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Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial
Background: The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods: Mixed-methods process evaluation, inclu...
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2021
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| LEADER | 00000njm a2000000a 4500 | ||
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| 001 | oai:repository.ui.edu.ng:123456789/11864 | ||
| 042 | |a dc | ||
| 720 | |a Vickery, N. |e author | ||
| 720 | |a Stephens, T. |e author | ||
| 720 | |a Toit, L. D. |e author | ||
| 720 | |a Straaten, D. V. |e author | ||
| 720 | |a Pearse, R. |e author | ||
| 720 | |a Torborg, A. |e author | ||
| 720 | |a Rolt, L. |e author | ||
| 720 | |a Puchert, M. |e author | ||
| 720 | |a Martin, G. |e author | ||
| 720 | |a Biccard, B. B. |e author | ||
| 720 | |a Osinaike, B. B. |e author | ||
| 720 | |a Ogunbode, O. O. |e author | ||
| 720 | |a Idowu, O. |e author | ||
| 720 | |a Lawal, T. A. |e author | ||
| 720 | |a Ogundiran, T. O. |e author | ||
| 720 | |a Shittu, O. B. |e author | ||
| 720 | |a Ayandipo, O. O |e author | ||
| 260 | |c 2021 | ||
| 520 | |a Background: The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods: Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results: The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n¼55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR¼3.0; 95% confidence interval [CI], 1.3e7.0); nursing management support of the trial (OR¼2.6; 95% CI, 1.1e6.5); performance of a dummy run (OR¼2.6; 95% CI, 1.1e6.1); nursing colleagues seeing the value of the intervention(s) (OR¼2.1; 95% CI, 0.9e5.7); and site investigators’ belief in the effectiveness of the intervention (OR¼3.2; 95% CI, 1.2e9.4). Conclusions: ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. | ||
| 024 | 8 | |a 0007-0912||1471-6771 | |
| 024 | 8 | |a ui_art_vickery_understanding_2021 | |
| 024 | 8 | |a British Journal of Anaesthesia 127(5), pp. 778-788 | |
| 024 | 8 | |a https://repository.ui.edu.ng/handle/123456789/11864 | |
| 653 | |a Africa | ||
| 653 | |a Global Health | ||
| 653 | |a Postoperative Mortality | ||
| 653 | |a Pragmatic Trails | ||
| 653 | |a Process | ||
| 245 | 0 | 0 | |a Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial |