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[Preprint]. 2024 May 31:rs.3.rs-4432440.
doi: 10.21203/rs.3.rs-4432440/v1.

Evaluating the Implementation of the Pediatric Acute Care Education (PACE) Program in Northwestern Tanzania: A Mixed-Methods Study Guided by Normalization Process Theory

Joseph R Mwanga  1 , Adolfine Hokororo  1 , Hanston Ndosi  1 , Theopista Masenge  2 , Florence S Kalabamu  2 , Daniel Tawfik  3 , Rishi P Mediratta  3 , Boris Rozenfeld  4 , Marc Berg  3 , Zachary H Smith  5 , Neema Chami  1 , Namala P Mkopi  2 , Castory Mwanga  2 , Enock Diocles  1 , Ambrose Agweyu  6 , Peter A Meaney  3
Affiliations

Evaluating the Implementation of the Pediatric Acute Care Education (PACE) Program in Northwestern Tanzania: A Mixed-Methods Study Guided by Normalization Process Theory

Joseph R Mwanga et al. Res Sq. .

Update in

Abstract

Background: In low- and -middle-income countries (LMICs) like Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this, we introduced PACE (Pediatric Acute Care Education), an adaptive e-learning program tailored to enhance provider competency in line with Tanzania's national guidelines for managing seriously ill children. Adaptive e-learning presents a promising alternative to traditional in-service education, yet optimal strategies for its implementation in LMIC settings remain to be fully elucidated.

Objectives: This study aimed to (1) evaluate the initial implementation of PACE in Mwanza, Tanzania, using the constructs of Normalization Process Theory (NPT), and (2) provide insights into its feasibility, acceptability, and scalability potential.

Methods: A mixed-methods approach was employed across three healthcare settings in Mwanza: a zonal hospital and two health centers. NPT was utilized to navigate the complexities of implementing PACE. Data collection involved a customized NoMAD survey, focus groups and in-depth interviews with healthcare providers.

Results: The study engaged 82 healthcare providers through the NoMAD survey and 79 in focus groups and interviews. Findings indicated high levels of coherence and cognitive participation, demonstrating that PACE is well-understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practice, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly affecting collective action, were noted. The short duration of the study limited the assessment of reflexive monitoring, though early indicators point towards the potential for PACE's long-term sustainability.

Conclusion: This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges is crucial for its successful and sustainable implementation. Furthermore, the study underscores the value of NPT as a framework in guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Keywords: Acceptability; Adaptive E-learning; Feasibility; Implementation Science; Normalization Process Theory; Pediatrics; Tanzania.

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Conflict of interest statement

Competing interests BR and MB are compensated by Area 9 Lyceum as Senior Learning Architect and Medical Director, respectively. Additional Declarations REDCap Database. Study data were collected and managed using REDCap electronic data capture tools hosted at Stanford University.71,72 REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources. The Stanford REDCap platform (http://redcap.stanford.edu) is developed and operated by the Stanford Medicine Research IT team. The REDCap platform services at Stanford are subsidized by a) the Stanford School of Medicine Research Office, and b) the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1 TR001085. Area9 Rhapsode™ meets the requirements for full GDPR compliance including encryption, data security, and ‘forget me’. Use of ChatGPT: We employed ChatGPT in two ways: 1) to edit and revise manuscripts for clarity, to ensure adherence to writing standards (such as STROBE, SRQR) and to format manuscripts, tables, and figures; and 2) to conduct preliminary data screening/monitoring using de-identified exported from our data from our REDCap databases. All statistical results and conclusions in this manuscript are confirmed by a biostatistician or member of the author group. Patient and public involvement. This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient-relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

Figures

Figure 1
Figure 1
Boxplot of Participant Responses to NoMAD Survey by NPT construct and subconstruct.
See this image and copyright information in PMC

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