What do we know about technical assistance? Enhancing the science and practice of technical assistance via a research synthesis.

摘要

Introduction. Each year billions of dollars are spent on providing technical assistance (TA) to build the capacity of host settings (e.g., organizations, communities) to implement innovations, but there is little consensus (or even discussion) about: what the essential features of TA are, how to provide TA with quality, and how a quality-based accountability perspective can help us to enhance the science and practice of TA. To begin to address these needs, a research synthesis methodology was used for conducting a content analysis of the current evidence base for TA using three frames: (1) applying a conceptual and operational model (Getting To OutcomesRTM (GTORTM)) that specifies steps for planning, implementing and evaluating TA; (2) understanding the relevance of a successful relationship between the TA provider and TA recipient; and (3) considering the extent to which TA fits the life-span needs of the innovation that is being implemented in the host organization or community.;Methods. This study used a research synthesis approach to accommodate a wide array of outcomes and project designs in a systematic review of TA literature. To identify salient publications, the search terms "technical assistance and (evaluation or outcomes)" were used in the MEDLINE, PsycInfo, CINAHL, and Social Work Abstracts databases. Initially, over 800 publications were identified. Evaluations based on pre-specified criteria identified 111 unduplicated papers for review. Information to address the issues of concern were abstracted using a structured data form with an inter-rater reliability (Cohen's Kappa) greater than 0.7.;Results. The information compiled for this synthesis revealed that some techniques (GTO steps) are not reported frequently (continuous quality improvement, sustainability) in the literature whereas other techniques are reported more frequently but with variable levels of rigor. For example, a TA needs/resource assessment was often specified and the step tended to be quite systematic in its application, while TA goal-setting was frequently reported but was often carried out in a way that lacked sufficient precision. The most commonly reported TA relationship features were collaboration, encouragement, and trust. With the exception of one technique (assessing fit of best practices), no significant differences in techniques were observed between major stages in the innovation life span. There were some differences between the stages in relationship features; for example, collaboration and respect were more important earlier in the life-span.;Conclusion. The findings from the synthesis provide a snapshot of what we know about TA, which can be used to enhance the science and practice of TA. The results indicate high variability in the utilization of TA techniques, and some of the underlying chaos or apparent omission of systematic forethought in selecting and using techniques may be reflected in the finding that techniques were largely independent of the innovation life-span. It may be useful to have a checklist listing GTO steps for TA providers to utilize as a decision aide when selecting and using techniques. The finding that relationships are reported relatively frequently suggests that there is value in taking steps to ensure that healthy and supportive TA relationships are in place. TA providers could benefit from a checklist that indicates the predominant relationship features that are reported in the literature, including some of the relationship features identified as being connected to particular life-span stages. Overall, the findings from this synthesis indicate that the rigor with which TA is being delivered is limited. We suggest that funders and other stakeholders develop and enforce standards for TA quality in order to assure that many of the gaps are improved.