needs assessment for multi-stakeholder implementation science training in LMIC settings: findings and recommendations

Author

Mallory Wolfe Turner, Stephanie Bogdewic, Erum Agha, Carrie Blanchard, Rachel Sturke, Audrey Pettifor, Kathryn Salisbury, Andrea Horvath Marques, Marie Lina Excellent, Nitya Rajagopal, and Rohit Ramaswamy

Subjects
Implementation science, Low- and middle-income countries, Capacity building, Intelligent swarming, Medicine (General), R5-920
Abstract

Abstract Background Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a “knowledge-practice gap,” where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. Methods We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30–60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. Results Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. Conclusion While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

Published
2021
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3. Learning needs assessment for multi-stakeholder implementation science training in LMIC settings: findings and recommendations

Author

Nitya Rajagopal, Mallory Wolfe Turner, Carrie M. Blanchard, Erum Agha, Andrea Horvath Marques, Rohit Ramaswamy, Kathryn Salisbury, Marie Lina Excellent, Stephanie Bogdewic, Audrey Pettifor, and Rachel Sturke

Subjects
Intelligent swarming, Medicine (General), Knowledge management, Low- and middle-income countries, Computer science, business.industry, Research, Capacity building, Training (civil), R5-920, Needs assessment, Implementation science, Multi stakeholder, business
Abstract

Background Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a “knowledge-practice gap,” where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. Methods We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30–60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. Results Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. Conclusion While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

Published
2021

4. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study)

Author

Anouk Pels, Ben Willem J. Mol, Joel Singer, Terry Lee, Peter von Dadelszen, Wessel Ganzevoort, Elizabeth Asztalos, Laura A. Magee, Amiram Gafni, Andrée Gruslin, Michael Helewa, Eileen Hutton, Shoo Lee, Alexander Logan, Jennifer Menzies, Jean-Marie Moutquin, Kellie Murphy, Evelyne Rey, Sue Ross, Johanna Sanchez, Jim G. Thornton, Ross Welch, Trinh Hoac, Joanne Kirton, Katherine Trigiani, Ainy Zahid, Michael B. Bracken, Patricia Crowley, Lelia Duley, Richard Ehrenkranz, Kevin Thorpe, Sunny Chan, Michael Shi, Shelley Yu, Raquel de Lourdes Martin, Maria Florencia Bassi, Mirta Clara Caruso, Valeria Lagunas, Fernando Vera, Maria Mohedano de Duhalde, Alicia Beatriz Roque, Patricia Roldan, Esteban Marcos Duhalde, Viviana Dip, Jesus Daniel Aguirre, Elba Mirta Alicia Morales, Griselda Itati Abreo, Teresa De Sagastizabal, Carolina Gomez, Nadia Rizzi, Carlos Arias, Ricardo Antonio Bruno, Kassam Mahomed, Alison Drew, Ann Green, Jane Hoare, Bill Hague, Suzette Coat, Caroline Crowther, Peter Muller, Sophie Trenowden, Barry Walters, Claire Parker, Dorothy Graham, Craig Pennell, Eileen Sung, Angela Makris, Gaksoo Lee, Charlene Thornton, Annemarie Hennessy, Louise Farrell, Nelson Sass, Henri Korkes, Dayana Couto Ferreira, Renato Augusto Moreira de Sa, Monique Schmidt Marques Abreu, Rita Guerios Bornia, Nancy Ribeiro da Silva, Fernanda Freitas Oliveira Cardoso, Caio Coelho Marques, Jorge Hornos, Ricardo Leal Davdt, Letícia Germany Paula, Pedro Luis Zanella, Gabrielle Inglis, Ruth Dillon, Ashley Docherty, Anna Hutfield, Keith Still, Sayrin Lalji, Tamara Van Tent, Chris Hotz, Tracy Messmer, Joel G. Ray, Howard Berger, Leanne De Souza, Andrea Lausman, Tatiana Freire-Lizama, Kate Besel, Paul Gibson, Greta Ellsworth, Leslie Miller, T. Lee-Ann Hawkins, Michelle Hladunewich, Anna Rogowsky, Dini Hui, Virginia Collins, Isabelle Delisle, Cora Fanning, Nestor Demianczuk, Rshmi Khurana, Winnie Sia, Catherine Marnoch, Carmen Young, Cheryl Lux, Sophie Perreault, Valerie Tremblay, Sophie Desindes, Anne-Marie Côté, Veronique Dagenais, Heather Clark, Elaine O’Shea, Ruth Rennicks White, Shital Gandhi, Mary-Jean Martin, Cheryl Brush, Gareth Seaward, Jill Newstead-Angel, Judy Brandt, Jocelyne Martel, Kristine Mytopher, Elise Buschau, Erin Keely, Patti Waddell, Svetlana Shachkina, Alan Karovitch, Robert Anderson, Nicole Koenig, Theresa Yong, Marie Vasiliou, Peri Johnson, Beth Allan, Renato Natale, Laura Kennedy, Lucie Opatrny, Lorraine Lavigne, George Carson, Sheila Kelly, Joan Crane, Donna Hutchens, Juan Pedro Kusanovic, Christian Figueroa, Karla Silva Neculman, Juan Andres Ortiz, Paula Vargas, Pedro Ferrand, Jorge Carrillo, Rodrigo Cifuentes Borrero, Dahiana Marcela Gallo, Luisa Fernanda Moreno, Fred Kirss, Kristiina Rull, Anne Kirss, Tamas Major, Andrea Fodor, Tunde Bartha, Mordechai Hallak, Nardin Aslih, Saja Anabousi-Murra, Ester Pri-Or, Linda Harel, Sima Siev, Marwan Hakim, Christina Simona Khoury, Najla Hamati, Mazen El-Zibdeh, Lama Yousef, Ruth Hughes, Di Leishman, Barbra Pullar, Matthew Farrant, Malgorzata Swiatkowska-Freund, Krzysztof Preis, Anette Aleksandra Traczyk-Los, Anna Partyka, Joanna Preis-Orlikowska, Mariusz Lukaszuk, Grzegorz Krasomski, Michael Krekora, Anna Kedzierska-Markowicz, Katarzyna Zych-Krekora, Grzegorz H. Breborowicz, Anna Dera-Szymanowska, Jannet Bakker, Joost Akkermans, Eline van den Akker, Sabine Logtenberg, Steven Koenen, Maartje de Reus, David Borman, Martijn A. Oudijk, Annemiek Bolte, Viki Verfaille, Bart Graaf, Martina Porath, Corine Verhoeven, Maureen T.M. Franssen, Lida Ulkeman, Ineke Hamming, Jose H.M. Keurentjes, Ina van der Wal, S.W.A. Nij Bijvank, A.A. Lutjes, Henricus Visser, Hubertina Catharina Johanna Scheepers, Erik van Beek, Coby van Dam, Kathy van den Berg-Swart, Paula Pernet, Birgit van der Goes, Nico Schuitemaker, Gunilla Kleiverda, Marcel van Alphen, Ageeth Rosman, Ingrid Gaugler-Senden, Marieke Linders, Catherine Nelson-Piercy, Annette Briley, May Ching Soh, Kate Harding, Hayley Tarft, David Churchill, Katherine Cheshire, Julia Icke, Mausumi Ghosh, James Thornton, Yvonne Toomassi, Karen Barker, Joanne Fisher, Nicky Grace, Amanda Green, Joanne Gower, Anna Molnar, Shobhana Parameshwaran, Andrew Simm, George Bugg, Yvette Davis, Ruta Desphande, Yvette Gunn, Mohammed Houda, Nia Jones, Jason Waugh, Carly Allan, Gareth Waring, Steve A. Walkinshaw, Angela Pascall, Mark Clement-Jones, Michelle Dower, Gillian Houghton, Heather Longworth, Tej Purewal, Derek Tuffnell, Diane Farrar, Jennifer Syson, Gillian Butterfield, Vicky Jones, Rebecca Palethorpe, Tracey Germaine, Marwan Habiba, Debbie Lee, Olufemi Eniola, Lynne Blake, Jane Khan, Helen M. Cameron, Kim Hinshaw, Amanda Bargh, Eileen Walton, Olanrewaju Sorinola, Anna Guy, Zoe D’Souza, Rhiannon Gabriel, Jo Williams, Heidi Hollands, Olujimi Jibodu, Sara Collier, Pauline Tottie, Claire Oxby, James Dwyer, Franz Majoko, Helen Goldring, Sharon Jones, Janet Cresswell, Louise Underwood, Mary Kelly-Baxter, Rebecca Robinson, Dilly Anumba, Anne Chamberlain, Clare Pye, Clare Tower, Sue Woods, Lisa Horrocks, Fiona Prichard, Lynsey Moorhead, Sarah Lee, Louise Stephens, Cara Taylor, Suzanne Thomas, Melissa Whitworth, Jenny Myers, Ellen Knox, Katie Freitas, Mark Kilby, Amanda Cotterill, Khalil Abdo, Katrina Rigby, Julie Butler, Fiona Crosfill, Sean Hughes, Sanjeev Prashar, Fatimah Soydemir, Janet Ashworth, Lorraine Mycock, Jill Smith, Amaju Ikomi, Kerry Goodsell, Jean Byrne, Maxwell Masuku, Alice Pilcher, Meena Khandelwal, Gunda Simpkins, Michelle Iavicoli, Yon Sook Kim, Richard Fischer, Robin Perry, Eugene Y. Chang, Tamara D. Saunders, Betty W. Oswald, Kristin D. Zaks, Sarosh Rana, Dawn McCullough, Anna Sfakianaki, Cheryl Danton, Erin Kustan, Luisa Coraluzzi, Helen How, Christina Waldon, Jeffrey Livingston, Sherry Jackson, Lisa Greene, Dinesh Shah, Jorge E. Tolosa, Monica Rincon, Leonardo Pereira, Amy E. Lawrence, Janice E. Snyder, D. Michael Armstrong, Teresa Blue, Austin Hester, Kathryn Salisbury, Obstetrics and gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Midwifery Science, Graduate School, Obstetrics and Gynaecology, and APH - Digital Health

Subjects
Gestational hypertension, medicine.medical_specialty, Randomization, Hypertension in Pregnancy, Birth weight, artikel tijdschrift, Preeclampsia, fetal growth restriction, preeclampsia, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, hypertension pregnancy-induced, 030212 general & internal medicine, humans, Pregnancy, 030219 obstetrics & reproductive medicine, pregnancy outcome, Obstetrics, business.industry, Gestational age, blood pressure, medicine.disease, 3. Good health, Blood pressure, business
Abstract

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Published
2018
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