Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health
Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia...
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doaj-3052f4a7def94cf586c4ba8311883faa2020-11-25T03:19:29ZengMDPI AGHealthcare2227-90322020-06-01818718710.3390/healthcare8020187Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn HealthAlessandra N. Bazzano0Jeni A. Stolow1Ryan Duggal2Richard A. Oberhelman3Yaoyao Sun4Chivorn Var5Department of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USADepartment of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USASchool of Medicine, Tulane University, New Orleans, 70112 LA, USADepartment of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USADepartment of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USAReproductive Health Association of Cambodia, Phnom Penh 905, CambodiaMaternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming.https://www.mdpi.com/2227-9032/8/2/187newbornimplementation researchprocess evaluationqualitativebehavior change |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alessandra N. Bazzano Jeni A. Stolow Ryan Duggal Richard A. Oberhelman Yaoyao Sun Chivorn Var |
spellingShingle |
Alessandra N. Bazzano Jeni A. Stolow Ryan Duggal Richard A. Oberhelman Yaoyao Sun Chivorn Var Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health Healthcare newborn implementation research process evaluation qualitative behavior change |
author_facet |
Alessandra N. Bazzano Jeni A. Stolow Ryan Duggal Richard A. Oberhelman Yaoyao Sun Chivorn Var |
author_sort |
Alessandra N. Bazzano |
title |
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health |
title_short |
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health |
title_full |
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health |
title_fullStr |
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health |
title_full_unstemmed |
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health |
title_sort |
assessing the implementation of a behavior change intervention: process evaluation of a stepped-wedge cluster randomized controlled trial for newborn health |
publisher |
MDPI AG |
series |
Healthcare |
issn |
2227-9032 |
publishDate |
2020-06-01 |
description |
Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming. |
topic |
newborn implementation research process evaluation qualitative behavior change |
url |
https://www.mdpi.com/2227-9032/8/2/187 |
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