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Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda
Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation ha...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987305/ https://www.ncbi.nlm.nih.gov/pubmed/35400072 http://dx.doi.org/10.3389/fpubh.2022.837211 |
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author | Davis, J. Lucian Ayakaka, Irene Ggita, Joseph M. Ochom, Emmanuel Babirye, Diana Turimumahoro, Patricia Gupta, Amanda J. Mugabe, Frank R. Armstrong-Hough, Mari Cattamanchi, Adithya Katamba, Achilles |
author_facet | Davis, J. Lucian Ayakaka, Irene Ggita, Joseph M. Ochom, Emmanuel Babirye, Diana Turimumahoro, Patricia Gupta, Amanda J. Mugabe, Frank R. Armstrong-Hough, Mari Cattamanchi, Adithya Katamba, Achilles |
author_sort | Davis, J. Lucian |
collection | PubMed |
description | Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users. |
format | Online Article Text |
id | pubmed-8987305 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89873052022-04-08 Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda Davis, J. Lucian Ayakaka, Irene Ggita, Joseph M. Ochom, Emmanuel Babirye, Diana Turimumahoro, Patricia Gupta, Amanda J. Mugabe, Frank R. Armstrong-Hough, Mari Cattamanchi, Adithya Katamba, Achilles Front Public Health Public Health Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users. Frontiers Media S.A. 2022-03-24 /pmc/articles/PMC8987305/ /pubmed/35400072 http://dx.doi.org/10.3389/fpubh.2022.837211 Text en Copyright © 2022 Davis, Ayakaka, Ggita, Ochom, Babirye, Turimumahoro, Gupta, Mugabe, Armstrong-Hough, Cattamanchi and Katamba. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Public Health Davis, J. Lucian Ayakaka, Irene Ggita, Joseph M. Ochom, Emmanuel Babirye, Diana Turimumahoro, Patricia Gupta, Amanda J. Mugabe, Frank R. Armstrong-Hough, Mari Cattamanchi, Adithya Katamba, Achilles Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title | Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title_full | Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title_fullStr | Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title_full_unstemmed | Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title_short | Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda |
title_sort | theory-informed design of a tailored strategy for implementing household tb contact investigation in uganda |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987305/ https://www.ncbi.nlm.nih.gov/pubmed/35400072 http://dx.doi.org/10.3389/fpubh.2022.837211 |
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