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'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study.

ABSTRACT: OBJECTIVE:To explore experts' views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes. DESIGN:This is an exploratory study based on semistructured expert interviews. Framework analysis was applied. PARTICIPANTS:The study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. RESULTS:This study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental stakeholders in ACF policy development. Such key stakeholders also influence ACF policy implementation, in addition to available systems and processes in a given health system, and implementers' motivation and incentives. According to the interviewees, the World Health Organization (WHO) guidelines for systematic screening face the innate challenge of providing guidance to countries across the broad area of ACF in terms of target groups, settings and screening algorithms. The guidelines could be improved by focusing on what should be done rather than what can be done in ACF, and by providing howto examples. Leadership, integration into health systems and long-term financing are key for ACF to be sustainable. CONCLUSIONS:We provide new insights into ACF policy processes globally, particularly regarding facilitators for and barriers to ACF policy development, evidence need and use, and donor organisations' influence. According to expert participants, national and global ACF policy development and implementation can be improved by broadening stakeholder engagement. Meanwhile, using diverse evidence to inform ACF policy development and implementation could mitigate the 'power plays plus push' that might otherwise disrupt and mislead these policy processes.

SUBMITTER: Biermann O

PROVIDER: S-EPMC7282330 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study.

Biermann Olivia O Atkins Salla S Lönnroth Knut K Caws Maxine M Viney Kerri K

BMJ open 20200603 6

<h4>Objective</h4>To explore experts' views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes.<h4>Design</h4>This is an exploratory study based on semistructured expert interviews. Framework analysis was applied.<h4>Participants</h4>The study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international ...[more]

PMID: 32499270

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Project description:OBJECTIVE:To explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation. DESIGN:Scoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses. RESULTS:Seventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO's ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF. CONCLUSION:We identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less about how to strengthen those facilitators and how to overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.

Dataset Information

'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study.

Publications

'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study.

Similar Datasets

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