| Title | The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation |
| Authors | Gong, Enying Sun, Lixin Long, Qian Xu, Hanzhang Gu, Wanbing Bettger, Janet Prvu Tan, Jingru Ma, Jixiang Jafar, Tazeen Hasan Oldenburg, Brian Yan, Lijing L. |
| Affiliation | China Acad Med Sci, Sch Populat Med & Publ Hlth, Beijing, Peoples R China Peking Union Med Coll, Beijing, Peoples R China Duke Kunshan Univ, Global Hlth Res Ctr, Suzhou, Peoples R China Univ Melbourne, Sch Populat & Global Hlth, Melbourne, Vic, Australia Duke Univ, Duke Global Hlth Inst, Durham, NC USA Duke Univ, Dept Orthoped Surg, Durham, NC USA Shandong Ctr Dis Control & Prevent, Jinan, Shandong, Peoples R China Duke NUS Med Sch, Program Hlth Serv & Syst Res, Singapore, Singapore Baker Inst, Noncommunicable Dis Unit, Melbourne, Vic, Australia Wuhan Univ, Sch Hlth Sci, Wuhan, Peoples R China Peking Univ, Sch Global Hlth & Dev, Beijing, Peoples R China |
| Keywords | MIDDLE-INCOME COUNTRIES PREVENTION STRATEGIES IMPROVE BURDEN SYSTEM MODEL |
| Issue Date | 17-Nov-2021 |
| Publisher | FRONTIERS IN PUBLIC HEALTH |
| Abstract | Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future.Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework.Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness.Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials. |
| URI | http://hdl.handle.net/20.500.11897/631426 |
| DOI | 10.3389/fpubh.2021.774907 |
| Indexed | SCI(E) SSCI |
| Appears in Collections: | 待认领 |
