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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.
- Source :
-
BJA: The British Journal of Anaesthesia . Nov2021, Vol. 127 Issue 5, p778-788. 11p. - Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.<bold>Clinical Trial Registration: </bold>ClinicalTrials gov NCT03853824. [ABSTRACT FROM AUTHOR]
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 127
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 152950218
- Full Text :
- https://doi.org/10.1016/j.bja.2021.07.001