Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Construção de um ambiente de desenvolvimento de software baseado em um sistema de gerência de workflow e outros produtos comerciais

Este trabalho apresenta uma arquitetura para Ambientes de Desenvolvimento de Software (ADS). Esta arquitetura é baseada em produtos comerciais de prateleira (COTS), principalmente em um Sistema de Gerência de Workflow – SGW (Microsoft Exchange 2000 Server – E2K) - e tem como plataforma de funcionamento a Internet, integrando também algumas ferramentas que fazem parte do grande conjunto de aplicativos que é utilizado no processo de desenvolvimento de software. O desenvolvimento de um protótipo (WOSDIE – WOrkflow-based Software Development Integrated Environment) baseado na arquitetura apresentada é descrito em detalhes, mostrando as etapas de construção, funções implementadas e dispositivos necessários para a integração de um SGW, ferramentas de desenvolvimento, banco de dados (WSS – Web Storage System) e outros, para a construção de um ADS. O processo de software aplicado no WOSDIE foi extraído do RUP (Rational Unified Process – Processo Unificado Rational). Este processo foi modelado na ferramenta Workflow Designer, que permite a modelagem dos processos de workflow dentro do E2K. A ativação de ferramentas a partir de um navegador Web e o armazenamento dos artefatos produzidos em um projeto de software também são abordados. O E2K faz o monitoramento dos eventos que ocorrem dentro do ambiente WOSDIE, definindo, a partir das condições modeladas no Workflow Designer, quais atividades devem ser iniciadas após o término de alguma atividade anterior e quem é o responsável pela execução destas novas atividades (assinalamento de atividades). A arquitetura proposta e o protótipo WOSDIE são avaliados segundo alguns critérios retirados de vários trabalhos. Estas avaliações mostram em mais detalhes as características da arquitetura proposta e proporcionam uma descrição das vantagens e problemas associados ao WOSDIE.

Supervisory software development according to IEEE 1451.1 standard

IEEE 1451 is Standard to connect transduscers through a communication network. This article describes a supervisory system implementaion according to IEEE 1451 Standard using Java. This software, named NCAP, may be used in several industrial applications, besides making feasible to obtain TEDS as a report or by Internet. NCAP communicates with transduscer module through RS232 Interface and was testes in industrial automation processes. © 2009 IEEE.