Applying a multi-layered, mixed methods approach to evaluate technology and workforce interventions in Kenyan neonatal units

Understanding how to best implement healthcare innovations in resource-poor settings requires complex interventions and evaluations, often straining existing healthcare systems. We aimed to address this challenge in our Kenyan neonatal intervention research by deeply integrating stakeholder engagement, applying layered methodologies, and leveraging our research team's diverse expertise. This paper reports on the design and implementation of a research programme examining the impact of new staff introductions on care quality, staff, and family experiences within an existing neonatal technology programme in Kenya. Collaborating with stakeholders, our multidisciplinary programme of research included the analysis of routine health data before and after staff introductions, co-creation of novel quantitative data collection tools, and embedded qualitative research. Continuous feedback from participants, stakeholders, and researchers facilitated an adaptive approach, with timelines and methods adjusted to minimise participant burden. This iterative process allowed for robust data collection to inform health system improvements. Our findings provide insights into implementation and evaluation research for healthcare innovations in resource-constrained settings and emphasise ethical, context-sensitive research practices for sustainable health system strengthening.