Fostering deliberation and action in context: An analysis of implementation research among healthcare professionals in <scp>LMICs</scp> from a post‐digital perspective

Abstract Strengthening health systems through workforce development is central to combating health crises and inequalities in some of the world's poorest countries and is a key objective for implementation research (IR). Workforce development programmes often include blended and online modalities, offering the means to reach relevant communities at scale, removing barriers in accessing lifelong learning opportunities. However, approaches that privilege issues of access, reach and scale are overlooking critical problems, such as the persistent gap between ‘what one knows’ and ‘what one practises’. In this paper, we describe the implementation of an EdTech innovation situated within a technology‐supported health workforce development programme in two distinct public health systems: Nepal and Ghana. This work focused on the challenge of antimicrobial resistance (AMR), a critical area of health practice related to the burden of bacterial infections. We report on an embedded multiple case study of a health workforce development programme across participating health facilities ( n = 12; 6 in each country). Taking a postdigital positionality and using critical analysis guided by Helfrich et al.'s (2007) adapted Framework for Complex Innovations, we examine contextual factors that facilitated or impeded implementation. We used an iterative process to collect and analyse qualitative data generated by healthcare workers (HCWs) leading implementation activities in their organisations. By bringing in the relevance of the health field perspectives on the EdTech, the analysis illustrates the impact on implementation climate and the fit between the innovation and the values of participants. It provides evidence of how the innovation supported HCWs in organising new spaces of action to negotiate wider work and learning arrangements and facilitate the move of knowledge into their practice, hence offering a potential pathway to address the ‘know‐do’ gap. The paper offers a significant contribution in understanding and conducting EdTech implementation research in professional settings in complex, resource‐constrained settings. Practitioner notes What is already known about this topic Implementing professional learning interventions in the complex environments of LMICs presents significant challenges and the ‘know‐do’ gap in the provision of health services is pervasive and enduring. Implementation research (IR) focuses on understanding and addressing the barriers to effective implementation of policies, practices and interventions with an aim to generate transferrable and replicable insights that may lead to scalable interventions. IR is widely used in the health sector to bridge gaps between evidence and practice. However, it has not yet been systematically used to guide educational interventions in complex, resource‐constrained settings such as low‐ and middle‐income countries (LMICs). What this paper adds The study illustrates how IR can be applied effectively to address the determinants of complex innovations, enabling alignment between blended and online professional learning interventions and the needs and values of the participants. The paper emphasises ways of conducting EdTech IR that include commitments to epistemological diversity and plurality and treating workers as highly agentic and ‘resourceful practitioners’. Based on analysis guided by Helfrich et al.'s (2007) adapted Framework for Complex Innovations, a key contribution of this paper is evidence of the implementation climate and the need for leadership through local ‘Innovation Champions’ who can navigate power dynamics, promote team autonomy and adapt interventions to suit local contexts. The paper demonstrates that IR can be used to analyse EdTech interventions and shows that a greater emphasis is needed on how the ‘digital’ relates to and operates in response to pre‐existing practices, objects and activities and the broader organisational and social factors. Implications for practice and/or policy The paper provides evidence that IR, when applied in the context of professional learning supported by EdTech, can serve as a valuable tool to inform both policy and practice, ultimately contributing to improved health outcomes. IR can be used to support change in EdTech interventions, such as online professional learning—an essential element for effectively implementing health‐related interventions in LMICs. The Framework for Complex Innovations used in this study offers a practical approach for developing context‐sensitive practices and guiding policy in complex LMIC settings, including in non‐health settings.