Publication: Reinforcement of Peer-Coaching and Clinical Audit to improve Implementation of the Package of Essential Non-Communicable Diseases (PEN) in Nepal: A Pilot Implementation Study Method
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Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
Introduction: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinforce peer coaching and clinical audit mechanisms in primary- level health facilities, and tested its feasibility and preliminary effectiveness. This paper details the methodology used in designing, implementing and assessing the intervention.
Methods: The study adoptes a hybrid type II implementation trial design. The intervention assignment followed a non-blinded, two-arm, parallel randomized controlled trial design with a 1:1 allocation ratio. Seventeen primary-level public health facilities with at least one trained staff were randomized. The clinical staff at the intervention health facilities received peer-coaching and
clinical audit reinforcement, while the control group followed their usual practice. The study was conducted over a 12-month duration. A mixed-method approach, applying pre-post assessment and thematic analysis, to inform the intervention development and assess implementation outcomes and its effectiveness was. The study was guided by the Proctor framework. Ethical clearance was
obtained from the Nepal Health Research Council (Registraion number: 30212021).
Discussion: The tools and methods that guide intervention implementation and assessment have the potential to be replicated in various settings to design strategies to improve Package of Essential Non-communicable Disease Intervention adoption and sustainment.
Description
Dipanker Prajapati
Shahid Gangalal National Heart Centre, Bansbari, Bagmati, Nepal. National Academy of Medical Sciences, Kathmandu, Bagmati, Nepal.
Sujata Sapkota
Manmohan Memorial Institute of Health Sciences, Soaltee Mode, Kathmandu, Nepal.Dhulikhel Hospital - Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
Punya Shori Suwal
Central Institute of Science and Technology, Baneswor, Kathmandu, Nepal
Anu Aryal
Department of Health Policy and Management, University of California, Los Angeles, USA
Rashmi Maharjan
Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
Sudip Ale Magar
Department of Health Services, Ministry of Health and Population, Teku, Kathmandu, Nepal
Kamala Rana Magar
Pokhara Academy of Health Sciences, Ramghat-10, Pokhara, Nepal
Kabita Poudel
School of Nursing, Pokhara Academy of Health Sciences, Pokhara-11, Kaski, Gandaki, Nepal
Prajjwal Pyakurel
SAARC TB and HIV/AIDS Centre, Thimi, Bhaktapur, Nepal
Abhinav Vaidya
Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
Archana Shrestha
Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal