Evaluation of Communities of Practice performance developing implementation research to enhance maternal health decision-making in Mexico and Nicaragua

摘要

Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings. To address this challenge, we developed a participatory capacity strengthening model based on Communities of Practice (CoPs) of maternal health frontline personnel and decision-makers involved in implementing maternal health programs in Latin America. The activities focused on the conduct and use of implementation research to enhance maternal health decision-making. Our objective is to evaluate the performance of the Communities of Practice in using implementation research to support decision-making in maternal health programs in Mexico and Nicaragua. We evaluated the CoPs’ performance using a mixed methods approach. We appraised the performance of CoPs using five criteria: (i) integration of the CoP, (ii) ownership of the methodology, (iii) timely delivery of products, (iv) feedback to decision-makers, and (v) influence on program changes. We also included an assessment of the barriers and facilitators to the conduct and uptake of implementation research findings in maternal health decision-making. Two CoPs showed “sub-optimal” performance, one was signaled as “needing strengthening,” and three reached “optimal” performance in the use of implementation research to enhance maternal health programs. The relationships between champions, facilitators, and research team were the main internal enabling factor for success. Externally, political and epidemiological environments acted as the main barriers to the performance of CoPs. Our study highlights the value of involving decision-makers in CoPs, ensuring varied skill sets and profiles of health professionals, as well as maintaining strong and continuous collaborations with researchers. Collaborative approaches and meaningful engagement of decision-makers and researchers are useful in conducting implementation research and promoting the use of evidence to improve maternal health programs in resource-strained settings.