The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation

Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-y...

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Autores principales: Enying Gong, Lixin Sun, Qian Long, Hanzhang Xu, Wanbing Gu, Janet Prvu Bettger, Jingru Tan, Jixiang Ma, Tazeen Hasan Jafar, Brian Oldenburg, Lijing L. Yan
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Publicado: Frontiers Media S.A. 2021
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spelling oai:doaj.org-article:1507ac1926f54cd69f9db69081f032d72021-11-17T05:18:39ZThe Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation2296-256510.3389/fpubh.2021.774907https://doaj.org/article/1507ac1926f54cd69f9db69081f032d72021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpubh.2021.774907/fullhttps://doaj.org/toc/2296-2565Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future.Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework.Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness.Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03185858.Enying GongEnying GongEnying GongLixin SunQian LongHanzhang XuWanbing GuJanet Prvu BettgerJanet Prvu BettgerJingru TanJingru TanJixiang MaTazeen Hasan JafarTazeen Hasan JafarBrian OldenburgBrian OldenburgLijing L. YanLijing L. YanLijing L. YanLijing L. YanFrontiers Media S.A.articlestrokeimplementation evaluationmobile healthrural ChinaRE-AIM (reacheffectivenessPublic aspects of medicineRA1-1270ENFrontiers in Public Health, Vol 9 (2021)
institution DOAJ
collection DOAJ
language EN
topic stroke
implementation evaluation
mobile health
rural China
RE-AIM (reach
effectiveness
Public aspects of medicine
RA1-1270
spellingShingle stroke
implementation evaluation
mobile health
rural China
RE-AIM (reach
effectiveness
Public aspects of medicine
RA1-1270
Enying Gong
Enying Gong
Enying Gong
Lixin Sun
Qian Long
Hanzhang Xu
Wanbing Gu
Janet Prvu Bettger
Janet Prvu Bettger
Jingru Tan
Jingru Tan
Jixiang Ma
Tazeen Hasan Jafar
Tazeen Hasan Jafar
Brian Oldenburg
Brian Oldenburg
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
description Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future.Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework.Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness.Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03185858.
format article
author Enying Gong
Enying Gong
Enying Gong
Lixin Sun
Qian Long
Hanzhang Xu
Wanbing Gu
Janet Prvu Bettger
Janet Prvu Bettger
Jingru Tan
Jingru Tan
Jixiang Ma
Tazeen Hasan Jafar
Tazeen Hasan Jafar
Brian Oldenburg
Brian Oldenburg
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
author_facet Enying Gong
Enying Gong
Enying Gong
Lixin Sun
Qian Long
Hanzhang Xu
Wanbing Gu
Janet Prvu Bettger
Janet Prvu Bettger
Jingru Tan
Jingru Tan
Jixiang Ma
Tazeen Hasan Jafar
Tazeen Hasan Jafar
Brian Oldenburg
Brian Oldenburg
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
Lijing L. Yan
author_sort Enying Gong
title The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
title_short The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
title_full The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
title_fullStr The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
title_full_unstemmed The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation
title_sort implementation of a primary care-based integrated mobile health intervention for stroke management in rural china: mixed-methods process evaluation
publisher Frontiers Media S.A.
publishDate 2021
url https://doaj.org/article/1507ac1926f54cd69f9db69081f032d7
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