The novel approach in this intervention centres around the engagement of community animal health workers (CHWs) in directing and conducting dog rabies vaccination days while promoting participation by formulating local engagement strategies, comparing this approach to the standard of care of centrally coordinated rabies vaccination program. We assume that currently provided canine vaccination programs show low vaccination uptake due to the lack of local community awareness and engagement.
Nature of evaluation
We created a 2-year process evaluation plan that focuses on the key aspects that we believe has a major effect on the results of the intervention arm. The process evaluation was guided by the intervention’s logic model. The design drew on the intervention theory to analyse the hypothesized processes in the logic model are valid and whether additional mechanisms arose that lead to the results. Implementation theory was used to assess whether the implementation was effective and successful, contributing to the observed outcomes (cite MRC).
Methods
Data collection
We conducted the process evaluation in three phases: pre-intervention (month 0), during intervention (month 1 to 24), and post-intervention (month 24). At the pre-intervention stage, CHWs will complete a questionnaire on knowledge and attitudes regarding rabies, personal information, and social status in the community. Focus group interviews (FGI) with the members of the community will be used to better understand the context that may affect the intervention. CHWs will also participate in FGI to analyse their understanding of the intervention and its adequacy. Review of updated documents regarding technological advances, policy, management of care, technological advances to address changes potentially impacting the intervention. During the intervention, fidelity, reach, doses, and adaptation of each activity proposed during the implementation is assessed through direct observation and review of various documents from CHWs. Checklist cores will be agreed by the observation team of researchers. Training and mentoring activities, formulation of community strategies, and organisation of vaccination days will be directly observed by 2 researchers per each intervention phase. Other activities will be assessed using monitoring documents such as attendance sheet, test scores, and feedback forms. Quantitative and qualitative information similar to those collected at the pre-intervention phase will be obtained for comparison and assess any changes pre- and post-intervention. A final FGI will also incorporate a panel discussion to map out a guideline of best approaches for future reference in similar interventions or policy implications.
Unintended or harmful consequences
Vaccination of ward-level coordinators and village-level vaccinators may cause them to experience side effects, possibly affecting their attendance at training, vaccination days and community engagement activities, or unintended mood and attitude towards participants which ultimately could negatively reflect on the intervention itself. Vaccinated dogs could also potentially experience side effects. If dog owners are not aware of possible side effects, it could lead to abandonment and increase of stray or free-roaming dogs, or even possibly lead to an increase in euthanasia of dogs. Even in cases that dog owners are aware, availability and affordability of veterinary services and willingness and ability of dog owners to seek these services could still pose as a challenge to addressing these unanticipated consequences.
Data analysis
Direct observations and document reviews are conducted throughout the activities to best assess the conduct of activities in a timely manner. These observations, however, are limited to settings where observation will not attract attention and possibly become obtrusive to the activity. We purposely scheduled household surveys, focus group interviews, and questionnaires at the pre-intervention and post-intervention stages as we believe these efforts will impact both awareness and engagement and best measure any observed changes. Although FGI provides deep insights into the experiences and perception of participants and allow for evaluation from multiple perspectives, participants might be influenced by the group dynamic and report inaccurate information, causing a response bias. Therefore, group sizes and other factors be carefully considered. A quantitative analysis will be conducted on all the collected data from questionnaires and documents using descriptive statistics on measures of fidelity, dose, reach, and adaptation. Measures will include frequencies, means, and ranges and reports summaries on the quality of the implementation, to what extent the intervention was implemented, how it was received, and contextual factors. The collection and analysis of qualitative data will occur in parallel to prevent being overwhelmed by the large data set and limited time resources. Qualitative data analysis will assess the extent of participants’ experiences, how they are shaped and transformed through narrative and discourse analysis. Ethnographic methods of qualitative research can be used to explore the social and cultural contexts that may influence the implementation and activities of the intervention. To test the mechanisms of intervention hypothesized, causal modelling is used to examine mechanism through mediation analysis and contextual contingencies through moderation analysis. Mapping of limitations and strength of the intervention from the final FCI is included to generate a causal pathway of the components of the intervention, its process measures, and intended outcomes to determine a generalizable process for future references.
2019-3-26-1553624885