RE-AIM dimension and operational definition | Plan | Indicators |
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How will I and the intervention reach the targeted population? Reach is the absolute number or proportion of individuals who are willing to participate in a given initiative. | • Project staff will visit clinics directly and meet with relevant local stakeholders. We already have support and permission from relevant local authorities to undertake the study. • TB staff at the participating health facilities will be trained in workshops and informal on-the-job interactions to undertake the intervention, comprising identifying TB symptoms and asymptomatic TB contacts, referral, education of patients, prescribing, and monitoring. • Project staff will also have direct contact with selected, consenting TB patients and their contacts through referral by clinic staff, for interviews and provision of education. | • Proportion of health providers who participate in the intervention • Uptake of contact investigation among smear sputum positive TB individual • Uptake of preventive therapy among child contact of smear sputum positive TB cases |
How do I know my intervention is effective? Effectiveness is the impact of an intervention on outcomes, including potential negative effects, quality of life, and economic outcomes. | • Relevant data will be collected regularly. The listed quantitative outcome measures will demonstrate whether interventions are working • Results of staff interviews will show whether staff have adequate knowledge of the process of contact management, and whether they are satisfied with the project. | • Significant change in the practice of contact investigation and preventive treatment identified using ARIMA model • Number of new TB cases (adult and children) identified from contact investigation • Number of children eligible for preventive therapy identified from contact investigation • Number of eligible children commence on preventive therapy • Adherence to preventive therapy among eligible contacts |
How do I develop organizational support to deliver my intervention? Adoption is the absolute number, proportion, and representativeness of settings and intervention agents who are willing to initiate a program. | • This has been achieved already through face-to-face meetings with and endorsement from the Timika Health Authority (Dinas Kesehatan Timika), as well as endorsement of the study protocol by the National TB expert committee. A partnership agreement has been signed with all selected health facilities. • Number of healthcare workers who were trained and actively participated in the program will be measured. | • Health staff perception about the appropriateness, comfort, relative advantage, and credibility of the intervention • Proportion of TB nurses, TB physicians, head of Puskesmas, hospital managements, and district health office staff who are willing to accept, support. and participate in the intervention • The extent of support and participation of TB-related health staff and stakeholders in the contact investigation and preventive therapy program |
How do I ensure the intervention is delivered properly? Implementation refers to the intervention agents’ fidelity to the various elements of the intervention’s protocol | • Project staff will directly supervise project implementation. The research team (study nurses working with doctoral researcher) has been well trained and already has a strong background in TB management. • Data checking will be undertaken regularly during the project. | • Fidelity of the intervention • The extent to which the intervention can be carried out in Puskesmas and Hospital • Gap between indigenous and non-indigenous Papuan people in the access and quality of the intervention |
How do I incorporate the intervention, so it is delivered over the long-term? Maintenance is the extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies. | • The use of continuous quality improvement will embed practice locally and sustainably. • Some actions to repair logistic barriers to TB contact tracing (e.g., lack of medication supply) are being overcome early in the study—this effect will be sustained. • Train-the-trainer concepts will be employed to ensure sustainability of knowledge within healthcare centers. • Inclusion of budget for isoniazid prevention therapy and contact investigation in primary care facilities or hospital budgets can also be indicators of program sustainability. | • The extent to which the intervention is institutionalized or maintained within health facility and district health system • Integration of the intervention to the other existing program in health facilities. |