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Prospective evaluation of a complex public health intervention: lessons from an initial and follow-up cross-sectional survey of the tuberculosis strain typing service in England

Prospective evaluation of a complex public health intervention: lessons from an initial and follow-up cross-sectional survey of the tuberculosis strain typing service in England
Prospective evaluation of a complex public health intervention: lessons from an initial and follow-up cross-sectional survey of the tuberculosis strain typing service in England
BACKGROUND: The national tuberculosis strain typing service (TB-STS) was introduced in England in 2010. The TB-STS involves MIRU-VNTR typing of isolates from all TB patients for the prospective identification, reporting and investigation of TB strain typing clusters. As part of a mixed-method evaluation, we report on a repeated cross-sectional survey to illustrate the challenges surrounding the evaluation of a complex national public health intervention.

METHODS: An online initial and follow-up questionnaire survey assessed the knowledge, attitudes and practices of public health staff, physicians and nurses working in TB control in November 2010 and March 2012. It included questions on the implementation, experience and uptake of the TB-STS. Participants that responded to both surveys were included in the analysis.

RESULTS: 248 participants responded to the initial survey and 137 of these responded to the follow-up survey (56% retention).

Knowledge: A significant increase in knowledge was observed, including a rise in the proportion of respondents who had received training (28.6% to 67.9%, p = 0.003), and the self-rated knowledge of how to use strain typing had improved ('no knowledge' decreased from 43.2% to 27.4%).

Attitudes: The majority of respondents found strain typing useful; the proportion that reported strain typing to be useful was similar across the two surveys (95.7% to 94.7%, p = 0.67).

Practices: There were significant increases between the initial and follow-up surveys in the number of respondents who reported using strain typing (57.0% to 80.5%, p < 0.001) and the proportion of time health protection staff spent on investigating TB (2.74% to 7.08%, p = 0.04).

CONCLUSIONS: Evaluation of a complex public health intervention is challenging. In this example, the immediate national roll-out of the TB-STS meant that a controlled survey design was not possible. This study informs the future development of the TB-STS by identifying the need for training to reach wider professional groups, and argues for its continuation based on service users' perception that it is useful. By highlighting the importance of a well-defined sampling frame, collecting baseline information, and including all stakeholders, it provides lessons for the implementation of similar services in other countries and future evaluations of public health interventions.
tuberculosis, strain typing, MIRU-VNTR, complex intervention, service evaluation
1471-2458
1-13
Mears, J.
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Abubakar, I.
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Crisp, D.
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Maguire, H.
0bf9d811-e3eb-4649-8783-8da179b58807
Innes, J.A.
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Lilley, M.
4b5eccd2-4575-4764-9f03-39bad0d43f68
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Cohen, T.
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Borgdorff, M.W.
74b1f999-16d5-414b-85a9-f160bdf07847
Vynnycky, E.
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McHugh, T.D.
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Sonnenberg, P.
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Mears, J.
80e4c897-b594-4c19-b90d-581239d60ba9
Abubakar, I.
6ff888fa-ccb5-40de-aba0-d916490bf14e
Crisp, D.
1de2cde4-2ce9-4c2b-a42a-29e35941bba0
Maguire, H.
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Innes, J.A.
8962a24a-eea6-4727-90cb-4ae8ed62a035
Lilley, M.
4b5eccd2-4575-4764-9f03-39bad0d43f68
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Cohen, T.
06b0f175-88b5-409f-b7e9-f64fb6cdb7fb
Borgdorff, M.W.
74b1f999-16d5-414b-85a9-f160bdf07847
Vynnycky, E.
db789668-47a0-429d-8c89-0416e03dd178
McHugh, T.D.
68ecc8b4-8354-49c1-85c3-9f4c81b43f93
Sonnenberg, P.
7d1f6b8f-b572-42d2-97b1-bc52925fca22

Mears, J., Abubakar, I., Crisp, D., Maguire, H., Innes, J.A., Lilley, M., Lord, J., Cohen, T., Borgdorff, M.W., Vynnycky, E., McHugh, T.D. and Sonnenberg, P. (2014) Prospective evaluation of a complex public health intervention: lessons from an initial and follow-up cross-sectional survey of the tuberculosis strain typing service in England. BMC Public Health, 14 (1023), 1-13. (doi:10.1186/1471-2458-14-1023). (PMID:25273511)

Record type: Article

Abstract

BACKGROUND: The national tuberculosis strain typing service (TB-STS) was introduced in England in 2010. The TB-STS involves MIRU-VNTR typing of isolates from all TB patients for the prospective identification, reporting and investigation of TB strain typing clusters. As part of a mixed-method evaluation, we report on a repeated cross-sectional survey to illustrate the challenges surrounding the evaluation of a complex national public health intervention.

METHODS: An online initial and follow-up questionnaire survey assessed the knowledge, attitudes and practices of public health staff, physicians and nurses working in TB control in November 2010 and March 2012. It included questions on the implementation, experience and uptake of the TB-STS. Participants that responded to both surveys were included in the analysis.

RESULTS: 248 participants responded to the initial survey and 137 of these responded to the follow-up survey (56% retention).

Knowledge: A significant increase in knowledge was observed, including a rise in the proportion of respondents who had received training (28.6% to 67.9%, p = 0.003), and the self-rated knowledge of how to use strain typing had improved ('no knowledge' decreased from 43.2% to 27.4%).

Attitudes: The majority of respondents found strain typing useful; the proportion that reported strain typing to be useful was similar across the two surveys (95.7% to 94.7%, p = 0.67).

Practices: There were significant increases between the initial and follow-up surveys in the number of respondents who reported using strain typing (57.0% to 80.5%, p < 0.001) and the proportion of time health protection staff spent on investigating TB (2.74% to 7.08%, p = 0.04).

CONCLUSIONS: Evaluation of a complex public health intervention is challenging. In this example, the immediate national roll-out of the TB-STS meant that a controlled survey design was not possible. This study informs the future development of the TB-STS by identifying the need for training to reach wider professional groups, and argues for its continuation based on service users' perception that it is useful. By highlighting the importance of a well-defined sampling frame, collecting baseline information, and including all stakeholders, it provides lessons for the implementation of similar services in other countries and future evaluations of public health interventions.

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Accepted/In Press date: 22 September 2014
Published date: 2 October 2014
Additional Information: Mears, Jessica Abubakar, Ibrahim Crisp, Debbie Maguire, Helen Innes, John A Lilley, Mike Lord, Joanne Cohen, Ted Borgdorff, Martien W Vynnycky, Emilia McHugh, Timothy D Sonnenberg, Pam eng Evaluation Studies Research Support, Non-U.S. Gov't England 2014/10/03 06:00 BMC Public Health. 2014 Oct 2;14:1023. doi: 10.1186/1471-2458-14-1023.
Keywords: tuberculosis, strain typing, MIRU-VNTR, complex intervention, service evaluation
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 382201
URI: https://eprints.soton.ac.uk/id/eprint/382201
ISSN: 1471-2458
PURE UUID: 16b068c9-82d1-41c5-82f7-404c33e688f2
ORCID for J. Lord: ORCID iD orcid.org/0000-0003-1086-1624

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Date deposited: 22 Jan 2016 16:15
Last modified: 20 Jul 2019 00:34

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