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Using intervention mapping to design and implement quality improvement strategies towards elimination of lymphatic filariasis in Northern Ghana. | LitMetric

Using intervention mapping to design and implement quality improvement strategies towards elimination of lymphatic filariasis in Northern Ghana.

PLoS Negl Trop Dis

Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina, McGavran-Greenberg Hall, Chapel Hill, North Carolina, United State of America.

Published: March 2019

AI Article Synopsis

  • The Global Strategy to Eliminate Lymphatic Filariasis in Ghana, initiated in 2000, has successfully interrupted transmission in 76 out of 98 affected districts but faces challenges in those with higher microfilaria prevalence.
  • A mixed methods assessment in the Bole District identified issues such as drug refusal, adverse reactions, low community coverage, and poor adherence to treatment protocols.
  • The study demonstrates the feasibility of developing a tailored Quality Improvement strategy through stakeholder involvement, emphasizing that quality improvement efforts require more time than typically allotted in public health initiatives.

Article Abstract

Introduction: The Global Strategy to Eliminate Lymphatic Filiariasis (GFELF) through Mass Drug Administration (MDA) has been implemented in Ghana since the year 2000 and transmission has been interrupted in 76 of 98 endemic districts. To improve the MDA in the remaining districts with microfilaria (MF) prevalence above the 1% threshold for the interruption of transmission, there is a need to identify and implement appropriate quality improvement (QI) strategies. This paper describes the use of intervention mapping to select QI strategies to improve an existing evidence-based MDA program in Northern Ghana.

Methods: Due to the complexities associated with implementing evidence-based programs (EBP) such as the lymphatic filariasis MDA and variability in the context, an initial assessment to identify implementation bottlenecks associated with the quality of implementation of lymphatic filariasis MDA in the Bole District of Ghana was conducted using a mixed methods approach. Based on the findings of the initial assessment, a context specific QI strategy was designed and operationalized using intervention mapping strategy in terms of seven domains: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification.

Results: The initial needs assessment shows that the persistent transmission of lymphatic filariasis in the Bole District is characterized by high levels of refusal to ingest the drug, high levels of reported adverse drug reactions, low MDA coverage at community level, poor adherence to the MDA protocol and non-participants' responsiveness.

Conclusion: This study has shown that it is feasible to develop a context specific QI strategy for an existing evidence-based intervention based on an initial needs assessment through stakeholder participation using the IM approach. However, working (towards) QI requires more time than is usually available in public health service. Sufficient theoretical knowledge of implementation research and experience with technical IM experts must be available.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448919PMC
http://dx.doi.org/10.1371/journal.pntd.0007267DOI Listing

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