Article type
Abstract
Background: The effective implementation of health system guidance (HSG) can help to strengthen health systems and thereby get the right mix of programs, services, and products to those who need them. However, there is a paucity of frameworks and tools specifically designed to support relatively complex HSG implementation.
Objectives: To bridge this gap by developing a theoretical framework and a tool designed to support HSG implementation at both national and subnational levels.
Methods: These objectives are achieved through three original studies. The first study uses a critical interpretive synthesis of existing literature to develop a theoretical framework. The second study employs a modified Delphi method to identify the components of an HSG implementation tool based on this framework. The third study adopts a formative evaluation study design to explore, through a talk-aloud process with semi-structured interviews with guideline implementers, whether, how, and why the HSG implementers will use the tool and how it can be refined, leading to the development of this tool.
Results: In the first study, a theoretical framework was developed to identify 10 facilitators, 10 barriers, 9 combined facilitators and barriers, and 11 strategies, with 28 general (versus 12 specific), across six levels: the political system, health system, community, organization, providers, and the public/patients. Following this, the second study yielded a total of 33 consensus-based candidate components of a tool for HSG implementation. In the third study, 17 interviews were carried out across 11 countries within six WHO regions. Interviewees recognized the tool's overall structure as clear and comprehensive, and the majority expressed a willingness to use this tool. Based on these findings, a tool was developed, featuring a one-page quick reference detailing explicit target users and usage instructions and a comprehensive two-page table presenting 33 items spanning six domains.
Conclusions: These studies collectively offer theoretical and substantive insights into understanding the facilitators, barriers, and strategies crucial for the effective implementation of HSG. The developed HSG implementation framework and accompanying tool can be useful for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle-, and high-income countries).
Objectives: To bridge this gap by developing a theoretical framework and a tool designed to support HSG implementation at both national and subnational levels.
Methods: These objectives are achieved through three original studies. The first study uses a critical interpretive synthesis of existing literature to develop a theoretical framework. The second study employs a modified Delphi method to identify the components of an HSG implementation tool based on this framework. The third study adopts a formative evaluation study design to explore, through a talk-aloud process with semi-structured interviews with guideline implementers, whether, how, and why the HSG implementers will use the tool and how it can be refined, leading to the development of this tool.
Results: In the first study, a theoretical framework was developed to identify 10 facilitators, 10 barriers, 9 combined facilitators and barriers, and 11 strategies, with 28 general (versus 12 specific), across six levels: the political system, health system, community, organization, providers, and the public/patients. Following this, the second study yielded a total of 33 consensus-based candidate components of a tool for HSG implementation. In the third study, 17 interviews were carried out across 11 countries within six WHO regions. Interviewees recognized the tool's overall structure as clear and comprehensive, and the majority expressed a willingness to use this tool. Based on these findings, a tool was developed, featuring a one-page quick reference detailing explicit target users and usage instructions and a comprehensive two-page table presenting 33 items spanning six domains.
Conclusions: These studies collectively offer theoretical and substantive insights into understanding the facilitators, barriers, and strategies crucial for the effective implementation of HSG. The developed HSG implementation framework and accompanying tool can be useful for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle-, and high-income countries).