Capacity building through comprehensive implementation research training and mentorship: an approach for translating knowledge into practice.

BACKGROUND: Implementation research (IR) is increasingly gaining popularity as the act of carrying an intention into effect. It is thus an important approach to addressing individual practices, policies, programmes and other technologies to solving public health problems. Low- and middle-income countries (LMICs) continue to experience public health problems which could be addressed using implementation research. These countries however fall behind prioritizing implementation research due to the disorganized approach used to providing knowledge about the value and scope of implementation research. This paper seeks to explain steps taken to resolve this by capacity strengthening activities through a comprehensive implementation research training and mentorship programme which was informed by needs assessment. METHODS: The roll-out of the comprehensive implementation research training and mentorship was done in phases, including engaging the implementation research community through TDR Global, competency building for programme officers and ethical review board/committee members, and practical guidance to develop an implementation research proposal. The Bloom taxonomy guided the training whilst the Kirkpatrick Model was used for the evaluation of the effectiveness of the capacity building. RESULTS: The findings identified critical areas of mentors and how mentorship should be structured and the most effective ways of delivering mentorship. These findings were used to develop a mentorship guide in IR. The mentorship guidance is to be used as a check-tool for mentoring participants during trainings as part of the package of resources in implementation research. It is also to be used in equipping review board members with knowledge on ethical issues in implementation research. CONCLUSION: The approach for providing comprehensive implementation research training and mentorship for programme personnel has provided an opportunity for both potential mentors and mentees to make inputs into developing a mentorship guidance for LMICs. This guidance would help address mentorship initiation and implementation challenges in IR.

Social innovations to increase health coverage: evidence from a crowdsourcing contest in Ghana.

OBJECTIVES: Despite progress made to expand access to health service in Ghana, inequities still exist. Social innovations have been developed as community-engaged solutions to decrease inequities. METHODS: In partnership with a multistakeholder group, our social innovation team organised a crowdsourcing contest to identify health innovations in Ghana. Informed by a WHO-Special Programme for Research and Training in Tropical Diseases framework, we organised a six-stage crowdsourcing challenge. RESULTS: In all, 13 innovations were received in the contest, while 2 innovations were rejected after initial screening. The 11 innovations were reviewed by a panel of four independent expert judges. Inter-rated reliability index (kappa) was 0.86. Following the review of the average score, five top innovations were recognised. These submissions can be put into three main themes: technology and strengthening (eg, mHealth for cervical cancer screening, video directly observed therapy), inclusiveness and reaching the marginalised (people with disability and infertility) and data utilisation for project improvement (seasonal calendar to reduce morbidity and mortality of children under 5 for malaria, diarrhoea and pneumonia). CONCLUSION: In conclusion, this study shows that solutions to local problems exist. Therefore, policymakers, the government and development partners should support the scale-up of such innovations.

Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana.

BACKGROUND: Adolescence, a transition period from childhood to adulthood forms the foundation of health in later life. The adolescence period which should have been characterised by good health is often marred with life-threatening and irreparable consequences of public health concern. Teen pregnancy is problematic because it could jeopardise adolescents' safe transition to adulthood which does not only affect adolescents, but also their families, babies and society. There is ample evidence about the determinants and effects of teen pregnancy, but it is fragmented and incomplete, especially in Sub-Sahara Africa. This study presents pregnant adolescents' voices to explain significant gaps in understanding their lived experiences and coping strategies. METHODS: This narrative inquiry, involved in-depth interviews with 16 pregnant adolescents, who were recruited from a peri-urban district in Southern Ghana using purposive and snowball techniques in health facilities and communities respectively. The audio recorded interviews were transcribed verbatim and analysed manually using content analysis. RESULTS: Many pregnant adolescents are silent victims of a hash socio-economic environment, in which they experience significant financial deprivation, parental neglect and sexual abuse. Also, negative experiences of some adolescent girls such as scolding, flogging by parents, stigmatisation and rejection by peers and neighbors result in grieve, stress and contemplation of abortion and or suicide. However, adolescents did not consider abortion as the best option with regard to their pregnancy. Rather, family members provided adolescents with critical support as they devise strategies such as avoiding people, depending on God and praying to cope with their pregnancy. CONCLUSION: Adolescent pregnancy occurred through consensual sex, transactional sex and sexual abuse. While parents provide support, pregnant adolescents self-isolate, depend on God and pray to cope with pregnancy and drop out of school. We recommend that the Ministries of Education and Health, and law enforcement agencies should engage community leaders and members, religious groups, non-governmental organisations and other key stakeholders to develop interventions aimed at supporting girls to complete at least Senior High School. While doing this, it is also important to provide support to victims of sexual abuse and punish perpetrators accordingly.

Preparation for COVID-19 vaccines rollout: Interventions to increase trust, acceptability, and uptake in West African countries.

INTRODUCTION: The approval of COVID-19 vaccines for use has come as a relief to West Africa and world. However, concerns raised about the vaccines in America and Europe have created anxiety among some citizens in Africa. These concerns are likely to affect the acceptance, and uptake of the COVID-19 vaccines in West Africa. METHODS: Guided by the principles of effective community engagement, this research reviewed typical case studies of past vaccination exercises to document concerns, challenges and lessons learnt. These were then used to propose pre-immunisation interventions in West Africa to increase the COVID-19 vaccines acceptance and uptake. RESULTS: Concerns about safety can undermine the rollout of the COVID-19 vaccines. These concerns can be addressed through effective community engagement. Community leaderships could be engaged through courtesy calls, workshops and durbars to sensitise them on immunisation. Engaging the scientific community can help build trust and reduce concerns about vaccine safety. In vaccines rollout, managing misinformation is important and the media can play a critical role in addressing these in their reportage. In addition, social media is an effective monitoring tool for vaccine-related misinformation. CONCLUSION: The analysis underscores the need for more community engagement before the importation and deployment of COVID-19 vaccines in West Africa. Experiences from community responses to previous vaccination exercises for emerging and remerging infectious diseases should inform the current efforts and enhance the process to achieve high uptake and reduce vaccine hesitancy.

Stakeholders perspective of, and experience with contact tracing for COVID-19 in Ghana: A qualitative study among contact tracers, supervisors, and contacts.

BACKGROUND: Ghana confirmed the first two cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection on 12th March 2020. Following this, the government introduced routine and enhanced contact tracing to identify, quarantine, and test contacts for COVID-19. This study, therefore, intends to document the experiences of contact tracers, their supervisors, during COVID-19 containment in Ghana. METHODS: Purposive sampling was used to select twenty-seven (27) participants; sixteen contact tracers, six supervisors, and five contacts of COVID-19 cases for an in-depth interview using a topic guide. These interviews were conducted on a phone or face-to-face basis whilst maintaining physical distancing protocol. All these were recorded and transcribed verbatim. Then, QSR NVivo 12 was used to analyse the data thematically. RESULTS: Contact tracers were selected based on their professional background and surveillance experience with other infectious diseases. They were trained before the first confirmed cases of COVID-19 in the country and before deployment. Deployment of contact tracers was in pairs to monitor contacts daily through physical visits or over the phone. Their activities included educating contacts about the condition, filling the symptoms diary, and providing psychological support. Contacts for COVID-19 were identified through case investigation, and their monitoring is done once a day despite the twice-daily requirement. Wherever a case was confirmed, enhanced contact tracing within a 2km radius was done. Furthermore, it was reported that some contacts were not adhering to the self-quarantine. In addition to this, other challenges included; unstable provision of PPEs and remuneration, refusal of some contact to test, delays in receiving test results, and poor coordination of the whole process. CONCLUSIONS: The study concludes that contact tracing was generally perceived to be helpful in COVID-19 containment in Ghana. However, adhering to self-quarantine protocol had many challenges for both contact tracers and the contacts. Improving coordination and quick release of test results to contacts is necessary for COVID-19 containment. Lastly, the supply of Personal Protection Equipment and motivation needs to be addressed to help position the country well for effective contact tracing.

"Once the child is delivered, he is no more your baby," Exclusive Breastfeeding experiences of first-time mothers in Kassena-Nankana Municipality, Ghana - a qualitative study.

BACKGROUND: Exclusive Breastfeeding (EBF), for the first 6 months of life, is globally accepted as the preferred method for infant feeding. In Ghana, an estimated 84% of children < 2 months old are exclusively breastfed. But by age 4 to 5 months, only 49% continue to receive EBF. This situation continues to deteriorate. Thus, the need to explore perceptions, practices as well as factors that influence EBF in Ghana. METHODS: Using a qualitative design, four focus group discussions were conducted among first-time mothers and eight in-depth interviews with health workers and traditional birth attendants. The study was conducted in four communities in the Kassena-Nankana municipality of Ghana. Discussions and interviews were recorded and later transcribed verbatim to English language. The transcribed data was then coded with the aid of analysis computer software (Nvivo version 10.0) and later analyzed for the generation of themes. RESULTS: Exclusive breastfeeding is practiced among first-time mothers due to its perceived benefits; which include nutritional advantage, ability to enhance growth whilst boosting immunity and its economic value. However misconceptions as well as, certain cultural practices (e.g. giving herbal concoctions, breastmilk purification rites), and relational influences, may threaten a mother's intention to exclusively breastfeed. Relational influences are mainly from mother in-laws, traditional birth attendants, grandmothers, herbalists and other older adults in the community. CONCLUSIONS: Although first time mothers attempt EBF, external influences make it practically challenging. The availability and utilization of information on EBF was found to positively influence perceptions towards EBF, leading to change in attitude towards the act. Thus, the practice of community-based health services may be strengthened to provide support for first-time mothers as well as continuous education to the mother in laws, female elders and community leaders who influence decision making on breastfeeding of infants.

Capacity building for implementation research: a methodology for advancing health research and practice.

BACKGROUND: Implementation research is increasingly being recognised as an important discipline seeking to maximise the benefits of evidence-based interventions. Although capacity-building efforts are ongoing, there has been limited attention on the contextual and health system peculiarities in low- and middle-income countries. Moreover, given the challenges encountered during the implementation of health interventions, the field of implementation research requires a creative attempt to build expertise for health researchers and practitioners simultaneously. With support from the Special Programme for Research and Training in Tropical Diseases, we have developed an implementation research short course that targets both researchers and practitioners. This paper seeks to explain the course development processes and report on training evaluations, highlighting its relevance for inter-institutional and inter-regional capacity strengthening. METHODS: The development of the implementation research course curriculum was categorised into four phases, namely the formation of a core curriculum development team, course content development, internal reviews and pilot, and external reviews and evaluations. Five modules were developed covering Introduction to implementation research, Methods in implementation research, Ethics and quality management in implementation research, Community and stakeholder engagement, and Dissemination in implementation research. Course evaluations were conducted using developed tools measuring participants' reactions and learning. RESULTS: From 2016 to 2018, the IR curriculum has been used to train a total of 165 researchers and practitioners predominantly from African countries, the majority of whom are males (57%) and researchers/academics (79.4%). Participants generally gave positive ratings (e.g. integration of concepts) for their reactions to the training. Under 'learnings', participants indicated improvement in their knowledge in areas such as identification of implementation research problems and questions. CONCLUSION: The approach for training both researchers and practitioners offers a dynamic opportunity for the acquisition and sharing of knowledge for both categories of learners. This approach was crucial in demonstrating a key characteristic of implementation research (e.g. multidisciplinary) practically evident during the training sessions. Using such a model to effectively train participants from various low- and middle-income countries shows the opportunities this training curriculum offers as a capacity-building tool.