No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study
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No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study. / Kjærgaard, Jesper; Nissen, Thomas Nørrelykke; Isaeva, Elvira; Quynh, Nguyen Nhat; Reventlow, Susanne; Lund, Stine; Sooronbaev, Talant; Le An, Pham; Østergaard, Marianne Stubbe; Stout, Jim; Poulsen, Anja; Anastasaki, Marilena; Akylbekov, Azamat; Barton, Andy; Bertsias, Antonios; Binh, Pham Duong Uyen; van Boven, Job F.M.; Brakema, Evelyn A.; Burges, Dennis; Cartwright, Lucy; Chatzea, Vasiliki E.; Chavannes, Niels H.; Cragg, Liza; Dang, Tran Ngoc; Dautov, Ilyas; Emilov, Berik; Ferarrio, Irene; van Gemert, Frederik A.; Hedrick, Ben; Hong, Le Huynh Thi Cam; Hopkinson, Nick; Jones, Rupert; de Jong, Corina; van Kampen, Sanne; Katagira, Winceslaus; Kirenga, Bruce; van der Kleij, Rianne Mjj; Kocks, Janwillem; Lan, Le Thi Tuyet; Linh, Tran Thanh Duv; Lionis, Christos; Loan, Kim Xuan; Luan, Nguyen Huy; Mademilov, Maamed; McEwen, Andy; Musinguzi, Patrick; Nantanda, Rebecca; Ndeezi, Grace; Papadakis, Sophia; Pinnock, Hilary; the FRESH AIR collaborators.
In: BMC Health Services Research, Vol. 20, No. 1, 1137, 2020.Research output: Contribution to journal › Journal article › peer-review
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TY - JOUR
T1 - No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study
AU - Kjærgaard, Jesper
AU - Nissen, Thomas Nørrelykke
AU - Isaeva, Elvira
AU - Quynh, Nguyen Nhat
AU - Reventlow, Susanne
AU - Lund, Stine
AU - Sooronbaev, Talant
AU - Le An, Pham
AU - Østergaard, Marianne Stubbe
AU - Stout, Jim
AU - Poulsen, Anja
AU - Anastasaki, Marilena
AU - Akylbekov, Azamat
AU - Barton, Andy
AU - Bertsias, Antonios
AU - Binh, Pham Duong Uyen
AU - van Boven, Job F.M.
AU - Brakema, Evelyn A.
AU - Burges, Dennis
AU - Cartwright, Lucy
AU - Chatzea, Vasiliki E.
AU - Chavannes, Niels H.
AU - Cragg, Liza
AU - Dang, Tran Ngoc
AU - Dautov, Ilyas
AU - Emilov, Berik
AU - Ferarrio, Irene
AU - van Gemert, Frederik A.
AU - Hedrick, Ben
AU - Hong, Le Huynh Thi Cam
AU - Hopkinson, Nick
AU - Jones, Rupert
AU - de Jong, Corina
AU - van Kampen, Sanne
AU - Katagira, Winceslaus
AU - Kirenga, Bruce
AU - van der Kleij, Rianne Mjj
AU - Kocks, Janwillem
AU - Lan, Le Thi Tuyet
AU - Linh, Tran Thanh Duv
AU - Lionis, Christos
AU - Loan, Kim Xuan
AU - Luan, Nguyen Huy
AU - Mademilov, Maamed
AU - McEwen, Andy
AU - Musinguzi, Patrick
AU - Nantanda, Rebecca
AU - Ndeezi, Grace
AU - Papadakis, Sophia
AU - Pinnock, Hilary
AU - the FRESH AIR collaborators
PY - 2020
Y1 - 2020
N2 - Background: Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms. Methods: Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations. Results: Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen’s d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen’s d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam. Discussion and conclusion: The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training.
AB - Background: Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms. Methods: Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations. Results: Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen’s d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen’s d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam. Discussion and conclusion: The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training.
KW - Asthma
KW - Contextual factors
KW - Knowledge
KW - Low- and middle-income countries
KW - Pediatrics
KW - Quality of care
KW - Time for consultation
KW - Training
U2 - 10.1186/s12913-020-05984-y
DO - 10.1186/s12913-020-05984-y
M3 - Journal article
C2 - 33302935
AN - SCOPUS:85097390267
VL - 20
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 1137
ER -
ID: 253880637