Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study
Abstract Background Current soil-transmitted helminth (STH) control programs target pre-school and school-age children with mass drug administration (MDA) of deworming medications, reducing morbidity without interrupting ongoing transmission. However, evidence suggests that STH elimination may be po...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Implementation Science Communications |
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| Online Access: | https://doi.org/10.1186/s43058-021-00164-3 |
| _version_ | 1829482315736154112 |
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| author | Arianna Rubin Means Elizabeth Orlan Marie-Claire Gwayi-Chore Angelin Titus Saravanakumar Puthupalayam Kaliappan Comlanvi Innocent Togbevi Félicien Chabi Katherine E. Halliday Providence Nindi Euripide Avokpaho Khumbo Kalua Moudachirou Ibikounlé Sitara S. R. Ajjampur Bryan J. Weiner Judd L. Walson Kumudha Aruldas |
| author_facet | Arianna Rubin Means Elizabeth Orlan Marie-Claire Gwayi-Chore Angelin Titus Saravanakumar Puthupalayam Kaliappan Comlanvi Innocent Togbevi Félicien Chabi Katherine E. Halliday Providence Nindi Euripide Avokpaho Khumbo Kalua Moudachirou Ibikounlé Sitara S. R. Ajjampur Bryan J. Weiner Judd L. Walson Kumudha Aruldas |
| author_sort | Arianna Rubin Means |
| collection | DOAJ |
| description | Abstract Background Current soil-transmitted helminth (STH) control programs target pre-school and school-age children with mass drug administration (MDA) of deworming medications, reducing morbidity without interrupting ongoing transmission. However, evidence suggests that STH elimination may be possible if MDA is delivered to all community members. Such a change to the STH standard-of-care would require substantial systems redesign. We measured baseline structural readiness to launch community-wide MDA for STH in Benin, India, and Malawi. Methods After field piloting and adaptation, the structural readiness survey included two constructs: Organizational Readiness for Implementing Change and Organizational Capacity for Change. Sub-constructs of organizational readiness include change commitment and change efficacy. Sub-constructs of organizational capacity include flexibility, organizational structure, and demonstrated capacity. Survey items were also separately organized into seven implementation domains. Surveys were administered to policymakers, mid-level managers, and implementers in each country using a five-point Likert scale. Item, sub-construct, construct, and domain-level medians and interquartile ranges were calculated for each stakeholder level within each country. Results Median organizational readiness for change scores were highest in Malawi (5.0 for all stakeholder groups). In India, scores were 5.0, 4.0, and 5.0 while in Benin, scores were 4.0, 3.0, and 4.0 for policymakers, mid-level managers, and implementers, respectively. Median change commitment was equal to or higher than median change efficacy across all countries and stakeholder groups. Median organizational capacity for change was highest in India, with a median of 4.5 for policymakers and mid-level managers and 5.0 for implementers. In Malawi, the median capacity was 4.0 for policymakers and implementers, and 3.5 for mid-level managers. In Benin, the median capacity was 4.0 for policymakers and 3.0 for mid-level managers and implementers. Median sub-construct scores varied by stakeholder and country. Across countries, items reflective of the implementation domain ‘policy environment’ were highest while items reflective of the ‘human resource’ domain were consistently lower. Conclusion Across all countries, stakeholders valued community-wide MDA for STH but had less confidence in their collective ability to effectively implement it. Perceived capacity varied by stakeholder group, highlighting the importance of accounting for multi-level stakeholder perspectives when determining organizational preparedness to launch new public health initiatives. Trial registration NCT03014167 |
| first_indexed | 2024-12-14T21:45:29Z |
| format | Article |
| id | doaj.art-5dc6c3dd713e4a679b4373501646f31a |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-14T21:45:29Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-5dc6c3dd713e4a679b4373501646f31a2022-12-21T22:46:22ZengBMCImplementation Science Communications2662-22112021-07-012113010.1186/s43058-021-00164-3Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid studyArianna Rubin Means0Elizabeth Orlan1Marie-Claire Gwayi-Chore2Angelin Titus3Saravanakumar Puthupalayam Kaliappan4Comlanvi Innocent Togbevi5Félicien Chabi6Katherine E. Halliday7Providence Nindi8Euripide Avokpaho9Khumbo Kalua10Moudachirou Ibikounlé11Sitara S. R. Ajjampur12Bryan J. Weiner13Judd L. Walson14Kumudha Aruldas15Department of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeInstitut de Recherche Clinique du BeninInstitut de Recherche Clinique du BeninFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineBlantyre Institute for Community Outreach (BICO), Lions Sight First Eye HospitalInstitut de Recherche Clinique du BeninBlantyre Institute for Community Outreach (BICO), Lions Sight First Eye HospitalInstitut de Recherche Clinique du BeninThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeAbstract Background Current soil-transmitted helminth (STH) control programs target pre-school and school-age children with mass drug administration (MDA) of deworming medications, reducing morbidity without interrupting ongoing transmission. However, evidence suggests that STH elimination may be possible if MDA is delivered to all community members. Such a change to the STH standard-of-care would require substantial systems redesign. We measured baseline structural readiness to launch community-wide MDA for STH in Benin, India, and Malawi. Methods After field piloting and adaptation, the structural readiness survey included two constructs: Organizational Readiness for Implementing Change and Organizational Capacity for Change. Sub-constructs of organizational readiness include change commitment and change efficacy. Sub-constructs of organizational capacity include flexibility, organizational structure, and demonstrated capacity. Survey items were also separately organized into seven implementation domains. Surveys were administered to policymakers, mid-level managers, and implementers in each country using a five-point Likert scale. Item, sub-construct, construct, and domain-level medians and interquartile ranges were calculated for each stakeholder level within each country. Results Median organizational readiness for change scores were highest in Malawi (5.0 for all stakeholder groups). In India, scores were 5.0, 4.0, and 5.0 while in Benin, scores were 4.0, 3.0, and 4.0 for policymakers, mid-level managers, and implementers, respectively. Median change commitment was equal to or higher than median change efficacy across all countries and stakeholder groups. Median organizational capacity for change was highest in India, with a median of 4.5 for policymakers and mid-level managers and 5.0 for implementers. In Malawi, the median capacity was 4.0 for policymakers and implementers, and 3.5 for mid-level managers. In Benin, the median capacity was 4.0 for policymakers and 3.0 for mid-level managers and implementers. Median sub-construct scores varied by stakeholder and country. Across countries, items reflective of the implementation domain ‘policy environment’ were highest while items reflective of the ‘human resource’ domain were consistently lower. Conclusion Across all countries, stakeholders valued community-wide MDA for STH but had less confidence in their collective ability to effectively implement it. Perceived capacity varied by stakeholder group, highlighting the importance of accounting for multi-level stakeholder perspectives when determining organizational preparedness to launch new public health initiatives. Trial registration NCT03014167https://doi.org/10.1186/s43058-021-00164-3Neglected tropical diseaseOrganizational readinessORICOrganizational capacity |
| spellingShingle | Arianna Rubin Means Elizabeth Orlan Marie-Claire Gwayi-Chore Angelin Titus Saravanakumar Puthupalayam Kaliappan Comlanvi Innocent Togbevi Félicien Chabi Katherine E. Halliday Providence Nindi Euripide Avokpaho Khumbo Kalua Moudachirou Ibikounlé Sitara S. R. Ajjampur Bryan J. Weiner Judd L. Walson Kumudha Aruldas Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study Implementation Science Communications Neglected tropical disease Organizational readiness ORIC Organizational capacity |
| title | Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study |
| title_full | Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study |
| title_fullStr | Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study |
| title_full_unstemmed | Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study |
| title_short | Structural readiness to implement community-wide mass drug administration programs for soil-transmitted helminth elimination: results from a three-country hybrid study |
| title_sort | structural readiness to implement community wide mass drug administration programs for soil transmitted helminth elimination results from a three country hybrid study |
| topic | Neglected tropical disease Organizational readiness ORIC Organizational capacity |
| url | https://doi.org/10.1186/s43058-021-00164-3 |
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