Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping.
| dc.contributor.author | Hertz, Julian T | |
| dc.contributor.author | Sakita, Francis M | |
| dc.contributor.author | Prattipati, Sainikitha | |
| dc.contributor.author | Coaxum, Lauren | |
| dc.contributor.author | Tarimo, Tumsifu G | |
| dc.contributor.author | Kweka, Godfrey L | |
| dc.contributor.author | Mlangi, Jerome J | |
| dc.contributor.author | Stark, Kristen | |
| dc.contributor.author | Thielman, Nathan M | |
| dc.contributor.author | Bosworth, Hayden B | |
| dc.contributor.author | Bettger, Janet P | |
| dc.date.accessioned | 2024-06-27T19:56:09Z | |
| dc.date.available | 2024-06-27T19:56:09Z | |
| dc.date.issued | 2024-03 | |
| dc.description.abstract | BackgroundEvidence-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.MethodsPurposive 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.ResultsThirty 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.ConclusionsMultiple 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. | |
| dc.identifier | 10.1186/s12913-024-10831-5 | |
| dc.identifier.issn | 1472-6963 | |
| dc.identifier.issn | 1472-6963 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Springer Science and Business Media LLC | |
| dc.relation.ispartof | BMC health services research | |
| dc.relation.isversionof | 10.1186/s12913-024-10831-5 | |
| dc.rights.uri | ||
| dc.subject | Humans | |
| dc.subject | Myocardial Infarction | |
| dc.subject | Delivery of Health Care | |
| dc.subject | Quality of Health Care | |
| dc.subject | Tanzania | |
| dc.subject | Implementation Science | |
| dc.title | Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Hertz, Julian T|0000-0002-7396-4789 | |
| duke.contributor.orcid | Coaxum, Lauren|0009-0000-1630-1009 | |
| duke.contributor.orcid | Thielman, Nathan M|0000-0001-8152-2879 | |
| duke.contributor.orcid | Bosworth, Hayden B|0000-0001-6188-9825 | |
| duke.contributor.orcid | Bettger, Janet P|0000-0001-9708-8413 | |
| pubs.begin-page | 393 | |
| pubs.issue | 1 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Orthopaedic Surgery | |
| pubs.organisational-group | Pathology | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences | |
| pubs.organisational-group | Medicine, General Internal Medicine | |
| pubs.organisational-group | Medicine, Infectious Diseases | |
| pubs.organisational-group | Duke Cancer Institute | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | University Initiatives & Academic Support Units | |
| pubs.organisational-group | University Institutes and Centers | |
| pubs.organisational-group | Duke Global Health Institute | |
| pubs.organisational-group | Center for the Study of Aging and Human Development | |
| pubs.organisational-group | Initiatives | |
| pubs.organisational-group | Duke Science & Society | |
| pubs.organisational-group | Population Health Sciences | |
| pubs.organisational-group | Duke Innovation & Entrepreneurship | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences | |
| pubs.organisational-group | Emergency Medicine | |
| pubs.organisational-group | Duke-Margolis Institute for Health Policy | |
| pubs.publication-status | Published | |
| pubs.volume | 24 |
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