Mise en oeuvre et recherches interventionnelles
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Présentation de Valéry Ridde, Université de Montréal, réalisé pour le 6e séminaire de l’Action Coordonnée Recherche Interventionnelle en Santé Publique. 7 juillet 2017, Paris.
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Mise en oeuvre et recherches interventionnelles
- 1. MISE EN ŒUVRE ET RECHERCHES INTERVENTIONNELLES Séminaire de l’Action Coordonnée Recherche Interventionnelle en Santé Publique Ridde, Valéry 7 Juillet, 2017 @equitesante @valeryridde
- 4. Definitions of implementation science in HIV/AIDS Odeny, Thomas A et al. The Lancet HIV , Volume 2 , Issue 5 , e178 - e180 69 articles 96-2013 73 definitions
- 6. DEFINITIONS • Scientific investigation of factors associated with effective implementation(Franks and Schroder, 2013) • implementation = process of putting an intervention into use - either evidence-based or theory-based – in a setting(Damschroder et al., 2009; Nash et al., 2006; Thompson et al., 2003)
- 7. Equitesante.org 8 Adapté de Pawson, Ridde et al, 2012; Robert 2015
- 10. Patton 2007
- 11. BOITE NOIRE ET ERREUR T3 INTERVENTION R E S S O U R C E S E F F E T S A T T E N D U S
- 13. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services.
- 15. L’ARBRE QUI CACHE LA FORET 0 20/m 40/m 60/m 80/m 100/m 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 Koutougou 0 20/m 40/m 60/m 80/m 100/m Nombre mensuel 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 0 20/m 40/m 60/m 80/m 100/m 110 SONU Fins de mois 0 3 2004 6 9 12 3 2005 6 9 12 3 2006 6 9 12 3 2007 6 9 12 3 2008 6 9 12 3 2009 6 9 • Paiements informels • Expériences passées • Perceptions de la qualité • Accès géographique Belaid et Ridde, 2015
- 16. 17
- 18. • Implementation = an actively planned and deliberately initiated effort with the intention to bring a given object into practice = Intermediate maturity • Context = a set of characteristics and circumstances that consist of active and unique factors that surround the implementation effort = Relatively less mature Pfadenhauer et al, 2015
- 20. DIFFERENTS TYPES DE THÉORIES • Hypothèses implicites/explicites sous-jacentes à la construction de l’intervention (Weiss, 1997) THÉORIE DE L’INTERVENTION • Organisation instable des idées, moins abstraites d’une grande théorie mais plus qu’une généralisation empirique ou qu’une théorie micro (Stinchcombe, 1968, quoted by Moore et al., 2012) THÉORIE DE MOYENNE PORTÉE • Théorie unifiée qui explique tous les comportements, organisations et changements sociaux disparates observés” (Merton, 1969) GRANDE THÉORIE NIVEAUD’ABSTRACTION Robert and Ridde, 2016
- 23. StrengtheningofhealthsystemstowardsUniversalHealthCoverage Supporttopolicydialogueprocessesforhealthplanning&financing Approach (SOFT) On-going technical support Training Capacitystrengtheningof MoH Knowledge and resources production Components of support (HARD) FlexibilityResponsiveness Ad hoc technical expertise Policy dialogue for health planning & financing What is expected from such a policy dialogue GoalResults MAKE IT HAPPEN MAKE IT HAPPEN Outcomes Formulation of robust and comprehensive health policies, strategies & plans Alignment and harmonization of stakeholders Strengthened leadership of MoH Fed by knowledge Inclusive and participatory Led by MoH Robert & Ridde, 2017
- 27. SOLENZO HSPC + HSPC + HSPC - HSPC - HSPC +/- HSPC +/- RBF1 RBF4 DIEBOUGOU HSPC + HSPC - RBF1 HSPC + HSPC - RBF2 HSPC + HSPC - RBF3 OUAHIGOUYA HSPC + HSPC - RBF1 HSPC + HSPC - RBF2 HSPC + HSPC - RBF3 R H C RBF1 M C S S RBF1 M C S S RBF1
- 30. SCIENCE POLITIQUE ET PS : 1986-2006 E. Breton and E. de Leeuw, 2010 ● 7% des articles en PS sur l’étude des PP ● 18% font référence à un cadre théorique de PP 0 0 1 0 0 3 1 1 6 0 1 7 0 12 8 9 10 16 15 26 3 0 5 10 15 20 25
- 31. Saetren , 2014
- 32. “Nous ne sommes même pas proche d’une théorie très développée de la mise en œuvre” Saetren’s (2005, p. 573) « Les bases théoriques de l’implantation sont relativement récentes et ont besoin d’être testées et opérationnalisées dans un contexte réel » Franks & Schroeder, 2013
- 33. Pulzi et Treib, 2007
- 36. IMPLANTATION SELON DURLAK, 2015 • 8 dimensions • 20/23 facteurs contextuels • 14 étapes pour réussir
- 37. Meyer et al, 2012 QUALITY IMPLEMENTATION FRAMEWORK
- 38. CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH Damschroder LJ, et al, 2009
- 39. Kirk et al. (2016) 11:72
- 43. Cole, C, et al 2016
- 44. Robert et Ridde, Mesure et évaluation en éducation Volume 36, numéro 3, 2013, p. 79-108
- 45. CONSÉQUENCES DE LA MISE EN OEUVRE • Acceptabilité • Adoption • Pertinence • Faisabilité • Fidélité • Coût • Couverture • Pérennité Proctor et al, 2010
- 46. SOCIETY FOR IMPLEMENTATION RESEARCH COLLABORATION Lewis et al. Implementation Science (2015) 10:155 Mental or behavioral health settings
- 47. IMPLANTATION INTERVENTION • ressources • activités FIDÉLITÉ • Contenu • Couverture • Temporalité IMPACTS MODÉRATEURS • Contexte • Acteurs et mécanismes Adapté de Carroll et al. (2007) ADAPTATION
- 48. 0% 25% 50% 75% 100% Planification Mise en œuvre Outils de mise en œuvre Autres Implanté Non Implanté Adapté Ajouté NR Fidélité de contenu par dimension Equitesante.org • Les activités de planification sont majoritairement implantées comme prévu • Les dimensions MEO et Autres présentent le moins d’activités implantées
- 49. DS 1 DS 2 DS3 DS1 DS2 DS3 DS1 DS2 DS3 DS1 DS2 0 DS3 0 0 10 20 30 40 50 60 70 80 90 100 Planification Mise en œuvre Outils de mise en œuvre Autres Homogénéité d’implantation Equitesante.org • Présence d’une certaine hétérogénéité Quali @Valéry Ridde
- 50. Sekhon et al. BMC Health Services Research (2017) 17:88 THEORETICAL FRAMEWORK OF ACCEPTABILITY
- 52. Effets non attendus Turcotte-Tremblay A-M et al, 2017
- 53. Bull World Health Organ 2016;94:58–64
- 54. WHAT EVERYONE SHOULD KNOW 1. Quality Implementation Is the Sine Qua Non of Effective Programs 2. Monitoring Implementation Is an Essential Component 3. It Is Extremely Costly to Ignore Implementation 4. Implementation Is a Multidimensional Concept 5. Implementation Exists along a Continuum 6. Adaptations Are Common and May Improve Program Outcomes 7. Effective Professional Development Services Are Essential 8. Multiple Factors Affect Implementation 9. at Least 14 Related Steps to Achieving Quality Implementation 10. Quality Implementation Requires Collaboration among Multiple Stakeholders 11. The Same Factors That Influence Quality of Implementation Also Influence Sustainability Durlak, 2015; pp. 395–405
Notes de l'éditeur
- Figure: Relatedness of definitions of implementation science in scientific literature Definitions are shown as nodes and citations as arrows. We classified each definition as either a definition (or exact meaning of the term) in pink; a characterization (general description of qualities or features of the term) in blue, or both in green.8 Definitions of implementation science in HIV/AIDS Almost all definitions of implementation science and research referred explicitly or implicitly to the gap between knowledge and evidence from research findings Implementation science is a multidisciplinary specialty that seeks generalisable knowledge about the behaviour of stakeholders, organisations, communities, and individuals in order to understand the scale of, reasons for, and strategies to close the gap between evidence and routine practice for health in real-world contexts.
- IS can be defined as the scientific investigation of factors associated with effective implementation » Franks and Schroder, 2013 Implementation science studies the use of strategies to adapt and use evidence-based interventions in targeted settings to sustain im- provements to population health. Annu. Rev. Public Health 2013. 34:235–51 implementati- on emerged as an actively planned and deliberately in- itiated effort with the intention to bring a given object into policy and/ or practice. fadenhauer et al., 2015). implementation is defined as the process, constellation of processes or means of as- similating or putting an intervention into use - either evidence-based or theory-based – in an organisation or a setting (Damschroder et al., 2009; Nash et al., 2006; Thompson et al., 2003) IS = The science of putting ideas into action—the science of implementation Implemenattion has been described as the .science, practice and policy of getting science into practice and policy » Kixsen, 2011
- Le cycle de projet de l’UE ! Les acteurs peuvent ainsi avoir un rôle et des actions dans chacune de ces dimensions, mais on n’en parlera pas trop ici et on ira plus sur leurs rôles dans le volet RI puisque objectif de l’atelier; par exemple on peut croire utile que les chercheurs participent aussi à la planification des interventions pour qu’elles soient construite sur la base des données probantes mais que les intervenants puissent les contextualiser pour les utiliser…
- third generation research paradigm Key variables must be clearly defined. Hypotheses derived from theoretical constructs should guide empirical analysis. More use of statistical analysis using quantitative data to supplement qualitative analysis. More comparison across different units of analysis within and across policy sectors. More longitudinal research design (i.e. research timeframe of at least 5 to 10 years).
- Guerre des paradigmes
- Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. The scheme is based on a flat fee pre-payment. = 18$ woman attending antenatal care is given the choice to enrol on a voluntary basis. demographic and health survey data between 2002 and 2011. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. Maternity-related care for the ORI membership included at least: four antenatal visits; all prophylactic treatments; one blood test (haemoglobin level, blood group and rhesus); one urine test (pro- teinuria, glycosuria) at each antenatal visit; one ultrasound scan dur- ing the first trimester; treatment for any pathologies related to pregnancy and delivery, skilled delivery and emergency obstetrical care (EmoC) if needed, including caesarean section; ambulance transportation to a higher level of health care; hospital care if trans- ferred; and one postnatal visit The ORI was firstly implemented in 2002 in two health districts of Nouakchott (Sebkha and El Mina) and since then, has extended still further in other districts outside of the capital. At the end of 2014, the ORI was available in 144 out of 627 public health care facilities
- Trop peu de recherches arrivent encore à tenir compte du contexte, comprendre ce qui se passe ou pas, comment une intervention fonctionne dans un contexte et pas dans un autre, etc. C’est notamment ce que nous avons essayer au Burkina et ce que nous faisons en ce moment pour le FBR ou les césariennes avec Alexandre
- 17 publications on context and 35 articles on implementation met our inclusion criteria. We conducted systematic literature searches and pragmatic utility (PU) concept analyses
- Setting refers to the physical, specific loca- tion in which the intervention is put into practice A fully mature concept has clear and consensual definitions, clearly described characteristics, fully described and demonstrated preconditions and outcomes as well as deli- neated boundaries
- Weiss : Theory of Change = Program theory + Implementation theory Marchal : TOC is essentially prospective (Dickinson, 2006) and seeks to establish the links between intervention, context and outcome (Barnes et al., 2003; Mason and Barnes, 2007; Weiss, 1995). It does so through development and testing of logic models (Douglas et al., 2010). Breuer: approach which describes how a programme brings about spe- cific long-term outcomes through a logical sequence of intermediate outcomes distinct from sociological or psychological the-ories which describe why change occurs RE = uncovering underlying programme theories. These theories are often more abstract than the theories developed through ToC or logic models [18].
- Flexibilité : « la capacité d’un système à s’adapter aisément à l’environnement ». Adaptabilité : capacité de l’organisation à modifier sa Niveau de l’intervention Niveau de l’OMS Dinstinguer pourquoi on soutient le DP (modèle théorique) vs. comment on soutient le DP (modèle opérationnel) Renforcer la gouvernance sanitaire = alignement des bailleurs, leadership des MoH et formuler du NHPSP robustes et complets Alignement = maillage et mise en commun des ressources
- Pressman, Jeffrey L. and Wildavsky, Aaron B. (1973)
- Frequency of eligible policy-related articles published in eleven journals pursuing the scholarly development of health promotion (Jan 1986 - Jun 2006 « all the most authoritative conceptualizations mentioned here were modelled on Western-style democratic governance systems » TOTAL 119 = Referring to a theoretical framework? 39 = Of these, from political science 21
- 3 générations : *70 et avant = quali, explo, sans théorie *80 : premier cadre d’analyse *fin 80 = plus recherche, comparative, théorie, longitudinale,
- Les acteurs s’adaptent aux failles du système = épisio remboursé plus car acc dysto mais pas dans les faits
- 8 dimensions de l’implantation : Fidélité, qualité, dosage, adaptation, participant, engagement, couverture, différenciation, suivi de conditions de comparaisons 20 facteurs contextuels (e.g., various features of the interven- tion, front-line providers, and the organization hosting the in- tervention;) 14 étapes pour réussir Phase One: Initial considerations regarding the host setting Assessment strategies 1. Conducting a needs and resources assessment 2. Conducting a fit assessment 3. Conducting a capacity/readiness assessment Decisions about adaptation 4. Possibility for adaptation Capacity-building strategies 5. Obtaining explicit buy-in from critical stakeholders and fostering a supportive community/organizational climate 6. Building general/organizational capacity 7. Staff recruitment/maintenance 8. Effective pre-innovation staff training Phase Two: Creating a structure for implementation Structural features for implementation 9. Creating implementation teams 10. Developing an implementation plan Phase Three: Ongoing structure once implementation begins Ongoing implementation support strategies 11. Technical assistance/coaching/supervision 12. Process evaluation 13. Supportive feedback mechanism Phase Four: Improving future applications 14. Learning from experience
- PHASE ONE: INITIAL CONSIDERATIONS REGARDING THE HOST SETTING ASSESSMENT STRATEGIES 1. Conducting a needs and resources assessment 2. Conducting a fit assessment 3. Conducting a capacity/readiness assessment Decisions about adaptation 4. Possibility for adaptation Capacity-building strategies 5. Obtaining explicit buy-in from critical stakeholders and fostering a supportive community/organizational climate 6. Building general/organizational capacity 7. Staff recruitment/maintenance 8. Effective pre-innovation staff training PHASE TWO: CREATING A STRUCTURE FOR IMPLEMENTATION STRUCTURAL FEATURES FOR IMPLEMENTATION 9. Creating implementation teams 10. Developing an implementation plan PHASE THREE: ONGOING STRUCTURE ONCE IMPLEMENTATION BEGINS Ongoing implementation support strategies 11. Technical assistance/coaching/supervision 12. Process evaluation 13. Supportive feedback mechanism PHASE FOUR: IMPROVING FUTURE APPLICATIONS 14. Learning from experience
- five major domains : intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation 37 constructs
- 26 articles (6 % of 429) were included in the final sample. This figure includes only studies which specified CFIR constructs used (n=15). Nine studies specified only domains that were used and no constructs. Two studies made no explicit reference to any CFIR domains or constructs
- Esther qui utile le CFIR + Étape Durlak pour compléter
- se strength?: System Strengthening Lessons From Applying the CFIR to Maternal Health Positive Deviance Cases in Nampula, Mozambique
- identify quantitative instruments of implementation outcomes relevant to mental or behavioral health settings We identified 104 instruments across eight constructs, with nearly half (n = 50) assessing acceptability and 19 identified for adoption , with all other implementation outcomes revealing fewer than 10 instruments. Only one instrument demonstrated at least minimal evidence for psychometric strength on all six of the evidence-based assessment criteria. The majority of instruments had no information regarding responsiveness or predictive validity. that the majority of instruments consisting of between 11 and 49 items (a rating reflecting “ good” ) may actually reflect unfeasible instrument length in a practical implementation context.
- Mise en oeuvre correspond aux activités de vérification et de détermination et paiement des subsides. La dimension ‘autres’ comportent les activités de recherche-action.
- Fidélité de couverture
- an overview of reviews
- C,est donc un très vieux débat et les écrits en SP sont très nombreux, quels sont ils donc en santé mondiale ?
- Unintended consequences : "changes for which there is a lack of purposeful action or causation that occur to a social system as a result of the innovation" (Ash et al., 2007) Design: Multiple case study Data collection • 6healthcarecenters • Fieldwork for ~ 2 weeks/center Falsification of community verification records Staged supervisions Dissatisfaction Loss of patient confidentiality Work overload created by patient sampling Inconclusive process for identifying fictitious patients Fear and apprehension among patients regarding community verification Fear of and conflicts regarding payment modalities
- OXFORD IMPLEMENTATION INDEX FOR TRIAL
- Concept multidimensionnel= 8 dimensions