Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainabil...

Autores
Paniagua Avila, Alejandra; Shelton, Rachel C.; Figueroa, Juan Carlos; Guzman, Ana Lissette; Gutierrez, Laura; Hernandez Galdamez, Diego Rolando; Ramirez, Juan Manuel; Rodriguez, Javier; Irazola, Vilma; Ramirez Zea, Manuel; Fort, Meredith P.
Año de publicación
2024
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala’s public pri‑ mary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innova‑ tive application of systems thinking visuals. Methods Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic’s onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff ), we evaluated dimensions of“Reach, Effectiveness, Adoption, Implementation and Maintenance,” RE-AIM (Reach, Implementa‑ tion delivery + adaptations), and“Practical Robust Implementation and Sustainability Model,” PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representative‑ ness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019–July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/ PRISM and health districts to identify equity and sustainability considerations. Results Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, pro‑ gram champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated.
Fil: Paniagua Avila, Alejandra. Instituto de Nutrición de Centro América y Panamá; Guatemala. Columbia University; Estados Unidos
Fil: Shelton, Rachel C.. Columbia University; Estados Unidos
Fil: Figueroa, Juan Carlos. Drexel University; Estados Unidos. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Guzman, Ana Lissette. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Hernandez Galdamez, Diego Rolando. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Ramirez, Juan Manuel. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Rodriguez, Javier. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ramirez Zea, Manuel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Fort, Meredith P.. University Of Colorado Anschutz Medical Campus.; Estados Unidos
Materia
Adaptations
Dynamic context
Hybrid trial
Hypertension
Implementation science
Latin America
Low- and middle-income countries
Mixed methods
RE-AIM/PRISM
Sustainability
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/284007
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/284007
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equityPaniagua Avila, AlejandraShelton, Rachel C.Figueroa, Juan CarlosGuzman, Ana LissetteGutierrez, LauraHernandez Galdamez, Diego RolandoRamirez, Juan ManuelRodriguez, JavierIrazola, VilmaRamirez Zea, ManuelFort, Meredith P.AdaptationsDynamic contextHybrid trialHypertensionImplementation scienceLatin AmericaLow- and middle-income countriesMixed methodsRE-AIM/PRISMSustainabilityhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala’s public pri‑ mary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innova‑ tive application of systems thinking visuals. Methods Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic’s onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff ), we evaluated dimensions of“Reach, Effectiveness, Adoption, Implementation and Maintenance,” RE-AIM (Reach, Implementa‑ tion delivery + adaptations), and“Practical Robust Implementation and Sustainability Model,” PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representative‑ ness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019–July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/ PRISM and health districts to identify equity and sustainability considerations. Results Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, pro‑ gram champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated.Fil: Paniagua Avila, Alejandra. Instituto de Nutrición de Centro América y Panamá; Guatemala. Columbia University; Estados UnidosFil: Shelton, Rachel C.. Columbia University; Estados UnidosFil: Figueroa, Juan Carlos. Drexel University; Estados Unidos. Instituto de Nutrición de Centro América y Panamá; GuatemalaFil: Guzman, Ana Lissette. Instituto de Nutrición de Centro América y Panamá; GuatemalaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernandez Galdamez, Diego Rolando. Instituto de Nutrición de Centro América y Panamá; GuatemalaFil: Ramirez, Juan Manuel. Instituto de Nutrición de Centro América y Panamá; GuatemalaFil: Rodriguez, Javier. Instituto de Nutrición de Centro América y Panamá; GuatemalaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ramirez Zea, Manuel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Fort, Meredith P.. University Of Colorado Anschutz Medical Campus.; Estados UnidosSpringer Nature2024-03info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/284007Paniagua Avila, Alejandra; Shelton, Rachel C.; Figueroa, Juan Carlos; Guzman, Ana Lissette; Gutierrez, Laura; et al.; Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity; Springer Nature; Implementation Science Communications; 5; 1; 3-2024; 1-172662-2211CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-024-00560-5info:eu-repo/semantics/altIdentifier/doi/10.1186/s43058-024-00560-5info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-06-17T09:41:50Zoai:ri.conicet.gov.ar:11336/284007instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-06-17 09:41:51.286CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
title Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
spellingShingle Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
Paniagua Avila, Alejandra
Adaptations
Dynamic context
Hybrid trial
Hypertension
Implementation science
Latin America
Low- and middle-income countries
Mixed methods
RE-AIM/PRISM
Sustainability
title_short Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
title_full Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
title_fullStr Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
title_full_unstemmed Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
title_sort Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity
dc.creator.none.fl_str_mv Paniagua Avila, Alejandra
Shelton, Rachel C.
Figueroa, Juan Carlos
Guzman, Ana Lissette
Gutierrez, Laura
Hernandez Galdamez, Diego Rolando
Ramirez, Juan Manuel
Rodriguez, Javier
Irazola, Vilma
Ramirez Zea, Manuel
Fort, Meredith P.
author Paniagua Avila, Alejandra
author_facet Paniagua Avila, Alejandra
Shelton, Rachel C.
Figueroa, Juan Carlos
Guzman, Ana Lissette
Gutierrez, Laura
Hernandez Galdamez, Diego Rolando
Ramirez, Juan Manuel
Rodriguez, Javier
Irazola, Vilma
Ramirez Zea, Manuel
Fort, Meredith P.
author_role author
author2 Shelton, Rachel C.
Figueroa, Juan Carlos
Guzman, Ana Lissette
Gutierrez, Laura
Hernandez Galdamez, Diego Rolando
Ramirez, Juan Manuel
Rodriguez, Javier
Irazola, Vilma
Ramirez Zea, Manuel
Fort, Meredith P.
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Adaptations
Dynamic context
Hybrid trial
Hypertension
Implementation science
Latin America
Low- and middle-income countries
Mixed methods
RE-AIM/PRISM
Sustainability
topic Adaptations
Dynamic context
Hybrid trial
Hypertension
Implementation science
Latin America
Low- and middle-income countries
Mixed methods
RE-AIM/PRISM
Sustainability
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala’s public pri‑ mary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innova‑ tive application of systems thinking visuals. Methods Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic’s onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff ), we evaluated dimensions of“Reach, Effectiveness, Adoption, Implementation and Maintenance,” RE-AIM (Reach, Implementa‑ tion delivery + adaptations), and“Practical Robust Implementation and Sustainability Model,” PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representative‑ ness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019–July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/ PRISM and health districts to identify equity and sustainability considerations. Results Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, pro‑ gram champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated.
Fil: Paniagua Avila, Alejandra. Instituto de Nutrición de Centro América y Panamá; Guatemala. Columbia University; Estados Unidos
Fil: Shelton, Rachel C.. Columbia University; Estados Unidos
Fil: Figueroa, Juan Carlos. Drexel University; Estados Unidos. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Guzman, Ana Lissette. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Hernandez Galdamez, Diego Rolando. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Ramirez, Juan Manuel. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Rodriguez, Javier. Instituto de Nutrición de Centro América y Panamá; Guatemala
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ramirez Zea, Manuel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Fort, Meredith P.. University Of Colorado Anschutz Medical Campus.; Estados Unidos
description Background The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala’s public pri‑ mary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innova‑ tive application of systems thinking visuals. Methods Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic’s onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff ), we evaluated dimensions of“Reach, Effectiveness, Adoption, Implementation and Maintenance,” RE-AIM (Reach, Implementa‑ tion delivery + adaptations), and“Practical Robust Implementation and Sustainability Model,” PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representative‑ ness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019–July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/ PRISM and health districts to identify equity and sustainability considerations. Results Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, pro‑ gram champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated.
publishDate 2024
dc.date.none.fl_str_mv 2024-03
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/284007
Paniagua Avila, Alejandra; Shelton, Rachel C.; Figueroa, Juan Carlos; Guzman, Ana Lissette; Gutierrez, Laura; et al.; Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity; Springer Nature; Implementation Science Communications; 5; 1; 3-2024; 1-17
2662-2211
CONICET Digital
CONICET
url http://hdl.handle.net/11336/284007
identifier_str_mv Paniagua Avila, Alejandra; Shelton, Rachel C.; Figueroa, Juan Carlos; Guzman, Ana Lissette; Gutierrez, Laura; et al.; Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity; Springer Nature; Implementation Science Communications; 5; 1; 3-2024; 1-17
2662-2211
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
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info:eu-repo/semantics/altIdentifier/doi/10.1186/s43058-024-00560-5
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eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
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publisher.none.fl_str_mv Springer Nature
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repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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