Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory
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Date
2024-09-13
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BMC health services research
Abstract
Background In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare provid-ers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Educa-tion (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal imple-mentation strategies in LMIC settings are unknown.
Objectives (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.
Methods Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collectedusing the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered
through in-depth interviews (IDIs) and focus groups discussions (FGDs).
Results Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrat-ing that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.
Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanza-nian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges
as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation.
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Keywords
Adaptive learning, Pediatrics, Tanzania
Citation
Mwanga, J.R., Hokororo, A., Ndosi, H., Masenge, T., Kalabamu, F.S., Tawfik, D., Mediratta, R.P., Rozenfeld, B., Berg, M., Smith, Z.H. and Chami, N., 2024. Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory. BMC health services research, 24(1), p.1066.