Abstract

Background

In Uganda, health system challenges limit access to good quality healthcare and contribute to slow progress on malaria control. We developed a complex intervention (PRIME), which was designed to improve quality of care for malaria at public health centres.

Objective

Responding to calls for increased transparency, we describe the PRIME intervention's design process, rationale, and final content and reflect on the choices and challenges encountered during the design of this complex intervention.

Design

To develop the intervention, we followed a multistep approach, including the following: 1) formative research to identify intervention target areas and objectives; 2) prioritization of intervention components; 3) review of relevant evidence; 4) development of intervention components; 5) piloting and refinement of workshop modules; and 6) consolidation of the PRIME intervention theories of change to articulate why and how the intervention was hypothesized to produce desired outcomes. We aimed to develop an intervention that was evidence-based, grounded in theory, and appropriate for the study context; could be evaluated within a randomized controlled trial; and had the potential to be scaled up sustainably.

Results

The process of developing the PRIME intervention package was lengthy and dynamic. The final intervention package consisted of four components: 1) training in fever case management and use of rapid diagnostic tests for malaria (mRDTs); 2) workshops in health centre management; 3) workshops in patient-centred services; and 4) provision of mRDTs and antimalarials when stocks ran low.

Conclusions

The slow and iterative process of intervention design contrasted with the continually shifting study context. We highlight the considerations and choices made at each design stage, discussing elements we included and why, as well as those that were ultimately excluded. Reflection on and reporting of ‘behind the scenes’ accounts of intervention design may improve the design, assessment, and generalizability of complex interventions and their evaluations.

Details

Title
Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda
Author
DiLiberto, Deborah D 1 ; Staedke, Sarah G 2 ; Nankya, Florence 3 ; Maiteki-Sebuguzi, Catherine 3 ; Taaka, Lilian 3 ; Nayiga, Susan 3 ; Kamya, Moses R 4 ; Haaland, Ane 5 ; Chandler, Clare I R 6 

 Department of Medical Statistics London School of Hygiene & Tropical Medicine, London, UK 
 Department of Clinical Research London School of Hygiene & Tropical Medicine, London, UK; Infectious Diseases Research Collaboration Kampala, Uganda 
 Infectious Diseases Research Collaboration Kampala, Uganda 
 Infectious Diseases Research Collaboration Kampala, Uganda; School of Medicine Makerere University College of Health Sciences, Kampala, Uganda 
 Institute of Health and Society University of Oslo, Oslo, Norway 
 Department of Global Health & Development London School of Hygiene & Tropical Medicine, London, UK 
Publication year
2015
Publication date
Dec 2015
Publisher
Taylor & Francis Ltd.
e-ISSN
16549880
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2215233186
Copyright
© 2015 Deborah D. DiLiberto et al. This work is licensed under the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.