背景:患有镰状细胞性贫血(SCA)的儿童卒中风险很高。中风预防方案,包括输血,筛查异常的非影像学经颅多普勒(TCD)测量,和羟基脲治疗在尼日利亚等低资源环境中很难实施。这项研究旨在使用定性访谈和焦点小组来检查尼日利亚社区医院TCD筛查的环境因素。
方法:我们在卡杜纳的一家社区医院进行了描述性定性研究,尼日利亚,使用焦点小组和访谈。采访指南和分析是由实施研究综合框架(CFIR)框架和计划行为理论提供的。使用迭代演绎(CFIR)/归纳(转录报价)定性方法对转录本进行编码和分析。
结果:我们对卫生保健工作者(护士和医生)和医院管理人员进行了两个焦点小组和五次访谈,分别。主题确定了内在环境的关键要素(临床特征,资源可用性,实施气候,和改变的张力),个体的特征(规范性、control,和行为信念),和实施过程(参与,工具,并采用),以及受外部环境影响的因素,看护者需要,团队功能,和干预特点。任务转移,它已经被使用了,被提供者和管理员视为在压力过大和资源不足的诊所环境中实施TCD筛查的必要策略,一个贫穷的社区,和一个卫生系统表现不佳的国家。
结论:任务转移提供了一种可行的选择,通过更有效地利用现有的人力资源,同时迅速扩大人力资源库和建立更可持续的经颅多普勒筛查SCD儿童的能力来改善医疗保健。
背景:NCT05434000。
BACKGROUND: 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.
METHODS: We conducted a descriptive qualitative
study in a community hospital in Kaduna, Nigeria, using focus groups and interviews. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework and the Theory of Planned Behavior. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology.
RESULTS: 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.
CONCLUSIONS: 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 for TCD screening of children with SCD that is more sustainable.
BACKGROUND: NCT05434000.