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Table 1 Acceptability & Appropriateness Testing by Stakeholder Group

From: Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya

 

Acceptability

 

Theme

Patients

Clinicians/Administrators

Peer Support

Improved Patient Experience

Peer navigators may address inefficiencies and delays during referrals

Peer navigators will help patients navigate unfamiliar health facilities

Stigma

Peer navigators may reduce perceived bias and judgement by clinic staff through accompanying patients and orienting them to the new health facility

Patients may feel uncomfortable disclosing personal health information to other community members (Peer navigators, who are not seen as health professionals)

Integrating Peer Navigators into local clinics

Due to regional differences in culture and language, patients referred to a different facility (in a different community) may not feel comfortable or trust their receiving peer

Nurses and administrators currently help facilitate referrals, and there may be conflict when peers come in to assume this role

HIT Package

Information Sharing Between Facilities

Referral information (including clinical data) can be available to clinicians at facilities across the health system

Electronic forms must be streamlined and user-friendly, as clinicians have encountered inefficient forms in the past

HIT Reliability

(No patients commented on HIT reliability)

The intervention would need a backup so that data is not lost and the core functionality of referral navigation may proceed in the event of power or network outage

 

Appropriateness

 

Theme

Patients

Clinicians/Administrators

Peer Support

Capacity of Peer-based Education

Peer navigators may provide patient education on hypertension on multiple occasions during referral process

Patients with hypertension may be inappropriate peer support providers as they may be older, harder to retain, and less familiar with technology; in addition, these patients lack formal health training necessary to provide peer support (participants advocated for use of Community Health Volunteers

Prohibitive Costs

Without transport or funds, referral barriers may still be insurmountable for patients

Patients may not complete referrals without providing transport, incentives, and/or peer accompaniment

Peer Navigator Accessibility

Peer navigators may be inaccessible or unreachable when needed by patients

Concerns that peer navigators may be difficult for patients to locate at busy facilities like MTRH

Peer-Clinician Information Sharing

(No patient comments on appropriateness of Peer-Clinician Interactions)

Peer navigators will effectively relay clinical information between clinicians at different facilities during referrals

HIT Package

Centralized Data Storage

(No patient comments on appropriateness of HIT tools)

Referral data is stored centrally and can be accessed via tablet by referring or receiving clinicians

Integration Barriers with Existing Record System

Clinical information must be accessible no matter what health record system is used, meaning that the intervention must integrate all existing systems