Implementing health psychology to strengthen health systems in low income countries: the change exchange

Abstract

Background Training to increase knowledge and skills is the typical solution for changing health professional practice within health partnerships between high and low income countries (LIC). Health psychology can enhance training and its evaluation by refocusing efforts on behaviour change. The Change Exchange implemented health psychology in four health partnerships: Mozambique, Sierra Leone & two in Uganda. Methods Two to three health psychologists took an ethnographic approach in each of four partnerships, each including 20-60 health professionals. Data collected included observations, interviews, focus groups and questionnaires, conducted and analysed thematically (within and between the partnerships) by the health psychologists. Written reports to health partnerships included recommendations to enable practice change. Findings 1. Embedding health psychologists in partnerships enabled challenging conversations with teams. 2. Reports were welcomed by the partnerships who implemented some but not all recommendations. 3. Partnerships adopted a variety of behaviour change techniques, with multiple examples of partial techniques. 4. Some evaluation methods (e.g., agreement ratings) were difficult to use in LIC. 5. Partnerships were committed to using their knowledge of behaviour change in their work. Discussion Partnerships saw the embedding of the health psychologists as crucial in ensuring that behavioural science was accepted by partners, including improving use of behaviour change techniques. Future work will focus on methods for investigating health professional practice change.