Thesis Chapters by Info Health
Implementation Fidelity of Trichiasis surgery prohram in Northern and Eastern Uganda, 2021
ABSTRACT
Implementation fidelity is the degree to which an intervention is delivered as intended.... more ABSTRACT
Implementation fidelity is the degree to which an intervention is delivered as intended. Reduced level of implementation fidelity of trichiasis surgery program may be why trichiasis surgery produces unfavourable outcomes follows after surgery. Trichiasis surgery is done to correct trachomatous trichiasis and prevent blindness. Trachomatous trichiasis (TT) is a sign of trachoma which comes as a result of multiple rounds of Chlamydial trachomatis infection which causes recurrent chronic inflammation in the tarsal conjunctiva. This results into conjunctival scaring, entropion, trichiasis and corneal opacification to blindness if left untreated. However, unfavorable outcomes after surgery are frequent. This study measured the level of implementation fidelity of trichiasis surgery and the factors associated with trichiasis surgery outcomes in Northern and Eastern Uganda.
We conducted a cross-sectional survey among health workers implementing Trichiasis surgery programmes in Eastern and Northern Uganda; from December 2019 to March 2020. A structured questionnaire and direct observations of Trichiasis surgeries were used to collect quantitative data on implementation fidelity. Level of fidelity programme content, coverage, duration, and methods of delivery, exposure and participants’ responsiveness were assessed. Multiple logistic regression models were used to report adjusted odds ratio for factors associated with implementation fidelity for Trichiasis surgery. Data was analyzed using STATA software and for all statistical analysis a p-value of <0.05 was considered statistically significant.
A total of 408 participants which included; 253 Trichiasis nurse and Trichiasis case finders were surveyed and 155 ophthalmology clinical officers and consultant ophthalmologist were directly observed and surveyed during Trichiasis surgery operations. The overall level of fidelity implementation was 14.3%. Out of these, the level of fidelity to programme content was 46.08% (189), coverage 51.72% (212), duration 31.86% (129), methods of delivery 82.80% (338), exposure 42.16% (172), and participants’ responsiveness 17.2% (71). Factors which were less likely associated with implementation fidelity for Trichiasis surgery programmes were quality of delivery (OR=0.44, 95% CI [0.27- 0.72], p=0.001), facilitation and sustainability strategies (OR=0.10, 95% CI [0.04 - 0.22], p=0.001), characteristics of patients (OR=0.11, 95% CI [0.01 - 0.17], p<0.001), Participants’ responsiveness (OR= 0.05, 95% CI [0.01 0.17], p<0.001), and structural/ organizational (OR=0.54, 95% CI [0.34 - 0.85], p=0.008). However, programme content (OR=8.1. 95% CI [1.71 - 38.58], p<0.001, and characteristics of the community (OR=19.83, 95% CI [8.60 - 45.70], p=0.001 were significantly more likely to increase the level of fidelity. There were five themes emerged from the qualitative data on barriers; (1) surgical related factors; (2) trichiasis surgery patient related factors; (3) environmental and geographical related factors; (4) health resources and financing challenges; and (5) the characteristics of trichiasis surgeon. The facilitators were; (1) Integration of trichiasis surgery program components into PHC package; (2) patriotization of health resources; (3) training and retraining of trichiasis surgeons; (4) facilitation and sustainability strategies; and (5) partnership with IPs.
Implementation fidelity of the Trichiasis surgery programme was found low. Trichiasis surgery programme outcomes can only improve if the level of implementation fidelity is high. This can only be achieved if the potential associated moderating factors such as; facilitation and sustainability strategies, quality of delivery, patient characteristics, and programme content are improved and critical to successfully translate evidence-based interventions into practice.
Keywords: The measure of Implementation fidelity, Trachomatous Trichiasis surgery, moderating factors
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Thesis Chapters by Info Health
Implementation fidelity is the degree to which an intervention is delivered as intended. Reduced level of implementation fidelity of trichiasis surgery program may be why trichiasis surgery produces unfavourable outcomes follows after surgery. Trichiasis surgery is done to correct trachomatous trichiasis and prevent blindness. Trachomatous trichiasis (TT) is a sign of trachoma which comes as a result of multiple rounds of Chlamydial trachomatis infection which causes recurrent chronic inflammation in the tarsal conjunctiva. This results into conjunctival scaring, entropion, trichiasis and corneal opacification to blindness if left untreated. However, unfavorable outcomes after surgery are frequent. This study measured the level of implementation fidelity of trichiasis surgery and the factors associated with trichiasis surgery outcomes in Northern and Eastern Uganda.
We conducted a cross-sectional survey among health workers implementing Trichiasis surgery programmes in Eastern and Northern Uganda; from December 2019 to March 2020. A structured questionnaire and direct observations of Trichiasis surgeries were used to collect quantitative data on implementation fidelity. Level of fidelity programme content, coverage, duration, and methods of delivery, exposure and participants’ responsiveness were assessed. Multiple logistic regression models were used to report adjusted odds ratio for factors associated with implementation fidelity for Trichiasis surgery. Data was analyzed using STATA software and for all statistical analysis a p-value of <0.05 was considered statistically significant.
A total of 408 participants which included; 253 Trichiasis nurse and Trichiasis case finders were surveyed and 155 ophthalmology clinical officers and consultant ophthalmologist were directly observed and surveyed during Trichiasis surgery operations. The overall level of fidelity implementation was 14.3%. Out of these, the level of fidelity to programme content was 46.08% (189), coverage 51.72% (212), duration 31.86% (129), methods of delivery 82.80% (338), exposure 42.16% (172), and participants’ responsiveness 17.2% (71). Factors which were less likely associated with implementation fidelity for Trichiasis surgery programmes were quality of delivery (OR=0.44, 95% CI [0.27- 0.72], p=0.001), facilitation and sustainability strategies (OR=0.10, 95% CI [0.04 - 0.22], p=0.001), characteristics of patients (OR=0.11, 95% CI [0.01 - 0.17], p<0.001), Participants’ responsiveness (OR= 0.05, 95% CI [0.01 0.17], p<0.001), and structural/ organizational (OR=0.54, 95% CI [0.34 - 0.85], p=0.008). However, programme content (OR=8.1. 95% CI [1.71 - 38.58], p<0.001, and characteristics of the community (OR=19.83, 95% CI [8.60 - 45.70], p=0.001 were significantly more likely to increase the level of fidelity. There were five themes emerged from the qualitative data on barriers; (1) surgical related factors; (2) trichiasis surgery patient related factors; (3) environmental and geographical related factors; (4) health resources and financing challenges; and (5) the characteristics of trichiasis surgeon. The facilitators were; (1) Integration of trichiasis surgery program components into PHC package; (2) patriotization of health resources; (3) training and retraining of trichiasis surgeons; (4) facilitation and sustainability strategies; and (5) partnership with IPs.
Implementation fidelity of the Trichiasis surgery programme was found low. Trichiasis surgery programme outcomes can only improve if the level of implementation fidelity is high. This can only be achieved if the potential associated moderating factors such as; facilitation and sustainability strategies, quality of delivery, patient characteristics, and programme content are improved and critical to successfully translate evidence-based interventions into practice.
Keywords: The measure of Implementation fidelity, Trachomatous Trichiasis surgery, moderating factors
Implementation fidelity is the degree to which an intervention is delivered as intended. Reduced level of implementation fidelity of trichiasis surgery program may be why trichiasis surgery produces unfavourable outcomes follows after surgery. Trichiasis surgery is done to correct trachomatous trichiasis and prevent blindness. Trachomatous trichiasis (TT) is a sign of trachoma which comes as a result of multiple rounds of Chlamydial trachomatis infection which causes recurrent chronic inflammation in the tarsal conjunctiva. This results into conjunctival scaring, entropion, trichiasis and corneal opacification to blindness if left untreated. However, unfavorable outcomes after surgery are frequent. This study measured the level of implementation fidelity of trichiasis surgery and the factors associated with trichiasis surgery outcomes in Northern and Eastern Uganda.
We conducted a cross-sectional survey among health workers implementing Trichiasis surgery programmes in Eastern and Northern Uganda; from December 2019 to March 2020. A structured questionnaire and direct observations of Trichiasis surgeries were used to collect quantitative data on implementation fidelity. Level of fidelity programme content, coverage, duration, and methods of delivery, exposure and participants’ responsiveness were assessed. Multiple logistic regression models were used to report adjusted odds ratio for factors associated with implementation fidelity for Trichiasis surgery. Data was analyzed using STATA software and for all statistical analysis a p-value of <0.05 was considered statistically significant.
A total of 408 participants which included; 253 Trichiasis nurse and Trichiasis case finders were surveyed and 155 ophthalmology clinical officers and consultant ophthalmologist were directly observed and surveyed during Trichiasis surgery operations. The overall level of fidelity implementation was 14.3%. Out of these, the level of fidelity to programme content was 46.08% (189), coverage 51.72% (212), duration 31.86% (129), methods of delivery 82.80% (338), exposure 42.16% (172), and participants’ responsiveness 17.2% (71). Factors which were less likely associated with implementation fidelity for Trichiasis surgery programmes were quality of delivery (OR=0.44, 95% CI [0.27- 0.72], p=0.001), facilitation and sustainability strategies (OR=0.10, 95% CI [0.04 - 0.22], p=0.001), characteristics of patients (OR=0.11, 95% CI [0.01 - 0.17], p<0.001), Participants’ responsiveness (OR= 0.05, 95% CI [0.01 0.17], p<0.001), and structural/ organizational (OR=0.54, 95% CI [0.34 - 0.85], p=0.008). However, programme content (OR=8.1. 95% CI [1.71 - 38.58], p<0.001, and characteristics of the community (OR=19.83, 95% CI [8.60 - 45.70], p=0.001 were significantly more likely to increase the level of fidelity. There were five themes emerged from the qualitative data on barriers; (1) surgical related factors; (2) trichiasis surgery patient related factors; (3) environmental and geographical related factors; (4) health resources and financing challenges; and (5) the characteristics of trichiasis surgeon. The facilitators were; (1) Integration of trichiasis surgery program components into PHC package; (2) patriotization of health resources; (3) training and retraining of trichiasis surgeons; (4) facilitation and sustainability strategies; and (5) partnership with IPs.
Implementation fidelity of the Trichiasis surgery programme was found low. Trichiasis surgery programme outcomes can only improve if the level of implementation fidelity is high. This can only be achieved if the potential associated moderating factors such as; facilitation and sustainability strategies, quality of delivery, patient characteristics, and programme content are improved and critical to successfully translate evidence-based interventions into practice.
Keywords: The measure of Implementation fidelity, Trachomatous Trichiasis surgery, moderating factors