SRS19 - Evaluating the implementation of the vignettes-based Injury Care Process Assessment tool in low- and middle-income countries settings

Abstract Background We previously developed a scenario-based clinical vignettes tool, the Injury Care Provision Assessment Tool (ICPAT), to evaluate injury care quality in low- and- middle-income countries (LMICs). This study aimed to assess the acceptability, appropriateness and feasibility of ICPAT. Methods We did a mixed-method sequential explanatory study using surveys assessing implementation constructs of acceptability, appropriateness, and feasibility, followed by a focus group discussion (FGD). Participants had administered ICPAT in Ghana, South Africa, Rwanda, and Pakistan. We described survey findings and performed thematic analysis according to a framework of strengths, limitations, and suggestions for improvement for each implementation construct. Results 16/23 invited data collectors responded to the survey. 12/16 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. 15/16 recommended using ICPAT in future. Regarding acceptability, ICPAT participants could experience ‘exam-like tension’, partially mitigated by data collector skill, achievable through training, by using two data collectors, and a private setting. 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. Conclusions This study demonstrated the acceptability, appropriateness and feasibility of ICPAT and proposed adjustments and recommendations for future use.