BMJ Global Health (Jan 2021)
A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries
- Sally Singh,
- Bruce Kirenga,
- Mattijs E Numans,
- Hilary Pinnock,
- Maarten J Postma,
- Niels H Chavannes,
- Susanne Reventlow,
- Andy Barton,
- Grace Ndeezi,
- Janwillem Kocks,
- Sian Williams,
- Winceslaus Katagira,
- Rebecca Nantanda,
- Ioanna Tsiligianni,
- Sophia Papadakis,
- Christos Lionis,
- Patrick Musinguzi,
- Rupert Jones,
- Evelyn A Brakema,
- Rianne MJJ van der Kleij,
- Charlotte C Poot,
- Simon Walusimbi,
- Pham Le An,
- Talant Sooronbaev,
- Matty R Crone,
- Ria R Reis,
- Marilena Anastasaki,
- Azamat Akylbekov,
- Antonios Bertsias,
- Pham Duong Uyen Binh,
- Job FM van Boven,
- Dennis Burges,
- Lucy Cartwright,
- Vasiliki E Chatzea,
- Liza Cragg,
- Tran Ngoc Dang,
- Ilyas Dautov,
- Berik Emilov,
- Irene Ferarrio,
- Frederik A van Gemert,
- Ben Hedrick,
- Le Huynh Thi Cam Hong,
- Nick Hopkinson,
- Elvira Isaeva,
- Corina de Jong,
- Sanne van Kampen,
- Jesper Kjærgaard,
- Rianne MJJ van der Kleij,
- Le Thi Tuyet Lan,
- Tran Thanh Duv Linh,
- Kim Xuan Loan,
- Maamed Mademilov,
- Andy McEwen,
- Jillian Pooler,
- Anja Poulsen,
- Pippa Powell,
- Nguyen Nhat Quynh,
- Dimitra Sifaki-Pistolla,
- Jaime Correia de Sousa,
- James Stout,
- Marianne Stubbe Østergaard,
- Aizhamal Tabyshova,
- Tran Diep Tuan,
- Le Thanh Van,
- Nguyen Nhu Vinh,
- Louise Warren
Affiliations
- Sally Singh
- 2University of Leicester
- Bruce Kirenga
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Hilary Pinnock
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
- Maarten J Postma
- Health-Ecore, Zeist, The Netherlands
- Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Susanne Reventlow
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Andy Barton
- consultant
- Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
- Janwillem Kocks
- Sian Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Winceslaus Katagira
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Rebecca Nantanda
- Makerere University College of Health Sciences, Kampala, Uganda
- Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
- Sophia Papadakis
- 3 Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Crete, Greece
- Christos Lionis
- Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Greece
- Patrick Musinguzi
- 6 Makerere University College of Health Sciences, Kampala, Uganda
- Rupert Jones
- Plymouth Marjon University, Plymouth, UK
- Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Rianne MJJ van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University Faculty of Medicine, Kampala, Uganda
- Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
- Talant Sooronbaev
- Respiratory medicine, National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
- Matty R Crone
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Ria R Reis
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Marilena Anastasaki
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
- Azamat Akylbekov
- Respiratory medicine, National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
- Antonios Bertsias
- Rheumatology, Clinical Immunology and Allergy Department, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Pham Duong Uyen Binh
- Job FM van Boven
- Dennis Burges
- Lucy Cartwright
- Vasiliki E Chatzea
- Liza Cragg
- Tran Ngoc Dang
- lecturer
- Ilyas Dautov
- Berik Emilov
- Irene Ferarrio
- Frederik A van Gemert
- Ben Hedrick
- Le Huynh Thi Cam Hong
- Nick Hopkinson
- chair and professor
- Elvira Isaeva
- Corina de Jong
- Sanne van Kampen
- Jesper Kjærgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Rianne MJJ van der Kleij
- Le Thi Tuyet Lan
- Tran Thanh Duv Linh
- Kim Xuan Loan
- Maamed Mademilov
- Respiratory medicine, National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
- Andy McEwen
- Jillian Pooler
- Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Pippa Powell
- Nguyen Nhat Quynh
- Dimitra Sifaki-Pistolla
- Jaime Correia de Sousa
- James Stout
- Marianne Stubbe Østergaard
- Aizhamal Tabyshova
- Tran Diep Tuan
- University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
- Le Thanh Van
- Nguyen Nhu Vinh
- Louise Warren
- DOI
- https://doi.org/10.1136/bmjgh-2020-003221
- Journal volume & issue
-
Vol. 6,
no. 1
Abstract
Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.
