Health Diplomacy the Adaptation of Global Health Interventions to Local Needs in sub-Saharan Africa and Thailand: Evaluating Findings from Project Accept (HPTN 043).

Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of 'global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation. Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of 'youth-friendly' services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective

An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States

<p>Abstract</p> <p>Background</p> <p>Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region.</p> <p>Methods</p> <p>Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (<it>e.g</it>., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations.</p> <p>Results</p> <p>Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in the future depending on endorsement from different key stakeholder groups. Most participants indicated that they would support the dissemination of the intervention by recommending it to other health departments and community-based organizations.</p> <p>Conclusions</p> <p>Findings from this exploratory study provide initial insight into factors associated with public health policy makers' intentions to adopt an LTC intervention. Implications for future research in this area, as well as potential policy-related strategies for enhancing the adoption of LTC interventions, are discussed.</p

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)

<p>Abstract</p> <p>Background</p> <p>Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.</p> <p>Objectives</p> <p>We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention.</p> <p>Methods</p> <p>The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (<it>e.g</it>., qualitative analyses--pattern matching; quantitative methods--linear mixed models).</p> <p>Discussion</p> <p>The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.</p

Coaching Models of School-Based Prevention and Promotion Programmes: A Qualitative Exploration of UK Teachers' Perceptions

There has been increased interest in recent years regarding the utility of imported universal prevention and promotion (P&P) programmes in UK schools, many of which have a coaching model attached. However, there have been relatively few studies exploring the cultural transferability and social validity of these models, even though evidence suggests that these factors are important to the successful implementation of the programmes, and thus the achievement of the intended outcomes. The aim of the current study was to explore the coaching practices that teachers report experiencing, and to further understanding of the perceived benefts of these coaching practices to teachers. The sample consisted of 33 teachers implementing one of two universal, school-based P&P programmes, Good Behavior Game and Promoting Alternative Thinking Strategies as part of large-scale, randomised controlled trials. Qualitative, semi-structured interviews were conducted, and data were analysed thematically utilising a hybrid approach. Teachers typically reported engaging in six distinct practices with their coaches. While the majority of these practices were in line with coaching literature, there were some discrepancies between intended coaching practices and teachers’ reports. The coaching practices were generally perceived to be acceptable to teachers. Two unanticipated practices, validation and motivation, appeared to be of particular value to teachers, although these are not currently a prominent feature in existing coaching models. The fndings provide implications for improving the development of socially valid coaching models for UK schools

Letter from W. H. McKleroy, Alabama National Guard, Anniston, Alabama, to General B. L. Holt, Montgomery, Alabama, July 26, 1907

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending

Letter from W. H. McKleroy, Alabama National Guard, Anniston, Alabama, to Brigadier General B. L. Holt, Montgomery, Alabama, September 21, 1907

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending

Letter from W. H. McKleroy, Alabama National Guard, Anniston, Alabama, to Brigadier General B. L. Holt, Montgomery, Alabama, September 30, 1907

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending

Letter from W. H. McKleroy, Alabama National Guard, Anniston, Alabama, to Brigadier General B. L. Holt, Montgomery, Alabama, September 23, 1907

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending

Letter from Colonel W. H. McKleroy, Third Infantry, Alabama National Guard, Anniston, Alabama, to General B. L. Holt, Montgomery, Alabama, January 8, 1908

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending

Letter from W. H. McKleroy, Alabama National Guard, Anniston, Alabama, to General B. L. Holt, Montgomery, Alabama, September 3, 1907

An item from the papers of Barrie Lucien Holt. These papers cover Holt's life as a capitalist, planter, financier and Quartermaster General of the Alabama National Guard. Holt was an organizer and majority shareholder in the Prattville Cotton Mills and Banking Company, as well as a partner in D.M. Snow and Company which owned a hardware store and engaged in money-lending