Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: A reflexive thematic analysis

Journal article


Smith, B. G., Whiffin, C., Esene, I. N, Karekezi, C., Bashford, T, Mukhtar Khan, M.,, Fontoura Solla, D. J., Devi,I. B., Paiva,W.S., Servadei,F., Hutchinson, P.J., Kolias, A.G., Figaji,A. and Rubiano, A.M. 2022. Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: A reflexive thematic analysis. PLos ONE. 17 (9). https://doi.org/10.1371/journal.pone.0274922
AuthorsSmith, B. G., Whiffin, C., Esene, I. N, Karekezi, C., Bashford, T, Mukhtar Khan, M.,, Fontoura Solla, D. J., Devi,I. B., Paiva,W.S., Servadei,F., Hutchinson, P.J., Kolias, A.G., Figaji,A. and Rubiano, A.M.
Abstract

Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden of TBI cannot be accurately quantified. To explore the specific contextual challenges of, and possible solutions to improve, long-term follow-up following TBI in low-resource settings. Methods: A cross-sectional, pragmatic qualitative study, that considered knowledge subjective and reality multiple (i.e. situated within the naturalistic paradigm). Data collection utilised semi-structured interviews, by videoconference and asynchronous e-mail. Data were analysed using Braun and Clarke’s six-stage Reflexive Thematic Analysis. 18 neurosurgeons from 13 countries participated in this study, and data analysis gave rise to five themes: Clinical Context: What must we understand?; Perspectives and Definitions: What are we talking about?; Ownership and Beneficiaries: Why do we do it?; Lost to Follow-up: Who misses out and why?; Processes and Procedures: What do we do, or what might we do? The collection of long-term outcome data plays an imperative role in reducing the global burden of neurotrauma. Therefore, this was an exploratory study that examined the contextual challenges associated with long-term follow-up in LMICs. Where technology can contribute to improved neurotrauma surveillance and remote assessment, these must be implemented in a manner that improves patient outcomes, reduces clinical burden on physicians, and does not surpass the comprehension, capabilities, or financial means of the end user. Future research is recommended to investigate patient and family perspectives, the impact on clinical care teams, and the full economic implications of new technologies for follow-up.

KeywordsResearch Article; Medicine and health sciences; Social sciences; Earth sciences; People and places; Research and analysis methods
Year2022
JournalPLos ONE
Journal citation17 (9)
PublisherPLOS
ISSN1932-6203
Digital Object Identifier (DOI)https://doi.org/10.1371/journal.pone.0274922
Web address (URL)https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274922
FunderNIHR
Output statusPublished
Publication dates
Online19 Sep 2022
Publication process dates
Accepted06 Sep 2022
Deposited17 Oct 2022
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https://repository.derby.ac.uk/item/996wz/neurotrauma-clinicians-perspectives-on-the-contextual-challenges-associated-with-traumatic-brain-injury-follow-up-in-low-income-and-middle-income-countries-a-reflexive-thematic-analysis

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