Evaluating the implementation of the vignettes-based injury care process assessment tool in low- and middle-income countries settings

Abstract

Little is known about the quality of injury clinical care in low- and- middle-income countries (LMICs). We previously developed a scenario-based clinical vignettes tool, the Injury Care Provision Assessment Tool (ICPAT), to evaluate injury clinical care quality. This study aimed to assess the acceptability, appropriateness and feasibility of ICPAT in LMICs. We undertook a mixed-method sequential explanatory study using surveys assessing implementation constructs of acceptability, appropriateness, and feasibility (Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM)), followed by a focus group discussion (FGD) with data collectors who had administered ICPAT in Ghana, South Africa, Rwanda, and Pakistan. We described survey findings and performed thematic analysis according to a framework of tool strengths, limitations, and suggestions for improvement according to each implementation construct. Sixteen of 23 invited data collectors (70%) responded to the survey. Nine were males. Six were from Ghana, one from Pakistan, three from Rwanda, and six from South Africa. Eleven (69%) were clinically trained. Twelve (75%) who completed the survey participated in the FGD. The mean score for acceptability, appropriateness and feasibility was 17.1, 16.7, and 17.0, respectively, representing good levels for each. Fifteen (94%), data collectors would recommend using ICPAT in future. Regarding acceptability, data collectors thought ICPAT participants could experience “exam-like tension”. This tension could be partially mitigated by data collector skill, achievable through training, as well as by using two data collectors, a private setting, and incorporating feedback for quality improvement. Regarding appropriateness, ICPAT was considered suitably directed at initial resuscitation with appropriate scenarios, complementary to other methods of health system research, simple to conduct and valid, with more experienced clinicians performing better. Suggestions to improve ICPAT included adding an extremity exsanguination scenario, adjusting the head injury scenario description, and rationalising the scoring criteria for the chest injury scenario. Regarding feasibility, scheduling flexibility could improve participation. This study has demonstrated the acceptability, appropriateness and feasibility of ICPAT to support its continued use. We have proposed some tool adjustments and recommendations for data collector training. Not applicable.