316 Before scaling-up, speak with the stakeholders: lessons from a preterm project

• Published in: BMJ paediatrics open Vol. 5; no. Suppl 1; pp. A92 - A93
• Main Authors: Agyeman-Duah, Josephine, Appiah, Anita, Asibey, Jacqueline, Asiedu, Ernest, Kennedy, Stephen, Villar, Jose
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2021; BMJ Publishing Group
• Subjects: Babies; Coronaviruses; COVID-19; Pediatrics; Premature birth; Public health; Stakeholders; Ghana
• ISSN: 2399-9772
• DOI: 10.1136/bmjpo-2021-RCPCH.175

BackgroundIn 2019, the [1]National Catholic Health Service (NCHS) initiated the INTERPRACTICE-21st Study in Ghana: implementation of the [2]INTERGROWTH-21st (IG21) Preterm Postnatal Growth Standards and Feeding Protocols within its hospitals.Implementation includedMonitoring the growth of preterm babies with the IG21 standards, rather than the traditional growth charts for term babies.Training health professionals involved with neonatal care to use the IG21 standards and evidence-based, feeding protocols (with their focus on the use of breast milk).Partner consultations.We present the results of the qualitative component of an evaluation study, conducted after the 15 month pilot phase, to inform future [3]spread and [4]scale-up of interventions.[1] https://www.nchs.org.gh[2] https://intergrowth21.tghn.org/interpractice-21st/[3] Spread definition: https://qi.elft.nhs.uk/collection/scale-up-and-spread/[4] Scale-up definition: https://qi.elft.nhs.uk/collection/scale-up-and-spread/ObjectivesTo describe stakeholder views and perspectives regarding the introduction of a novel public health intervention aimed at improving care for preterm babies in a low-resource setting.To compile lessons learned for national scale-up of preterm interventions.MethodsA questionnaire was developed based on the literature relating to implementation science. In-depth interviews were conducted with eight key stakeholders who were purposively sampled because of their prior knowledge of the INTERPRACTICE-21st Study and/or preterm care in Ghana. Eligible stakeholders were invited via email to participate. Interviewees included officials at the Ministry of Health and NCHS, and other stakeholders in the field of paediatrics and public health.Due to COVID-19 restrictions, interviews were conducted virtually (via a video call). Verbal consent was obtained prior to the interviews. Recorded audio files were transcribed and thematic content analysis was performed using [5]Pope’s Approach to extract emerging themes from the interviews. The Oxford Tropical Research Ethics Committee approved the study (no. 536–20).[5] https://www.bmj.com/content/320/7227/114ResultsEmerging themes from the interviews are presented in table 1 below:Abstract 316 Table 1Emerging themes from interviews Strengths and enabling factors Limitations/challenges Recommendations for improvement Better monitoring of preterm baby growth Continuous on-site supportive monitoring Staff motivation through supportive supervision Involvement of paediatricians as local leads Data sharing Data management: • Data quality improvement including providing feedback to facilities • Involving nurses to coordinate data monitoring • Enrolling health information officers to support doctors to manage data • Publication is an incentive for doctors • A harmonised records book to include preterm growth charts and indicatorsSupportive supervision Impact of Covid-19 Embedding sustainable funding model before scale-up Communication Attitudes and priorities: more focus on mother than preterm baby Active involvement of parents, caregivers and community Management support Identifying strategic alliances for local and global partnerships Quality Improvement as a service-wide culture Staff commitment Parent involvement ConclusionsStakeholder responses show positive feedback to the pilot phase of the project.The study emphasises the need to seek the views of stakeholders in a pilot phase before embarking on nationwide scale-up of a preterm intervention in a low-resource setting.