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Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

Anna Bergström12*, Stefan Peterson123, Sarah Namusoko3, Peter Waiswa13 and Lars Wallin45

Author Affiliations

1 Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Nobels väg 9, Stockholm SE-17177, Sweden

2 Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Akademiska sjukhuset, Uppsala SE-75185, Sweden

3 School of Public Health, Makerere University College of Health Sciences, Plot 1, New Mulago Hospital Complex, Makerere, Uganda

4 Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, 141 83, Sweden

5 School of Health and Social Studies, Dalarna University, Falun, SE-79188, Sweden

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Implementation Science 2012, 7:117  doi:10.1186/1748-5908-7-117

Published: 3 December 2012

Abstract

Background

A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this ‘know-do’ gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the sub-elements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting.

Methods

This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data.

Results

The sub-elements of organizational context in the PARIHS framework—i.e., receptive context, culture, leadership, and evaluation—also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT.

Conclusions

In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings—resources, community involvement, and commitment and informal payment—should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate sub-element of the PARIHS framework as a whole.

Keywords:
Organizational context; PARIHS; Knowledge translation; Low-income settings; Focus group discussions; Interviews