Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of adoption.

Bright, S; Moses, F; Ridout, A; Sam, B; Momoh, M; Goodhart, V; Smart, F; Mannah, M; Issa, S; Herm-Singh, S; Reid, F; Seed, PT; Bunn, J; Shennan, A; Augustin, K; Sandall, J

Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of adoption.

Bright, S Moses, F Ridout, A Sam, B Momoh, M Goodhart, V Smart, F Mannah, M Issa, S Herm-Singh, S Reid, F Seed, PT Bunn, J Shennan, A Augustin, K Sandall, J

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Publisher:: BMC
Publication Type:: Journal Article
Citation:: Reprod Health, 2023, 20, (1), pp. 6
Issue Date:: 2023-01-06

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Field	Value	Language
dc.contributor.author	Bright, S
dc.contributor.author	Moses, F
dc.contributor.author	Ridout, A
dc.contributor.author	Sam, B
dc.contributor.author	Momoh, M
dc.contributor.author	Goodhart, V
dc.contributor.author	Smart, F
dc.contributor.author	Mannah, M
dc.contributor.author	Issa, S
dc.contributor.author	Herm-Singh, S
dc.contributor.author	Reid, F
dc.contributor.author	Seed, PT
dc.contributor.author	Bunn, J
dc.contributor.author	Shennan, A
dc.contributor.author	Augustin, K
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.date.accessioned	2023-10-04T03:01:53Z
dc.date.available	2022-12-13
dc.date.available	2023-10-04T03:01:53Z
dc.date.issued	2023-01-06
dc.identifier.citation	Reprod Health, 2023, 20, (1), pp. 6
dc.identifier.issn	1742-4755
dc.identifier.issn	1742-4755
dc.identifier.uri	http://hdl.handle.net/10453/172461
dc.description.abstract	BACKGROUND: The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device-designed specifically to improve maternity care in low resource settings-had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variation, this study retrospectively evaluated the adoption of CRADLE, during scale-up in Sierra Leone. METHODS: This was a mixed methods study. A quantitative indicator of adoption (the proportion of facilities trained per district) was calculated from existing training records, then focus groups were held with 'CRADLE Champions' in each district (n = 32), to explore adoption qualitatively. Template Analysis was used to deductively interpret qualitative data, guided by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) Framework. FINDINGS: Substantial but non-significant variation was found in the proportion of facilities trained in each district (range 59-90%) [X2 (7, N = 8) = 10.419, p = 0.166]. Qualitative data identified complexity in two NASSS domains that may have contributed to this variation: 'the technology' (for example, charging issues, difficulty interpreting device output and concerns about ongoing procurement) and 'the organisation' (for example, logistical barriers to implementing training, infighting and high staff turnover). Key strategies mentioned to mitigate against these issues included: transparent communication at all levels; encouraging localised adaptations during implementation (including the involvement of community leaders); and selecting Champions with strong soft skills (particularly conflict resolution and problem solving). CONCLUSIONS: Complexity related to the technology and the organisational context were found to influence the adoption of CRADLE in Sierra Leone, with substantial inter-district variation. These findings emphasise the importance of gaining an in-depth understanding of the specific system and context in which a new healthcare technology is being implemented. This study has implications for the ongoing scale-up of CRADLE, and for those implementing or evaluating other health technologies in similar contexts.
dc.format	Electronic
dc.language	eng
dc.publisher	BMC
dc.relation.ispartof	Reprod Health
dc.relation.isbasedon	10.1186/s12978-022-01551-2
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
dc.subject	1114 Paediatrics and Reproductive Medicine
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.subject.classification	3215 Reproductive medicine
dc.subject.classification	4206 Public health
dc.subject.mesh	Humans
dc.subject.mesh	Female
dc.subject.mesh	Pregnancy
dc.subject.mesh	Sierra Leone
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Africa
dc.subject.mesh	Vital Signs
dc.subject.mesh	Humans
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Pregnancy
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Africa
dc.subject.mesh	Sierra Leone
dc.subject.mesh	Female
dc.subject.mesh	Vital Signs
dc.subject.mesh	Humans
dc.subject.mesh	Female
dc.subject.mesh	Pregnancy
dc.subject.mesh	Sierra Leone
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Africa
dc.subject.mesh	Vital Signs
dc.title	Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of adoption.
dc.type	Journal Article
utslib.citation.volume	20
utslib.location.activity	England
utslib.for	1114 Paediatrics and Reproductive Medicine
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.date.updated	2023-10-04T03:01:50Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	20
utslib.citation.issue	1

Abstract:

BACKGROUND: The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device-designed specifically to improve maternity care in low resource settings-had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variation, this study retrospectively evaluated the adoption of CRADLE, during scale-up in Sierra Leone. METHODS: This was a mixed methods study. A quantitative indicator of adoption (the proportion of facilities trained per district) was calculated from existing training records, then focus groups were held with 'CRADLE Champions' in each district (n = 32), to explore adoption qualitatively. Template Analysis was used to deductively interpret qualitative data, guided by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) Framework. FINDINGS: Substantial but non-significant variation was found in the proportion of facilities trained in each district (range 59-90%) [X2 (7, N = 8) = 10.419, p = 0.166]. Qualitative data identified complexity in two NASSS domains that may have contributed to this variation: 'the technology' (for example, charging issues, difficulty interpreting device output and concerns about ongoing procurement) and 'the organisation' (for example, logistical barriers to implementing training, infighting and high staff turnover). Key strategies mentioned to mitigate against these issues included: transparent communication at all levels; encouraging localised adaptations during implementation (including the involvement of community leaders); and selecting Champions with strong soft skills (particularly conflict resolution and problem solving). CONCLUSIONS: Complexity related to the technology and the organisational context were found to influence the adoption of CRADLE in Sierra Leone, with substantial inter-district variation. These findings emphasise the importance of gaining an in-depth understanding of the specific system and context in which a new healthcare technology is being implemented. This study has implications for the ongoing scale-up of CRADLE, and for those implementing or evaluating other health technologies in similar contexts.

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