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

Authors

• John Whitaker, University of Birmingham
• Leila Ghalichi, University of Birmingham
• Alemayehu Amberbir, University of Global Health Equity
• Agnieszka Ignatowicz, University of Birmingham
• Tamlyn MacQuene, Stellenbosch University
• Derbew Fikadu Berhe, University of Global Health Equity
• Zabin Wajidali, Aga Khan UniversityFollow
• Debra Sithole, University of Birmingham
• Anita Eseenam Agbeko, Kwame Nkrumah University of Science and Technology
• Eric Twizeyimana, University of Global Health Equity
• Ngirabeza Oda Munyura, University of Global Health Equity
• Komal Abdul Rahim, Aga Khan UniversityFollow
• Senyo Gudugbe, Holy Family Hospital
• Pascal Deeshini Aliu Alhassan, Tamale Teaching Hospita
• Pradeep Navsaria, University of Cape Town
• Lucia D'Ambruoso, University of Aberdeen
• Junaid Razzak, Aga Khan UniversityFollow
• Kathryn Chu, Stellenbosch University
• Justine Davies, University of Birmingham

Document Type

Article

Department

Community Health Sciences

Abstract

Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.

Comments

Volume, issue, and pagination are not provided by the author/publihser.

Publication (Name of Journal)

BMC Health Services Research

DOI

10.1186/s12913-026-14424-2

Recommended Citation

Whitaker, J., Ghalichi, L., Amberbir, A., Ignatowicz, A., MacQuene, T., Berhe, D. F., Wajidali, Z., Sithole, D., Agbeko, A. E., Twizeyimana, E., Munyura, N. O., Rahim, K. A., Gudugbe, S., Alhassan, P. A., Navsaria, P., D'Ambruoso, L., Razzak, J., Chu, K., Davies, J. (2026). Evaluating the implementation of the vignettes-based injury care process assessment tool in low- and middle-income countries settings. BMC Health Services Research.
Available at: https://ecommons.aku.edu/cete/23