Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil.
Glob Health Action. 2023 Dec 31;16(1):2231763. doi: 10.1080/16549716.2023.2231763.
Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking.
To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka.
Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country.
The required sample size was met in Brazil ( = 267) and China ( = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample ( = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka.
Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.
识别现有的护理路径是了解如何改进服务以实现非传染性疾病（NCD）早期诊断和有效随访护理的第一步；然而，关于护理路径如何以及应该在中低收入国家（LMICs）中确定的证据却很少。
描述巴西、中国和斯里兰卡一项旨在确定心房颤动（AF）护理路径的混合方法研究的定量部分的招募和数据收集的普遍性和经验教训。
年龄在 18 岁及以上、会讲当地语言且患有 AF 的成年人符合条件。我们排除了任何有听力或认知障碍或不合格地址的人。在巴西和中国，合格的参与者是通过电子记录确定的；在斯里兰卡，研究人员参加了门诊，以确定合格的参与者。使用至少相隔 2 个月的两份定量问卷收集数据。每个国家都需要至少 238 名参与者。
巴西（n=267）和中国（n=298）达到了所需的样本量，但很大一部分 AF 患者无法联系（分别为 47%和 27%）或拒绝参与（分别为 36%和 38%）。在斯里兰卡，招募工作极具挑战性，导致样本量减少（n=151）。来自巴西、中国和斯里兰卡的参与者的平均年龄分别为 69（SD=11.3）、65（SD=12.8）和 58（SD=11.7）。女性分别占巴西样本的 49%、中国样本的 62%和斯里兰卡样本的 70%。
巴西和中国存在普遍性问题，同时也存在选择偏倚。斯里兰卡则突出了招募偏倚问题。在未来旨在确定 LMIC 中 NCD 护理路径的研究中，可能需要额外或替代的招募方法，以确保普遍性并减少偏倚。
