1. Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial.
- Author
-
Vickery, Nicola, Stephens, Timothy, du Toit, Leon, van Straaten, Dawid, Pearse, Rupert, Torborg, Alexandra, Rolt, Lucy, Puchert, Mariechen, Martin, Graham, Biccard, Bruce, ASOS-2 Investigators, and Torburg, Alexandra
- Subjects
- *
MORTALITY , *QUESTIONNAIRES , *ODDS ratio , *CONFIDENCE intervals , *ACQUISITION of data , *HOSPITAL statistics , *PUBLIC health surveillance , *MEDICAL quality control , *RESEARCH , *RESEARCH methodology , *SURGICAL complications , *COOPERATIVENESS , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *RANDOMIZED controlled trials , *INTERPROFESSIONAL relations , *POSTOPERATIVE period - Abstract
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% (n=55/96) 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 (OR=3.0; 95% confidence interval [CI], 1.3-7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1-6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1-6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9-5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2-9.4).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.Clinical Trial Registration: ClinicalTrials gov NCT03853824. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF