What do we think we are doing? How might a clinical information network be promoting implementation of recommended paediatric care practices in Kenyan hospitals?
Autor: | Fred Were, Philip Ayieko, Mike English, Grace Irimu, Rachel Nyamai, David Githanga |
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Rok vydání: | 2017 |
Předmět: |
Persuasion
Knowledge management Restructuring media_common.quotation_subject Context (language use) Health Promotion Health informatics Health administration 03 medical and health sciences 0302 clinical medicine Nursing Humans Medicine 030212 general & internal medicine Child Care Child media_common Information Services business.industry Research 030503 health policy & services Health Policy Health services research Professional Practice Theory of change Kenya Hospitals Hospitalization Intervention (law) Diffusion of Innovation 0305 other medical science business Medical Informatics |
Zdroj: | Health Research Policy and Systems |
ISSN: | 1478-4505 |
Popis: | BACKGROUND: The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our 'insider' interpretation of how the network is functioning as an intervention. METHODS: We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context-mechanism-outcome configuration. RESULTS: We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway. CONCLUSIONS: We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised statement of our theory of change in a context-mechanism-outcome configuration. We hope this will complement a planned independent evaluation of 'how things work', will help others interpret results of change reported more formally in the future and encourage others to consider further examination of networks as means to scale up improvement practices in health in lower income countries. |
Databáze: | OpenAIRE |
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