Analysis of a theory of change to evaluate the Health Care-Associated Infection Prevention Program (HAI) in Colombia

Healthcare-associated infections affect the safety of patients, health personnel, and families and generate expenses for health systems. The Theory of Change allows us to evaluate the strengths and weaknesses of a program, hoping to achieve change and improve its design. The objective was to analyze the change theory underpinning the actions proposed by the Program for the Prevention of Healthcare-Associated Infections (HAI) in Colombia.

The research used a case study. The case is the implementation of this program in the Colombian context. A documentary review of the Patient Safety Policy and the prevention, surveillance, and control of HAI events from 2006 to 2020 was conducted. Subsequently, semi-structured interviews were conducted with the actors who designed the patient safety policy and the HAI program. Of these, two had the role of national political and administrative authorities; one participated in the design of the guidelines for the implementation of the patient safety policy, and the other in the design of the IAAS program. Likewise, two academics and researchers, one who contributed to the design of the patient safety policy and the other who played a fundamental role in the development of the IAAS program, each of them contributing significantly to the advancement of their respective areas. Qualitative content analysis was used to analyze the data. Data processing, coding, grouping into categories, and network construction were performed in the Atlas Ti 23 program and represented as a theory of change diagram.

The results show that the desired impacts of the program are to reduce the incidence of HAI, improve the quality of life of patients, and their families, and improve the country's General Social Security Health System. Among the long-term results identified are the strengthening of the prevention and control of HAI, adjusting regulations, strengthening surveillance, implementing actions for the prevention and control of HAI, and improving the knowledge and skills of health personnel to contain these events. Five preconditions and 14 strategies were identified. Finally, four assumptions were identified that potentially influence the achievement of the program's results.

The analyzed theory integrates the elements of a theory of change, explaining how this type of intervention works to generate changes and prevent these infections associated with health care, which is the expected impact. However, strategies and indicators were identified that were not incorporated, and that are needed to assess the impact of these interventions. The study allows us to advance in the development of the design and evaluation of HAI programs, supporting them in a theory of change as a guide to detect failures during their implementation for their improvement.