Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping
Abstract Background Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of evidence-based AMI care in high-inc...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10831-5 |
| _version_ | 1827301264259547136 |
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| author | Julian T Hertz Francis M Sakita Sainikitha Prattipati Lauren Coaxum Tumsifu G Tarimo Godfrey L Kweka Jerome J Mlangi Kristen Stark Nathan M Thielman Hayden B Bosworth Janet P Bettger |
| author_facet | Julian T Hertz Francis M Sakita Sainikitha Prattipati Lauren Coaxum Tumsifu G Tarimo Godfrey L Kweka Jerome J Mlangi Kristen Stark Nathan M Thielman Hayden B Bosworth Janet P Bettger |
| author_sort | Julian T Hertz |
| collection | DOAJ |
| description | Abstract Background Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of evidence-based AMI care in high-income settings, but interventions to improve quality of AMI care have not been studied in sub-Saharan Africa. Methods Purposive sampling was used to recruit participants from key stakeholder groups (patients, providers, and healthcare administrators) in northern Tanzania. Semi-structured in-depth interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded to identify barriers to AMI care, using the 39 CFIR constructs. Barriers relevant to emergency department (ED) AMI care were retained, and the Expert Recommendations for Implementing Change (ERIC) tool was used to match barriers with Level 1 recommendations for targeted implementation strategies. Results Thirty key stakeholders, including 10 patients, 10 providers, and 10 healthcare administrators were enrolled. Thematic analysis identified 11 barriers to ED-based AMI care: complexity of AMI care, cost of high-quality AMI care, local hospital culture, insufficient diagnostic and therapeutic resources, inadequate provider training, limited patient knowledge of AMI, need for formal implementation leaders, need for dedicated champions, failure to provide high-quality care, poor provider-patient communication, and inefficient ED systems. Seven of these barriers had 5 strong ERIC recommendations: access new funding, identify and prepare champions, conduct educational meetings, develop educational materials, and distribute educational materials. Conclusions Multiple barriers across several domains limit the uptake of evidence-based AMI care in northern Tanzania. The CFIR-ERIC mapping approach identified several targeted implementation strategies for addressing these barriers. A multi-component intervention is planned to improve uptake of evidence-based AMI care in Tanzania. |
| first_indexed | 2024-04-24T16:21:24Z |
| format | Article |
| id | doaj.art-99bd3a42017044808f4a6402cd611100 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-24T16:21:24Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-99bd3a42017044808f4a6402cd6111002024-03-31T11:13:54ZengBMCBMC Health Services Research1472-69632024-03-012411910.1186/s12913-024-10831-5Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mappingJulian T Hertz0Francis M Sakita1Sainikitha Prattipati2Lauren Coaxum3Tumsifu G Tarimo4Godfrey L Kweka5Jerome J Mlangi6Kristen Stark7Nathan M Thielman8Hayden B Bosworth9Janet P Bettger10Duke Global Health Institute, Duke University School of MedicineDepartment of Emergency Medicine, Kilimanjaro Christian Medical CenterDuke Global Health Institute, Duke University School of MedicineDepartment of Emergency Medicine, Duke University School of MedicineKilimanjaro Christian Research InstituteKilimanjaro Christian Research InstituteKilimanjaro Christian Research InstituteDuke Global Health Institute, Duke University School of MedicineDuke Global Health Institute, Duke University School of MedicineDepartment of Internal Medicine, Duke University School of MedicineDuke Global Health Institute, Duke University School of MedicineAbstract Background Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of evidence-based AMI care in high-income settings, but interventions to improve quality of AMI care have not been studied in sub-Saharan Africa. Methods Purposive sampling was used to recruit participants from key stakeholder groups (patients, providers, and healthcare administrators) in northern Tanzania. Semi-structured in-depth interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded to identify barriers to AMI care, using the 39 CFIR constructs. Barriers relevant to emergency department (ED) AMI care were retained, and the Expert Recommendations for Implementing Change (ERIC) tool was used to match barriers with Level 1 recommendations for targeted implementation strategies. Results Thirty key stakeholders, including 10 patients, 10 providers, and 10 healthcare administrators were enrolled. Thematic analysis identified 11 barriers to ED-based AMI care: complexity of AMI care, cost of high-quality AMI care, local hospital culture, insufficient diagnostic and therapeutic resources, inadequate provider training, limited patient knowledge of AMI, need for formal implementation leaders, need for dedicated champions, failure to provide high-quality care, poor provider-patient communication, and inefficient ED systems. Seven of these barriers had 5 strong ERIC recommendations: access new funding, identify and prepare champions, conduct educational meetings, develop educational materials, and distribute educational materials. Conclusions Multiple barriers across several domains limit the uptake of evidence-based AMI care in northern Tanzania. The CFIR-ERIC mapping approach identified several targeted implementation strategies for addressing these barriers. A multi-component intervention is planned to improve uptake of evidence-based AMI care in Tanzania.https://doi.org/10.1186/s12913-024-10831-5CFIR-ERICAcute myocardial infarctionTanzaniaStrategy mapping |
| spellingShingle | Julian T Hertz Francis M Sakita Sainikitha Prattipati Lauren Coaxum Tumsifu G Tarimo Godfrey L Kweka Jerome J Mlangi Kristen Stark Nathan M Thielman Hayden B Bosworth Janet P Bettger Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping BMC Health Services Research CFIR-ERIC Acute myocardial infarction Tanzania Strategy mapping |
| title | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping |
| title_full | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping |
| title_fullStr | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping |
| title_full_unstemmed | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping |
| title_short | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping |
| title_sort | improving acute myocardial infarction care in northern tanzania barrier identification and implementation strategy mapping |
| topic | CFIR-ERIC Acute myocardial infarction Tanzania Strategy mapping |
| url | https://doi.org/10.1186/s12913-024-10831-5 |
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