Stages of change: A qualitative study on the implementation of a perinatal audit programme in South Africa

Details

• Alternative Title:
  BMC Health Serv Res
• Personal Author:
  Belizán, María ; Bergh, Anne-Marie ; Cilliers, Carolé ; Pattinson, Robert C ; Voce, Anna
• Description:
  Background
  
  Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme.
  
  Methods
  
  Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices).
  
  Results
  
  Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players.
  
  Conclusion
  
  Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed.
  
  
• Subjects:
  Developing Countries Evaluation Studies As Topic Female Health Plan Implementation Humans Infant, Newborn Infant Mortality Male Medical Audit Perinatal Care Program Development Program Evaluation Quality Of Health Care Research Article

  More +
• Source:
  BMC Health Serv Res. 2011; 11:243.
• Pubmed ID:
  21958353
• Pubmed Central ID:
  PMC3195711
• Document Type:
  Journal Article
• Funding:
  U2G/PS001053-03/PS/NCHHSTP CDC HHS/United States
• Place as Subject:
  South Africa
• Volume:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2939538bb138feb994203933eaa99e1aca5e5ff9e3210defa3ec4d63cf38d856
• Download URL:
  https://stacks.cdc.gov/view/cdc/22774/cdc_22774_DS1.pdf
• File Type:
  [PDF - 264.92 KB ]