scholarly journals Provider Barriers and Facilitators of Breast Cancer Guideline‐Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis

2021 ◽  
Author(s):  
Tlotlo B. Ralefala ◽  
Lebogang Mokokwe ◽  
Swetha Jammalamadugu ◽  
Dumelang Legobere ◽  
Warona S. Motlhwa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Implementation Research ◽  
Barriers And Facilitators ◽  
Provider Barriers ◽  
Research Analysis ◽  
Therapy Delivery

The Mismatch between Expectations and Realities of AS4 Audits: A Post-Implementation Research Analysis

2017 ◽  
Vol 37 (1) ◽  
pp. 1-19 ◽  
Author(s):  
Sanaz Aghazadeh ◽  
Marietta Peytcheva
Keyword(s):  
Implementation Research ◽  
Risk Premium ◽  
Cost Benefit ◽  
Multiple Methods ◽  
Material Weakness ◽  
Key Stakeholders ◽  
Auditing Standards ◽  
Equilibrium Market ◽  
The Cost ◽  
Research Analysis

SUMMARY We conduct a post-implementation research analysis of AS4, a standard guiding voluntary audits of material weakness (MW) remediation disclosures, to understand the reasons for the scarcity of AS4 audits in practice. We use multiple methods (experiments, comment letter analysis, and surveys) to understand the perspectives of key stakeholders. We find that regulators' expectations of the use of the standard did not come to fruition because an equilibrium market for active use of the standard could not be achieved; that managers desire to engage in AS4 audits for the riskier MWs but do not expect the associated costs to be high; and that auditors are reluctant to audit riskier MWs and would charge a considerable risk premium. Finally, we find that investors value AS4 audits, especially for riskier MWs, and find value in an AS4 audit for those risky MWs beyond that of the year-end audit. The overall findings of our study indicate that a mismatch in the cost-benefit functions of the key stakeholders led to a lack of AS4 audits. Our findings are important given the high costs associated with auditing standards development and approval.

scholarly journals Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rawlance Ndejjo ◽  
Rhoda K. Wanyenze ◽  
Fred Nuwaha ◽  
Hilde Bastiaens ◽  
Geofrey Musinguzi
Keyword(s):  
Cardiovascular Disease ◽  
Low Income ◽  
Implementation Research ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Prevention Programme ◽  
Intervention Implementation ◽  
Design Quality ◽  
Middle Income

Abstract Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.

scholarly journals Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States

JAMA Oncology ◽  
2017 ◽  
Vol 3 (7) ◽  
pp. 928 ◽  
Author(s):  
Bobby Daly ◽  
Olufunmilayo I. Olopade ◽  
Ningqi Hou ◽  
Katharine Yao ◽  
David J. Winchester ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Endocrine Therapy ◽  
Cancer Care ◽  
The United States ◽  
Adjuvant Endocrine Therapy ◽  
Breast Cancer Care ◽  
Therapy Delivery
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