Implementing validating environmental health monitoring system

The tool was developed in Canada, has been psychometrically tested also in other countries and is presently used in several large studies in high-income settings [20, 25–27].

The ACT contains eight dimensions measuring (1) leadership, (2) culture, (3) feedback, (4) connection amongst people, (5) formal interactions, (6) informal interactions, (7) structural and electronic resources and (8) organizational slack (sub-divided into staffing, space and time) [19].

The objective of the Context Assessment for Community Health (COACH) project was to develop and psychometrically validate a tool for LMICs to assess aspects of context influencing the implementation of evidence-based practices (EBP) [30] that could be used to achieve better insights into the process of implementing EBPs.

The name of the tool was chosen to reflect the focus of the project in terms of understanding how health systems context relates to the provision of care to community members.

The rationale for forming this multi-country team was our common interest in context as an explanatory factor influencing the implementation of health interventions.

The COACH tool development has gone through six different phases resulting in five different versions of the COACH tool (see Fig. Findings from one phase fed into the development of the next version of the tool including deletion of items, revisions of items and development of new items.

Thus, the network formed a core group to carry out the COACH project including health services researchers from Bangladesh, Vietnam, Uganda, South Africa, Nicaragua and Sweden having extensive experience from working in LMICs and implementing EBPs in these settings.

Early in the development, we initiated collaboration with two Canadian researchers who lead the development of the ACT.

Out of the three tools, the Alberta Context Tool (ACT) is the one that has been most widely used and has been subjected to the most rigorous evaluation of validity and reliability [13, 20–24].The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool.Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.The framework emphasizes the strength of and interplay between the following: (a) the nature of the evidence being used, (b) the quality of the context in terms of coping with change and (c) the facilitation relevant for a successful change process [6, 7].Thus, in addition to the availability of evidence for a certain innovation or practice and facilitation as a strategy used to implement this evidence, the context in which the evidence is implemented matters.

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