Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina
Abstract Background In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degr...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00367-2 |
| _version_ | 1797952521389473792 |
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| author | Melisa Paolino Victoria Sánchez Antelo Milca Cuberli Mariana Curotto Anabella Le Pera Fernando Binder Juan David Mazzadi Beatriz Firmenich Silvina Arrossi |
| author_facet | Melisa Paolino Victoria Sánchez Antelo Milca Cuberli Mariana Curotto Anabella Le Pera Fernando Binder Juan David Mazzadi Beatriz Firmenich Silvina Arrossi |
| author_sort | Melisa Paolino |
| collection | DOAJ |
| description | Abstract Background In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity—in relation to the core components proposed by the National Program on Cervical Cancer Prevention—with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. Methods This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. Results Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. Conclusions Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings. |
| first_indexed | 2024-04-10T22:47:40Z |
| format | Article |
| id | doaj.art-f3d42991a74f40518d818cde20da3864 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-04-10T22:47:40Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-f3d42991a74f40518d818cde20da38642023-01-15T12:13:24ZengBMCImplementation Science Communications2662-22112023-01-014111910.1186/s43058-022-00367-2Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in ArgentinaMelisa Paolino0Victoria Sánchez Antelo1Milca Cuberli2Mariana Curotto3Anabella Le Pera4Fernando Binder5Juan David Mazzadi6Beatriz Firmenich7Silvina Arrossi8Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y TécnicasCentro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y TécnicasPrograma Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina)Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina)Centro de Estudios de Estado y Sociedad, Buenos Aires, ArgentinaCentro de Estudios de Estado y Sociedad, Buenos Aires, ArgentinaCentro de Estudios de Estado y Sociedad, Buenos Aires, ArgentinaDirección de Formación Capacitación y Planificación de Recursos Humanos en Salud. Secretaría de Salud Pública de La MatanzaCentro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y TécnicasAbstract Background In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity—in relation to the core components proposed by the National Program on Cervical Cancer Prevention—with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. Methods This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. Results Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. Conclusions Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings.https://doi.org/10.1186/s43058-022-00367-2Implementation fidelity; Cervical cancer preventionHPV self-collection testArgentina |
| spellingShingle | Melisa Paolino Victoria Sánchez Antelo Milca Cuberli Mariana Curotto Anabella Le Pera Fernando Binder Juan David Mazzadi Beatriz Firmenich Silvina Arrossi Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina Implementation Science Communications Implementation fidelity; Cervical cancer prevention HPV self-collection test Argentina |
| title | Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina |
| title_full | Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina |
| title_fullStr | Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina |
| title_full_unstemmed | Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina |
| title_short | Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina |
| title_sort | assessing the implementation fidelity of hpv self collection offered by community health workers during home visits the ema strategy a case study in a low middle resource setting in argentina |
| topic | Implementation fidelity; Cervical cancer prevention HPV self-collection test Argentina |
| url | https://doi.org/10.1186/s43058-022-00367-2 |
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