Individual and Contextual Factors Affect the Implementation Fidelity of Youth-friendly Services, Northwest Ethiopia: A Multilevel Analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Feb 10

PMID 35143579

Authors

Yohannes Ayanaw Habitu

Gashaw Andargie Biks

Abebaw Gebeyehu Worku

Kassahun Alemu Gelaye

Affiliations

Soon will be listed here.

Abstract

Background: The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels.

Methods: This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI.

Results: Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants.

Conclusions: The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.

Citing Articles

Empowering youth and ensuring health: utilization of youth friendly service among preparatory school students in Gambella, Southwest Ethiopia.

Hailu N, Negero B, Melkamu K, Tsega Y Front Reprod Health. 2024; 6:1452315.

PMID: 39722896 PMC: 11668764. DOI: 10.3389/frph.2024.1452315.

Characterizing models of adolescent and youth-friendly health services in sub-Saharan Africa: a scoping review.

Embleton L, Boal A, Sawarkar S, Chory A, Bandanapudi R, Patel T Int J Adolesc Med Health. 2024; 36(3):203-236.

PMID: 38838271 DOI: 10.1515/ijamh-2024-0001.

References

Mashamba A, Robson E . Youth reproductive health services in Bulawayo, Zimbabwe. Health Place. 2002; 8(4):273-83. DOI: 10.1016/s1353-8292(02)00007-2. View

Lee L, Yehia B, Gaur A, Rutstein R, Gebo K, Keruly J . The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth. AIDS Patient Care STDS. 2016; 30(4):170-7. PMC: 4827281. DOI: 10.1089/apc.2015.0263. View

Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S . A conceptual framework for implementation fidelity. Implement Sci. 2007; 2:40. PMC: 2213686. DOI: 10.1186/1748-5908-2-40. View

Cross W, West J . Examining implementer fidelity: Conceptualizing and measuring adherence and competence. J Child Serv. 2011; 6(1):18-33. PMC: 3171488. DOI: 10.5042/jcs.2011.0123. View

Durlak J, DuPre E . Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008; 41(3-4):327-50. DOI: 10.1007/s10464-008-9165-0. View

Berkel C, Mauricio A, Schoenfelder E, Sandler I . Putting the pieces together: an integrated model of program implementation. Prev Sci. 2010; 12(1):23-33. PMC: 5591031. DOI: 10.1007/s11121-010-0186-1. View

Patton G, Coffey C, Cappa C, Currie D, Riley L, Gore F . Health of the world's adolescents: a synthesis of internationally comparable data. Lancet. 2012; 379(9826):1665-75. DOI: 10.1016/S0140-6736(12)60203-7. View

Austin A, Gulema H, Belizan M, Colaci D, Kendall T, Tebeka M . Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study. BMC Pregnancy Childbirth. 2015; 15:74. PMC: 4407297. DOI: 10.1186/s12884-015-0493-4. View

Waye J, Toouli J, Guelrud M, Kothari K, KOTRLIK J, Nowak A . Who is permitted to do endoscopy?. Gastrointest Endosc. 2001; 53(2):267-9. DOI: 10.1067/mge.2001.112642. View

10.

Speizer I, Magnani R, Colvin C . The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence. J Adolesc Health. 2003; 33(5):324-48. DOI: 10.1016/s1054-139x(02)00535-9. View

11.

Romero L, Olaiya O, Hallum-Montes R, Varanasi B, Mueller T, House L . Efforts to Increase Implementation of Evidence-Based Clinical Practices to Improve Adolescent-Friendly Reproductive Health Services. J Adolesc Health. 2017; 60(3S):S30-S37. PMC: 6650772. DOI: 10.1016/j.jadohealth.2016.07.017. View

12.

Helfrich C, Weiner B, McKinney M, Minasian L . Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev. 2007; 64(3):279-303. DOI: 10.1177/1077558707299887. View

13.

Dusenbury L, Brannigan R, Falco M, Hansen W . A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res. 2003; 18(2):237-56. DOI: 10.1093/her/18.2.237. View

14.

Ayehu A, Kassaw T, Hailu G . Level of Young People Sexual and Reproductive Health Service Utilization and Its Associated Factors among Young People in Awabel District, Northwest Ethiopia. PLoS One. 2016; 11(3):e0151613. PMC: 4798641. DOI: 10.1371/journal.pone.0151613. View

15.

Worku A, Yalew A, Afework M . Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int Health Hum Rights. 2013; 13:20. PMC: 3639034. DOI: 10.1186/1472-698X-13-20. View

16.

Bonham C, Sommerfeld D, Willging C, Aarons G . Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies. Psychiatry J. 2014; 2014:802983. PMC: 3989772. DOI: 10.1155/2014/802983. View

17.

Wang B, Stanton B, Deveaux L, Poitier M, Lunn S, Koci V . Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program. Implement Sci. 2015; 10:44. PMC: 4409749. DOI: 10.1186/s13012-015-0236-y. View

18.

Thin Zaw P, Liabsuetrakul T, Htay T, McNeil E . Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar. BMC Health Serv Res. 2012; 12:458. PMC: 3546958. DOI: 10.1186/1472-6963-12-458. View

19.

Dane A, Schneider B . Program integrity in primary and early secondary prevention: are implementation effects out of control?. Clin Psychol Rev. 1998; 18(1):23-45. DOI: 10.1016/s0272-7358(97)00043-3. View

20.

Rohrbach L, Grana R, Sussman S, Valente T . Type II translation: transporting prevention interventions from research to real-world settings. Eval Health Prof. 2006; 29(3):302-33. DOI: 10.1177/0163278706290408. View