Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting

a mixed-methods protocol for a multicenter health system strengthening study

Trisasi Lestari, Steve Graham, Christel Van den Boogard, Rina Triasih, Jeanne Rini Poespoprodjo, Reynold Rizal Ubra, Enny Kenangalem, Yodi Mahendradhata, Nicholas M. Anstey, Ross S. Bailie, Anna P. Ralph

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    Abstract

    Background: People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system - policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome.

    Methods: This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework.

    Discussion: Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration: Australian New Zealand Clinical Trials Register 375803 .

    Original languageEnglish
    Article number31
    Pages (from-to)1-15
    Number of pages15
    JournalImplementation Science
    Volume14
    Issue number1
    DOIs
    Publication statusPublished - 19 Mar 2019

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    Tuberculosis
    Health Personnel
    Health
    Quality Improvement
    Social Media
    Indonesia
    Health Policy
    Focus Groups
    New Zealand
    Research
    Therapeutics
    Maintenance
    Clinical Trials
    Interviews
    Delivery of Health Care
    Education
    Professional Practice Gaps

    Cite this

    Lestari, Trisasi ; Graham, Steve ; Van den Boogard, Christel ; Triasih, Rina ; Poespoprodjo, Jeanne Rini ; Ubra, Reynold Rizal ; Kenangalem, Enny ; Mahendradhata, Yodi ; Anstey, Nicholas M. ; Bailie, Ross S. ; Ralph, Anna P. / Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting : a mixed-methods protocol for a multicenter health system strengthening study. In: Implementation Science. 2019 ; Vol. 14, No. 1. pp. 1-15.
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    abstract = "Background: People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system - policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. Methods: This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. Discussion: Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration: Australian New Zealand Clinical Trials Register 375803 .",
    keywords = "Behaviour Change Wheel, Consolidated Framework for Implementation Research, Preventive treatment, RE-AIM model, Tuberculosis contact investigation",
    author = "Trisasi Lestari and Steve Graham and {Van den Boogard}, Christel and Rina Triasih and Poespoprodjo, {Jeanne Rini} and Ubra, {Reynold Rizal} and Enny Kenangalem and Yodi Mahendradhata and Anstey, {Nicholas M.} and Bailie, {Ross S.} and Ralph, {Anna P.}",
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    Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting : a mixed-methods protocol for a multicenter health system strengthening study. / Lestari, Trisasi; Graham, Steve; Van den Boogard, Christel; Triasih, Rina; Poespoprodjo, Jeanne Rini; Ubra, Reynold Rizal; Kenangalem, Enny; Mahendradhata, Yodi; Anstey, Nicholas M.; Bailie, Ross S.; Ralph, Anna P.

    In: Implementation Science, Vol. 14, No. 1, 31, 19.03.2019, p. 1-15.

    Research output: Contribution to journalArticleResearchpeer-review

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    T2 - a mixed-methods protocol for a multicenter health system strengthening study

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    AU - Graham, Steve

    AU - Van den Boogard, Christel

    AU - Triasih, Rina

    AU - Poespoprodjo, Jeanne Rini

    AU - Ubra, Reynold Rizal

    AU - Kenangalem, Enny

    AU - Mahendradhata, Yodi

    AU - Anstey, Nicholas M.

    AU - Bailie, Ross S.

    AU - Ralph, Anna P.

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    N2 - Background: People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system - policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. Methods: This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. Discussion: Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration: Australian New Zealand Clinical Trials Register 375803 .

    AB - Background: People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system - policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. Methods: This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. Discussion: Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration: Australian New Zealand Clinical Trials Register 375803 .

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