Browsing by Author "Stark, Kristen"

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    Designing an Intervention to Improve MI Care in a Tanzanian Emergency Department
    (2023) Stark, Kristen

    Background: Myocardial Infarction (MI) was previously thought to be rare in sub-Saharan Africa (SSA) but a growing body of evidence suggests MI is in reality under-diagnosed. Multiple studies from Tanzania show there is a need for intervention to improve MI diagnosis, treatment, and outcomes. Our objective was to create an intervention targeting MI care in the emergency department of a Tanzanian referral hospital. Methods: To address this gap an interdisciplinary group of individuals from Tanzania and the United States formed a Design Team to co-create an intervention. The group utilized the ADAPT-ITT model to guide the process of assessing need, identifying an intervention to adapt, and begin the process of adaptation and production to meet the needs of the target population. Results: In the Assessment phase, the team found substantial under-diagnosis of MI, a low rate of aspirin administration, and a lack of both patient and provider awareness. In the Decision phase, the team reviewed 10 interventions of various types before deciding upon the BRIDGE-ACS study as an ideal target for adaptation. In the Adaptation phase, the team discussed intervention content with a focus on ensuring appropriateness for local context. The team is currently in the Production phase creating the necessary materials for implementation of the intervention. Conclusions: In the emergency department of a Tanzanian referral hospital, intervention is needed to improve MI diagnosis, treatment, and outcomes. While the adaptation process is still ongoing, this paper can serve as a guide for others wanting to engage in collaborative intervention development targeting clinical care.

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    Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping.
    (BMC health services research, 2024-03) Hertz, Julian T; Sakita, Francis M; Prattipati, Sainikitha; Coaxum, Lauren; Tarimo, Tumsifu G; Kweka, Godfrey L; Mlangi, Jerome J; Stark, Kristen; Thielman, Nathan M; Bosworth, Hayden B; Bettger, Janet P

    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.