Bello-Manga Halima, Haliru Lawal, Ahmed Kudirat, Ige Samuel, Musa Hayatu, Muhammad-Idris Zainab Kwaru, Monday Binshak, Sani Abdulrashid M, Bonnet Kemberlee, Schlundt David G, Varughese Taniya, Tabari Abdulkadir M, DeBaun Michael R, Baumann Ana A, King Allison A
Kaduna State University.
Yusuf Dantsoho Memorial Hospital, Ministry of Health, Kaduna.
Res Sq. 2023 Jul 3:rs.3.rs-2985921. doi: 10.21203/rs.3.rs-2985921/v1.
Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups.
We conducted focus groups with health care providers and interviews with administrative leadership of the community hospital. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology.
We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system.
Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity that is more sustainable.
NCT05434000.
镰状细胞贫血（SCA）患儿患中风的风险很高。包括输血、筛查异常的非影像学经颅多普勒（TCD）测量结果以及羟基脲治疗在内的中风预防方案，在尼日利亚等资源匮乏的环境中难以实施。本研究旨在通过定性访谈和焦点小组讨论，研究尼日利亚一家社区医院TCD筛查周围的背景因素。
我们与医疗服务提供者进行了焦点小组讨论，并对社区医院的行政领导进行了访谈。访谈指南和分析以实施研究综合框架（CFIR）为依据。使用迭代演绎（CFIR）/归纳（转录引语）定性方法对转录本进行编码和分析。
我们分别与医护人员（护士和医生）以及医院管理人员进行了两个焦点小组讨论和五次访谈。主题确定了内部环境的关键要素（诊所特征、资源可用性、实施氛围和变革压力）、个体特征（规范、控制和行为信念）以及实施过程（参与、实施和采用），以及受外部环境、护理人员需求、团队功能和干预特征影响的因素。已经在使用的任务转移，被提供者和管理人员视为在一个压力过大且资源不足的诊所环境、一个受贫困困扰的社区以及一个卫生系统表现不佳的国家实施TCD筛查的必要策略。
任务转移提供了一个可行的选择，通过更有效地利用现有人力资源，同时迅速扩大人力资源库并建设更具可持续性的能力，来改善医疗保健。
NCT05434000。
