RT Journal Article
SR Electronic
T1 Implementing lung health interventions in low- and middle-income countries – a FRESH AIR systematic review and meta-synthesis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2000127
DO 10.1183/13993003.00127-2020
A1 Evelyn A. Brakema
A1 Debbie Vermond
A1 Hilary Pinnock
A1 Christos Lionis
A1 Bruce Kirenga
A1 An Pham Le
A1 Talant Sooronbaev
A1 Niels H. Chavannes
A1 Rianne M. J. J. van der Kleij
A1 ,
YR 2020
UL http://erj.ersjournals.com/content/early/2020/04/27/13993003.00127-2020.abstract
AB The vast majority of patients with chronic respiratory disease live in low- and middle-income countries (LMICs). Paradoxically, relevant interventions often fail to be effective particularly in these settings, as LMICs lack solid evidence on how to implement interventions successfully. Therefore, we aimed to identify factors critical to the implementation of lung health interventions in LMICs, and weight their level of evidence.This systematic review followed Cochrane methodology and PRISMA reporting standards. We searched eight databases without date- or language restrictions in July 2019, and included all relevant original, peer-reviewed articles. Two researchers independently selected articles, critically appraised them (using CASP/MetaQAT), extracted data, coded factors (following CFIR), and assigned levels of confidence in the factors (via GRADE-CERQual). We meta-synthesised levels of evidence of the factors based on their frequency and the assigned level of confidence. (PROSPERO:CRD42018088687)We included 37 articles out of 9111 screened. Studies were performed across the globe in a broad range of settings. Factors identified with a high level of evidence were 1) Understanding needs of local users, 2) ensuring Compatibility of interventions with local contexts (cultures, infrastructures), 3) identifying influential stakeholders and applying Engagement strategies, 4) ensuring adequate Access to knowledge and information, and 5) addressing Resource Availability. All implementation factors and their level of evidence were synthesised in an implementation tool.To conclude, this study identified implementation factors for lung health interventions in LMICs, weighted their level of evidence, and integrated the results into an implementation tool for practice. Policymakers, non-governmental organisations, practitioners, and researchers may use this FRESH AIR Implementation tool to develop evidence-based implementation strategies for related interventions. This could increase interventions’ implementation success, thereby optimising the use of already-scarce resources and improving health outcomes.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Brakema has nothing to disclose.Conflict of interest: Dr. Vermond has nothing to disclose.Conflict of interest: Dr. Pinnock has nothing to disclose.Conflict of interest: Dr. Lionis has nothing to disclose.Conflict of interest: Dr. Kirenga has nothing to disclose.Conflict of interest: Dr. Sooronbaev has nothing to disclose.Conflict of interest: Dr. Chavannes has nothing to disclose.Conflict of interest: Dr. van der Kleij has nothing to disclose.Conflict of interest: Dr. Pham Le has nothing to disclose.