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Cited by 34Health Policy Implementation ScienceHIV/AIDS Research and InterventionsHealthcare Quality and Management

Innovation in evaluating the impact of Integrated Service-Delivery: the Integra indexes of HIV and Reproductive Health integration

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Mayhew, Susannah H., Ploubidis, George B., Sloggett, Andy, Church, Kathryn, Obure, Carol D., Birdthistle, Isolde, Sweeney, Sedona, Warren, Charlotte E. +3 more·2016·PLoS ONE
DOI 10.1371/journal.pone.0146694PMC PMC4723242
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Abstract

BACKGROUND: The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of 'integrated service delivery' and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. METHODS AND FINDINGS: Data were drawn from the Integra Initiative's client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008-2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients--i.e. "functional integration". CONCLUSIONS: These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its 'impact' on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments.

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Crossref · 10.1371/journal.pone.0146694

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  • The structural realities of girls' and women's lives in many low and middle-income countries create a gap in information through minimum media exposure to health messages, lack of accessible reproductive health clinics, low rates of secondary and tertiary education, lower access to internet and media compared with boys and men, and health clinic staff who may be insufficiently trained to conduct差分

    “The structural realities of girls and women’s lives in many LMICs create a gap in information through, for example, minimum media exposure to health messages, the lack of accessible health clinics that are focused on reproductive health43; the low rates of secondary and tertiary education persisting in many countries,44 45 the lower access to internet and media that girls and women have in compar”

    From Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries (2017) · cites this paper as [43]

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Research works printed but not linked: 2

  1. [8]Criel B., De Brouwere V., and Dugas S., Integration of vertical programmes in multi-function health services, in Studies in Health Services Organisation and Policy. 1997, ITG Press: Antwerp.
  2. [29]Muthen L.K. and Muthen B.O., Mplus User's Guide. Sixth Edition, ed. Muthen M.. 1998–2010, Los Angeles, CA.

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Authors
Mayhew, S. H., Ploubidis, G. B., Sloggett, A., Church, K., Obure, C. D., Birdthistle, I., Sweeney, S., Warren, C. E., Watts, C., Vassall, A., & Initiative, I.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • University College London (GB)
  • Swiss Tropical and Public Health Institute (CH)
  • Population Council (US)
  • Vanderbilt University (US)
Corresponding author
Mayhew, Susannah H.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2016-01-22
Volume
11
Issue
1
Pages
e0146694
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0146694
PMC
PMC4723242
OpenAlex
W2270928010
Cited by
34
References
32
Citations by year
2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 9 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 9 · 2016: 2
FWCI
9.92
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • London School of Hygiene & Tropical Medicine (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • Bill and Melinda Gates Foundation (48733)
  • Johns Hopkins University
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
service integration, integration index, structural integration, functional integration, complex interventions, health service evaluation, health care costs, Swaziland, Kenya
MeSH terms
Female, Humans, Kenya, Male, Eswatini, Models, Statistical, HIV Infections, Models, Organizational, Delivery of Health Care, Integrated, Reproductive Health Services, Reproductive Health

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