Implementation Science

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Browsing Implementation Science by Subject "Research Subject Categories::IMPLEMENTATION SCIENCE"

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    Apredictive monitoring system for criticaly ill children in Malawi. A mixed methods usability and implentation research
    (2022-03-22) Manda Taylor, Lucinda
    Type of Research: This study will employ qualitative and quantitative research methods from the social sciences and human-centred design to assess the usability and implementation determinants of a predictive vital sign monitoring system for critically ill children in Queen Elizabeth Central and Zomba Central hospitals in Malawi. The problem: Each year in low-income countries, millions of children die because high-quality healthcare is not provided. Many of these deaths result from poverty-related diseases that are recognized too late. The monitoring of vital signs is essential to detect critical illness promptly. However, the monitoring systems widely and effectively used in high-resource settings are not suitable for lowincome settings because of their high up-front and ongoing costs, and limited adaptation to the socioeconomic background, working conditions and workflows. To address this problem, a consortium of Malawian and European researchers is developing an affordable, durable, and user-friendly monitoring system (IMPALA) for hospitalised children in lowincome countries. The IMPALA system combines innovative sensors, predictive machine learning algorithms, and point-of-care biomarkers within a simple monitoring system that enables health workers to detect and predict critical illness quickly. The implementation and usability research will run prior to and in parallel with clinical research on the IMPALA system. The setting often complicates the implementation and ultimate impact of health interventions: even interventions that may seem simple, such as the mass rollout of malaria rapid diagnostic tests, can fail to deliver the desired effects and have unintended consequences. Usability and implementation research seeks to examine the acceptability, accessibility, feasibility, and appropriateness of interventions in real-life circumstances and the factors (barriers and drivers) that influence their impact. Such research hence enables health interventions such as IMPALA to maximize the desired impact, in this case, improving critical care for children and their health outcomes. The objectives: The study's broad aim is to explore the (healthcare system, social and cultural) context-related factors to be considered in the design and implementation of the IMPALA system to optimise its feasibility, usability and impact on clinical care. The methodology: A mixed-methods approach, combining qualitative and quantitative methods from the social sciences and user-centered design, will be used. The study comprises three stages (pre- IMPALA, IMPALA 2.0 and IMPALA 3.0). During pre-IMPALA, the current context of care for critically ill children in Zomba Central Hospital will be studied. In stage 2.0, alongside clinical research on the IMPALA system 2.0 (described in a separate protocol), the implementation of the monitoring system will be studied. Stage 3.0 focuses on the updated IMPALA system with monitoring based on predictive algorithms. Methods include questionnaire-based surveys, in-depth interview, focus group discussions/co-design sessions, cognitive walkthroughs, heuristic evaluation, analysis of de-identified routine monitoring data and medical records, and ethnographic and structured observations. Data will be collected with healthcare providers, support staff, and the parents/guardians of critically ill children. Expected findings: The study results will be used to adapt the system during its ongoing development and make recommendations to ensure that its implementation has the desired impact on clinical practice and the health outcomes of critically ill children.