Designing an Intervention to Improve MI Care in a Tanzanian Emergency Department

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.