Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Bergström, Anna; Skeen, Sarah; Duc, Duong M.; Zelaya Blandon, Elmer; Estabrooks, Carole; Gustavsson, Petter; Phuong Hoa, Dinh Thi; Källestål, Carina; Målqvist, Mats; Nguyen Thu Nga; Persson, Lars-Åke; Pervin, Jesmin; Peterson, Stefan; Rahman, Anisur; Selling, Katarina; Squires, Janet E.; Tomlinson, Mark; Waiswa, Peter; Wallin, Lars; Blandon, Elmer Zelaya
August 2015
Implementation Science;Aug2015, Vol. 10 Issue 1, p1
Academic Journal
journal article
Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.


Related Articles

  • Strengthening the quality agenda in health care in low- and middle-income countries: questions to consider. Ruelas, Enrique; Gómez-Dantés, Octavio; Leatherman, Sheila; Fortune, Triona; Gay-Molina, Juan Gabriel // International Journal for Quality in Health Care;Dec2012, Vol. 24 Issue 6, p553 

    There is a widespread interest in strengthening the quality agenda in low- and middle-income countries, but the optimal strategies for achieving this are not well defined. We offer an appraisal of the health challenges these countries are confronting, the resources and services provided by their...

  • Public health oncology: a framework for progress in low- and middle-income countries†. Love, R. R.; Ginsburg, O. M.; Coleman, C. N. // Annals of Oncology;Dec2012, Vol. 23 Issue 12, p3040 

    Background The problems of cancer are increasing in low- and middle-income countries (LMCs), which now have significant majorities of the global case and mortality burdens. The professional oncology community is being increasingly called upon to define pragmatic and realistic approaches to these...

  • Exploring the Ethics of Long-Term Research Engagement With Communities in Low- and Middle-Income Countries. Hyder, Adnan A.; Krubiner, Carleigh B.; Bloom, Gerald; Bhuiya, Abbas // Public Health Ethics;Nov2012, Vol. 5 Issue 3, p252 

    Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to...

  • The HIV-1 Rev Protein Enhances Encapsidation of Unspliced and Spliced, RRE-Containing Lentiviral Vector RNA. Grewe, Bastian; Ehrhardt, Katrin; Hoffmann, Bianca; Blissenbach, Maik; Brandt, Sabine; Überla, Klaus // PLoS ONE;Nov2012, Vol. 7 Issue 11, Special section p1 

    Background:During the RNA encapsidation process of human immunodeficiency virus (HIV) viral genomic, unspliced RNA (gRNA) is preferentially incorporated into assembling virions. However, a certain amount of spliced viral transcripts can also be detected in viral particles. Recently, we observed...

  • Moving beyond prevalence studies: screening and interventions for children with disabilities in low-income and middle-income countries. Yousafzai, Aisha K.; Lynch, Paul; Gladstone, Melissa // Archives of Disease in Childhood;Sep2014, Vol. 99 Issue 9, p840 

    Research understanding the lives of children with disabilities in low-income and middle-income countries has predominantly focused on prevalence studies with little progress on evidence-based service development. At the same time, global attention in child health has shifted from child survival...

  • Resource Leveraging to Achieve Large-Scale Implementation of Effective Educational Practices. Horner, Robert H.; Ward, Caryn S.; Fixsen, Dean L.; Sugai, George; McIntosh, Kent; Putnam, Robert; Little, Hannah D. // Journal of Positive Behavior Interventions;Apr2019, Vol. 21 Issue 2, p67 

    We propose in this article that a central element in the large-scale implementation of evidence-based practices is the process by which initial investment in local demonstrations is leveraged into larger implementation efforts. We offer a definition of this "resource leveraging" and propose a...

  • Protocols, policy making and scientific progress. Pawson, Ray // Journal of Epidemiology & Community Health;May2012, Vol. 66 Issue 5, p386 

    The author comments on a paper by M. Petticrew and colleagues about deciding when more evidence is needed for public health policy and practice in line with randomized controlled trials (RCTs). The author highlights the problem with the scheme proposed by Petticrew and colleagues for failing to...

  • Developing an Evidence Review Cycle Model for Canadian Dietary Guidance. Colapinto, Cynthia K.; Ellis, Ann; Faloon-Drew, Katie; Lowell, Hélène // Journal of Nutrition Education & Behavior;Jan/Feb2016, Vol. 48 Issue 1, p77 

    Formulating dietary guidance involves navigating a large volume of substantive, conflicting evidence. Canada's guidance is determined after periodic evidence reviews. Health Canada identified the need for a more formal and systematic process to gather, assess, and analyze evidence. This led to...

  • The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations. Ngo, Victoria K.; Weiss, Bahr; Trung Lam; Thanh Dang; Tam Nguyen; Mai Hien Nguyen // Journal of Cognitive Psychotherapy;2014, Vol. 28 Issue 3, p156 

    In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics