Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review.
Background: Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to imple...
| Publicado en: | BMC Medicine Vol. 17; no. 1 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
BioMed Central
2/15/2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=134730104&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 134730104 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17417015 1CI2 jtl: BMC Medicine issn: 17417015 maglogo: N pubinfo: dt: 2/15/2019 vid: 17 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 134730104 134730104 NLM30764820 134730104 10.1186/s12916-018-1237-x NLM30764820 134730104 ppct: 1 formats: tig: atl: Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review. aug: au: Kemp, Christopher G. Jarrett, Brooke A. Kwon, Churl-Su Song, Lanxin Jetté, Nathalie Sapag, Jaime C. Bass, Judith Murray, Laura Rao, Deepa Baral, Stefan affil: Department of Global Health, University of Washington, Seattle, WA, USA sug: subj: Stigma Africa South of the Sahara Health Care Delivery Human Poverty Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales ab: Background: Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions.Methods: PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR).Results: A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven.Conclusion: Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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