Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework
Abstract Background Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize...
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| Format: | Article |
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BMC
2025-01-01
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| Series: | BMC Medical Education |
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| Online Access: | https://doi.org/10.1186/s12909-025-06666-1 |
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| author | Doris Akolbire Lora L. Sabin Paballo P. Lethunya Abhinav Sharma Howard J. Cabral Brian W. Jack Nancy A. Scott |
| author_facet | Doris Akolbire Lora L. Sabin Paballo P. Lethunya Abhinav Sharma Howard J. Cabral Brian W. Jack Nancy A. Scott |
| author_sort | Doris Akolbire |
| collection | DOAJ |
| description | Abstract Background Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho. Methods A mixed-methods study employing a single-group pre-test post-test design was conducted, guided by the RE-AIM theory. Training occurred from November 2021 to June 2022. Nurses completed the Problem-Solving Inventory (PSI) before and 3–6 months after training to measure changes in problem-solving efficacy. Quality scores were assigned to nurses’ planned quality improvement projects; project implementation was assessed 3–6 months after training. In-depth interviews (IDIs) explored changes in knowledge, problem-solving efficacy, and skills. Statistical analyses utilized paired T-tests and logistic regressions using STATA 17; content analysis was conducted on IDIs using NVivo12. Results Of 300 nurses, 89 were trained (30%) in the first year. Mainly medium or high-quality scores were achieved for the project designed. However, among 79 participants, only 49.4% reported initiating their projects. Overall problem-solving efficacy improved 3–6 months after training, but the increase was not statistically significant. Nurses reported improved knowledge, confidence and communication skills, enhanced problem-solving approaches, and increased emotional maturity in solving problems. A one-unit increase in project quality score correlated with a 35.0% increase in the odds of project initiation. Conclusion PSBHN demonstrated improved knowledge and minimal improvement in problem-solving efficacy among nurses 3–6 months post-training. However, application of skills gained in implementing their projects was insufficient. Still, PSBHN shows promise in addressing healthcare challenges in resource-limited settings. Some participants were able to start their projects but the inconsistency in follow-through suggests a need for more research into the factors that can improve completion of implementation for better health outcomes. |
| format | Article |
| id | doaj-art-5745964ae3cc4435b2af1762ef4c0187 |
| institution | Kabale University |
| issn | 1472-6920 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj-art-5745964ae3cc4435b2af1762ef4c01872025-01-19T12:27:39ZengBMCBMC Medical Education1472-69202025-01-0125111110.1186/s12909-025-06666-1Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) frameworkDoris Akolbire0Lora L. Sabin1Paballo P. Lethunya2Abhinav Sharma3Howard J. Cabral4Brian W. Jack5Nancy A. Scott6Boston University School of Public HealthBoston University School of Public HealthLesotho Boston-Health AllianceVancouverBoston University School of Public HealthAvedisian School of Medicine, Boston UniversityBoston University School of Public HealthAbstract Background Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho. Methods A mixed-methods study employing a single-group pre-test post-test design was conducted, guided by the RE-AIM theory. Training occurred from November 2021 to June 2022. Nurses completed the Problem-Solving Inventory (PSI) before and 3–6 months after training to measure changes in problem-solving efficacy. Quality scores were assigned to nurses’ planned quality improvement projects; project implementation was assessed 3–6 months after training. In-depth interviews (IDIs) explored changes in knowledge, problem-solving efficacy, and skills. Statistical analyses utilized paired T-tests and logistic regressions using STATA 17; content analysis was conducted on IDIs using NVivo12. Results Of 300 nurses, 89 were trained (30%) in the first year. Mainly medium or high-quality scores were achieved for the project designed. However, among 79 participants, only 49.4% reported initiating their projects. Overall problem-solving efficacy improved 3–6 months after training, but the increase was not statistically significant. Nurses reported improved knowledge, confidence and communication skills, enhanced problem-solving approaches, and increased emotional maturity in solving problems. A one-unit increase in project quality score correlated with a 35.0% increase in the odds of project initiation. Conclusion PSBHN demonstrated improved knowledge and minimal improvement in problem-solving efficacy among nurses 3–6 months post-training. However, application of skills gained in implementing their projects was insufficient. Still, PSBHN shows promise in addressing healthcare challenges in resource-limited settings. Some participants were able to start their projects but the inconsistency in follow-through suggests a need for more research into the factors that can improve completion of implementation for better health outcomes.https://doi.org/10.1186/s12909-025-06666-1Quality improvement projectLow- and middle-income country projectResource constrained projectQuality improvement rubric |
| spellingShingle | Doris Akolbire Lora L. Sabin Paballo P. Lethunya Abhinav Sharma Howard J. Cabral Brian W. Jack Nancy A. Scott Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework BMC Medical Education Quality improvement project Low- and middle-income country project Resource constrained project Quality improvement rubric |
| title | Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework |
| title_full | Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework |
| title_fullStr | Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework |
| title_full_unstemmed | Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework |
| title_short | Implementation effectiveness of ‘Problem solving for better health’ training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework |
| title_sort | implementation effectiveness of problem solving for better health training in lesotho using mixed methods and the reach effectiveness adoption implementation and maintenance re aim framework |
| topic | Quality improvement project Low- and middle-income country project Resource constrained project Quality improvement rubric |
| url | https://doi.org/10.1186/s12909-025-06666-1 |
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