{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:33:53Z","timestamp":1787654033730,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,7,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Rheumatic heart disease is a high\u2010burden condition in Australian Aboriginal communities. We evaluated a stepped\u2010wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed\u2010methods evaluation, designed a priori\n              <jats:italic>,<\/jats:italic>\n              aimed to determine the association between methodological approaches and outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health\u2010center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of \u201caction items,\u201d which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health\u2010center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project\u2010level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing \u201cself\u2010management support\u201d and \u201ccommunity linkage\u201d streams of the chronic care model. Increased momentum was evident in later stages of the study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009376","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T09:15:21Z","timestamp":1531818921000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis"],"prefix":"10.1161","volume":"7","author":[{"given":"Clancy","family":"Read","sequence":"first","affiliation":[{"name":"Telethon Kids Institute University of Western Australia Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison G.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"de Dassel","sequence":"additional","affiliation":[{"name":"Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clair","family":"Scrine","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute University of Western Australia Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hendrickx","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute University of Western Australia Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross S.","family":"Bailie","sequence":"additional","affiliation":[{"name":"University of Sydney University Centre for Rural Health Lismore New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Johnston","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Darwin Northern Territory Australia"},{"name":"Medical School Australian National University Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme P.","family":"Maguire","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie","family":"Schultz","sequence":"additional","affiliation":[{"name":"Centre For Remote Health Alice Springs Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute University of Western Australia Western Australia Australia"},{"name":"Perth Children's Hospital Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna P.","family":"Ralph","sequence":"additional","affiliation":[{"name":"Charles Darwin University Darwin Northern Territory Australia"},{"name":"Menzies School of Health Research Darwin Northern Territory Australia"},{"name":"Royal Darwin Hospital Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-525"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-016-1166-y"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009308"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.20.6.64"},{"key":"e_1_3_2_7_2","unstructured":"RHDAustralia (ARF\/RHD writing group) . The Australian guideline for prevention diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition). National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. 2012. Available at: http:\/\/www.rhdaustralia.org.au\/sites\/default\/files\/guideline_0.pdf. Accessed July 1 2018."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2747-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2007.04.007"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0842-7"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00076"},{"key":"e_1_3_2_12_2","unstructured":"RHD Australia . E\u2010learning: Health worker modules Clinician modules Administering bicillin. 2015. Available at: https:\/\/www.rhdaustralia.org.au\/arf-rhd-guideline. 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Accessed July 1 2018."}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.009376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:06:56Z","timestamp":1715598416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.009376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,17]]},"references-count":29,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2018,7,17]]}},"alternative-id":["10.1161\/JAHA.118.009376"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.009376","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,17]]},"assertion":[{"value":"2018-05-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e009376"}}