Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis

Clancy Read, Alison G. Mitchell, Jessica L. de Dassel, Clair Scrine, David Hendrickx, Ross S. Bailie, Vanessa Johnston, Graeme P. Maguire, Rosalie Schultz, Jonathan R. Carapetis, Anna P. Ralph

    Research output: Contribution to journalArticleResearchpeer-review

    11 Downloads (Pure)

    Abstract

    Background: Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a steppedwedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes.

    Methods and Results: An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial’s aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self-management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study.

    Conclusions: The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.

    Original languageEnglish
    Article numbere009376
    Pages (from-to)1-15
    Number of pages15
    JournalJournal of the American Heart Association
    Volume7
    Issue number14
    DOIs
    Publication statusPublished - 17 Jul 2018

    Fingerprint

    Rheumatic Heart Disease
    Penicillins
    Interviews
    Health
    Self Care
    Quality Improvement
    Observation
    Injections

    Cite this

    Read, Clancy ; Mitchell, Alison G. ; de Dassel, Jessica L. ; Scrine, Clair ; Hendrickx, David ; Bailie, Ross S. ; Johnston, Vanessa ; Maguire, Graeme P. ; Schultz, Rosalie ; Carapetis, Jonathan R. ; Ralph, Anna P. / Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 14. pp. 1-15.
    @article{f318e3c1fd8c427385e4ba84c05d5411,
    title = "Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis",
    abstract = "Background: Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a steppedwedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. Methods and Results: An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial’s aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self-management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study. Conclusions: The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.",
    keywords = "Acute rheumatic fever, Adherence, Chronic disease, Quality improvement, Rheumatic heart disease, Systems of Care",
    author = "Clancy Read and Mitchell, {Alison G.} and {de Dassel}, {Jessica L.} and Clair Scrine and David Hendrickx and Bailie, {Ross S.} and Vanessa Johnston and Maguire, {Graeme P.} and Rosalie Schultz and Carapetis, {Jonathan R.} and Ralph, {Anna P.}",
    year = "2018",
    month = "7",
    day = "17",
    doi = "10.1161/JAHA.118.009376",
    language = "English",
    volume = "7",
    pages = "1--15",
    journal = "Journal of the American Heart Association",
    issn = "2047-9980",
    publisher = "Wiley-Blackwell",
    number = "14",

    }

    Read, C, Mitchell, AG, de Dassel, JL, Scrine, C, Hendrickx, D, Bailie, RS, Johnston, V, Maguire, GP, Schultz, R, Carapetis, JR & Ralph, AP 2018, 'Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis', Journal of the American Heart Association, vol. 7, no. 14, e009376, pp. 1-15. https://doi.org/10.1161/JAHA.118.009376

    Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis. / Read, Clancy; Mitchell, Alison G.; de Dassel, Jessica L.; Scrine, Clair; Hendrickx, David; Bailie, Ross S.; Johnston, Vanessa; Maguire, Graeme P.; Schultz, Rosalie; Carapetis, Jonathan R.; Ralph, Anna P.

    In: Journal of the American Heart Association, Vol. 7, No. 14, e009376, 17.07.2018, p. 1-15.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis

    AU - Read, Clancy

    AU - Mitchell, Alison G.

    AU - de Dassel, Jessica L.

    AU - Scrine, Clair

    AU - Hendrickx, David

    AU - Bailie, Ross S.

    AU - Johnston, Vanessa

    AU - Maguire, Graeme P.

    AU - Schultz, Rosalie

    AU - Carapetis, Jonathan R.

    AU - Ralph, Anna P.

    PY - 2018/7/17

    Y1 - 2018/7/17

    N2 - Background: Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a steppedwedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. Methods and Results: An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial’s aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self-management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study. Conclusions: The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.

    AB - Background: Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a steppedwedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. Methods and Results: An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial’s aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self-management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study. Conclusions: The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.

    KW - Acute rheumatic fever

    KW - Adherence

    KW - Chronic disease

    KW - Quality improvement

    KW - Rheumatic heart disease

    KW - Systems of Care

    UR - http://www.scopus.com/inward/record.url?scp=85050473107&partnerID=8YFLogxK

    U2 - 10.1161/JAHA.118.009376

    DO - 10.1161/JAHA.118.009376

    M3 - Article

    VL - 7

    SP - 1

    EP - 15

    JO - Journal of the American Heart Association

    JF - Journal of the American Heart Association

    SN - 2047-9980

    IS - 14

    M1 - e009376

    ER -