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. 2023 Oct 28;13(10):e071540. doi: 10.1136/bmjopen-2022-071540

Table 4.

The evaluation of implementation outcomes

Definition (Proctor et al 2011)35 Provider level Patient level Facility level ACT application audits Record audit at RRH visits
Acceptability Relates to perceptions on suitability and agreeability of the innovation and the satisfaction among stakeholders. Analysis will be at the patient and provider level. Provider pre/post decentralisation interviews Patient pre/post decentralisation interviews
Coded under acceptability and health setting preferences		 Administrator interview ACT usage audit/data queries.
Documented ACT application changes.		 RRH injection record audits
Self-decentralisation rates and rates of return to RRH post-decentralisation
Adoption Defined as the intention to take up an innovation; also quoted as ‘uptake’ (Proctor et al, 2011, p.69).35 In this study adoption will be analysed at the provider level at the health facilities. Provider pre/post decentralisation interviews
Observation
Time and Motion study		 N/A Monthly Health facility survey—organisation and
appropriateness of RHD medicinal and supplies order based on need.
Direct observation.		 ACT usage audit

  • Trends of use by HC nurses

  • Completeness of BPG injections

  • Use of additional features (Reminder and Update of stock alerts)

 Examination of entered data on BPG card versus ACT application
Penetration Refers to the absorption or incorporation of the practice into the service setting and looks at the integration of the innovation in question. The level of analysis is at the health facility level. Provider pre/post decentralisation interviews.
Attendance to RHD cases. Numbers of providers trained vs numbers delivering service.		 N/A Monthly Health facility survey—Improvements in medicinal (BPG) and supply shortages
Direct observation
Regular attendance of patients with RHD		 Query-generation rates on ACT application
Use of paper records for RHD care
ACT usage by HC nurses—completion of information and other usage parameters overtime
Rates of re-education for HC nurses on deficient areas identified		 Reduction in BPG visits to RRH services for decentralised registrants

ACT, active community case management tool; BPG, benzathine penicillin G; HC, health centre; RHD, rheumatic heart disease; RRH, regional referral hospital.