Communities of Practice for lay health worker-delivered contact investigation for TB: Mechanisms and context

由非专业卫生工作者进行的结核病接触者调查的实践社区：机制和背景

基本信息

批准号：
10536979
负责人：
Rachel Hennein
金额：
$ 3.16万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-16 至 2025-09-15
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10536979
关键词：
Address Behavior Biometry Caring Cause of Death Clinic Clinical Cluster randomized trial Code Communicable Diseases Community Health Aides Community of Practice Consolidated Framework for Implementation Research Country Data Data Analyses Diagnosis Disease Effectiveness Epidemiologist Evaluation Evidence based practice Fostering Funding Goals Group Practice Health Health Personnel Health Services Income Infectious Agent Inservice Training Intervention Interview Investigation Knowledge Linear Regressions Low income Measures Mediating Mediation Medicine Mentors Mentorship Methods Modeling Nurses Outcome Parents Participant Performance Persons Physicians Play Psychometrics Qualitative Methods Qualitative Research Quality of Care Reduce health disparities Research Research Methodology Role Scientist Self Efficacy Services Social Environment Social support Source Specific qualifier value Structure Survey Methodology Surveys Testing Training Tuberculosis Uganda apprenticeship base career collaborative environment contextual factors design evidence base experience global health health care delivery health care quality health disparity high risk implementation research implementation science implementation trial improved improved outcome insight low income country meetings member patient screening prevent programs skills social social learning systematic review theories

Address Behavior Biometry Caring Cause of Death Clinic Clinical Cluster randomized trial Code Communicable Diseases Community Health Aides Community of Practice Consolidated Framework for Implementation Research Country Data Data Analyses Diagnosis Disease Effectiveness Epidemiologist Evaluation Evidence based practice Fostering Funding Goals Group Practice Health Health Personnel Health Services Income Infectious Agent Inservice Training Intervention Interview Investigation Knowledge Linear Regressions Low income Measures Mediating Mediation Medicine Mentors Mentorship Methods Modeling Nurses Outcome Parents Participant Performance Persons Physicians Play Psychometrics Qualitative Methods Qualitative Research Quality of Care Reduce health disparities Research Research Methodology Role Scientist Self Efficacy Services Social Environment Social support Source Specific qualifier value Structure Survey Methodology Surveys Testing Training Tuberculosis Uganda apprenticeship base career collaborative environment contextual factors design evidence base experience global health health care delivery health care quality health disparity high risk implementation research implementation science implementation trial improved improved outcome insight low income country meetings member patient screening prevent programs skills social social learning systematic review theories

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项目摘要

Project Summary/Abstract Tuberculosis (TB) remains among the top 10 causes of death worldwide, disproportionately impacting low- income countries. Contact investigation for TB is recommended by the WHO to find and prevent additional cases. Contact investigation is often carried out by lay health workers who receive on-the-job training; however, lack of relevant in-service training is a major barrier to their delivery of high-quality health services. One approach to facilitating lay health worker training is to implement Communities of Practice (CoPs). CoPs are groups of professionals who meet regularly to support each other and share knowledge to advance their practice toward a common goal. CoPs have been used in the health field to improve the delivery of high-quality care by physicians and nurses in middle- and high-income countries. However, additional studies are needed that identify how CoPs can be used to facilitate the performance of lay health workers in low-income countries. My training proposal addresses the gaps in understanding how CoPs function in low-income countries through two scientific aims and four training aims that leverage Dr. Luke Davis’ (Sponsor) implementation trial of CoPs (5R01 AI104824-08, 2021-2023). Dr. Davis’ trial aims to address gaps in the implementation of TB contact investigation in Uganda; our research team found that only 20% of high-risk contacts completed TB evaluation in full, far below the WHO target of ≥90%. Separate from the funded trial, I will test my conceptual model of how and in what contexts CoPs can improve delivery of contact investigation. In Aim 1, I will test my hypothesis that lay health worker self-efficacy, or their confidence delivering high-quality health services, mediates the effects of CoPs on contact investigation. I will seek training and mentorship in survey methods and psychometrics to validate a widely used self-efficacy measure for use in Uganda. I will also receive training and guided mentorship in mediation analysis to assess if lay health worker self-efficacy mediates the effects of CoPs on contact investigation. In Aim 2, I will seek training and mentorship in advanced qualitative methods to identify contextual factors that impact the effectiveness of CoPs. By evaluating mechanisms of action and contextual factors pertinent to CoPs, our findings can explain why the parent trial improved, or failed to improve, outcomes. Our findings will also yield insights on how to design and implement lay health worker CoPs to improve delivery of high-quality health services, which can be applied to other low-income settings. My training plan and the collaborative environments at Yale and the Uganda TB Implementation Research Consortium will allow me to develop research, clinical, and professional skills needed for a research career as a physician-epidemiologist who uses implementation science to mitigate health disparities in low-income countries. My training plan outlines coursework, mentored research, and clinical experiences to enhance my skills in implementation trials, advanced biostatistics, qualitative methods, and infectious diseases medicine.

项目摘要/摘要结核病（TB）仍然是全球死亡的十大原因之一，对低 - 收入国家。世卫组织建议联络投资用于结核病，以查找并防止其他案例。接触调查通常由接受在职培训的外行卫生工作者进行；但是，缺乏相关的在职培训是他们提供高质量保健服务的主要障碍。促进外行卫生工作者培训的一种方法是实施实践社区（COP）。警察是一群定期见面以互相支持并分享知识以促进他们的专业人士的团体实现共同目标。警察在健康领域已被用于改善高质量的交付中等和高收入国家的医生和护士的护理。但是，需要其他研究这可以确定如何使用警察来促进低收入国家的外行健康工作者的表现。我的培训建议解决了了解低收入国家警察的运作的差距通过两个科学目标和四个培训目标，以利用卢克·戴维斯博士（赞助商）实施审判警察（5R01 AI104824-08，2021-2023）。戴维斯博士的审判旨在解决实施结核病的差距与乌干达的调查联系；我们的研究小组发现，只有20％的高风险联系人完成了结核病全面评估远低于WHO目标≥90％。与资助的试验分开，我将测试我的概念如何和在哪些情况下，警察可以改善接触调查的交付。在AIM 1中，我将测试我的假设卫生工作者自我有效，或者他们提供高质量卫生服务的信心，介导警察对接触调查的影响。我将寻求调查方法的培训和训练和心理计量学验证一种广泛使用的自我效能措施，以在乌干达使用。我还将接受培训并在调解分析中进行指导性指导力量，以评估外行卫生工作者是否自我介入接触调查的警察。在AIM 2中，我将寻求高级定性方法的培训和心态确定影响警察有效性的上下文因素。通过评估行动机制和与警察有关的上下文因素，我们的发现可以解释为什么父母的审判改善或未能改善改进，结果。我们的发现还将产生有关如何设计和实施外行卫生工作者的见解 COPS改善高质量保健服务的交付，可以应用于其他低收入环境。我的培训计划和耶鲁大学的协作环境和乌干达结核病实施研究财团将使我能够发展研究职业所需的研究，临床和专业技能一位使用实施科学来减轻低收入健康差异国家。我的培训计划概述了课程，指导研究和临床经验，以增强我的实施试验，高级生物统计学，定性方法和传染病的技能。