How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review

Catherine Arsenault, Samantha Y. Rowe, Dennis Ross-Degnan, David H. Peters, Sanam Roder-Dewan, Margaret E. Kruk, Alexander K. Rowe

Research output: Contribution to journalReview articlepeer-review

Abstract

Background A recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability. Methods We conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance. Results The primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI:-0.36 to-0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI:-0.68 to-0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time. Conclusions Time trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.

Original languageEnglish (US)
Article number011717
Pages (from-to)123-133
Number of pages11
JournalBMJ Quality and Safety
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2022

Keywords

  • health services research
  • implementation science
  • performance measures
  • quality improvement
  • standards of care

ASJC Scopus subject areas

  • Health Policy

Fingerprint

Dive into the research topics of 'How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review'. Together they form a unique fingerprint.

Cite this