Ijaz Nadir, Nader Marie, Ponticiello Matthew, Vance Ashlee J, van de Water Brittney J, Funaro Melissa C, Abbas Qalab, Adabie Appiah John, Chisti Mohammod Jobayer, Commerell Walter, Elvis Dzelamunyuy Suiyven, Martinez Fernandez Rudimar, Gonzalez Anjelica L, Johnston Cintia, Luckson Kaiwe Evance, Kaur Manjinder, Lang Hans-Joerg, McCollum Eric D, Marcos González Moraga José, Muralidharan Jayashree, Renning Kelsey, Tan Herng Lee, Alejandra Vélez Ruiz Gaitán Laura, González-Dambrauskas Sebastián, Wilson Patrick T, Morrow Brenda M, Davis J Lucian
Yale School of Medicine, New Haven, CT, USA; Yale National Clinician Scholars Program, New Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
Lancet Glob Health. 2025 Feb;13(2):e232-e245. doi: 10.1016/S2214-109X(24)00453-4. Epub 2024 Dec 12.
Bubble continuous positive airway pressure (bCPAP) is a low-cost, non-invasive respiratory support therapy for children with respiratory distress, but its effectiveness is dependent on the context. We aimed to understand contextual factors influencing bCPAP implementation for children aged 1-59 months in low-income and middle-income countries (LMICs) and to develop a theory explaining how these factors influence implementation outcomes.
In this realist review, we generated an initial programme theory comprising candidate context-mechanism-outcome configurations (CMOCs) via review of key references and team discussion. On July 25, 2023, we conducted a search for peer-reviewed and grey literature, without date restrictions, describing bCPAP use for paediatric respiratory distress in LMICs. We included references describing related contexts, mechanisms, or outcomes. We coded statements from the literature supporting each CMOC, iteratively revising and adding CMOCs using inductive and deductive logic. We assembled an international, interdisciplinary panel of 22 bCPAP stakeholders to refine CMOCs using iterative surveys, focus groups, and interviews until we reached thematic saturation. This realist review is registered with PROSPERO (CRD42023403584).
Of 1640 peer-reviewed references and eight grey literature references retrieved, 38 peer-reviewed articles and two grey literature documents were deemed eligible for inclusion after removal of duplicates and screening. After four rounds of expert surveys and three focus groups, we identified 18 CMOCs. CMOCs were synthesised into a final programme theory operating at five levels to influence implementation feasibility, fidelity, and sustainability: (1) the bCPAP device, (2) local partnerships and infrastructure, (3) clinical and technical teams, (4) caregivers and the community, and (5) institutional practices.
Using realist methods with a diverse, international stakeholder panel, we generated a theory that could explain how bCPAP therapy works in different contexts. This theory could be leveraged to enhance the rigour of future bCPAP implementation trials.
Yale National Clinician Scholars Program, US National Center for Advancing Translational Science (TL1TR001864), and National Heart, Lung, and Blood Institute (T32HL155000).
气泡持续气道正压通气（bCPAP）是一种针对呼吸窘迫儿童的低成本、无创呼吸支持疗法，但其有效性取决于具体情况。我们旨在了解影响低收入和中等收入国家（LMICs）1至59个月儿童实施bCPAP的背景因素，并构建一种理论来解释这些因素如何影响实施结果。
在这项实证性综述中，我们通过查阅关键参考文献并经团队讨论，生成了一个初始项目理论，其中包括候选背景 - 机制 - 结果构型（CMOCs）。2023年7月25日，我们对同行评审文献和灰色文献进行了检索，无日期限制，以描述LMICs中bCPAP用于儿科呼吸窘迫的情况。我们纳入了描述相关背景、机制或结果的参考文献。我们对支持每个CMOC的文献陈述进行编码，使用归纳和演绎逻辑迭代地修订和添加CMOCs。我们组建了一个由22名bCPAP利益相关者组成的国际跨学科小组，通过迭代调查、焦点小组和访谈来完善CMOCs，直至达到主题饱和。这项实证性综述已在PROSPERO（CRD42023403584）注册。
在检索到的1640篇同行评审参考文献和8篇灰色文献参考文献中，去除重复文献并筛选后，38篇同行评审文章和2篇灰色文献文件被认为符合纳入标准。经过四轮专家调查和三次焦点小组讨论，我们确定了18个CMOCs。CMOCs被综合成一个最终的项目理论，在五个层面发挥作用以影响实施的可行性、保真度和可持续性：（1）bCPAP设备，（2）当地合作伙伴关系和基础设施，（3）临床和技术团队，（4）护理人员和社区，以及（5）机构实践。
通过对不同的国际利益相关者小组运用实证性方法，我们生成了一种理论，该理论可以解释bCPAP疗法在不同情况下的作用机制。这一理论可用于提高未来bCPAP实施试验的严谨性。
耶鲁国家临床学者项目、美国国家转化科学推进中心（TL1TR001864）以及国家心肺血液研究所（T32HL155000）。
