Contextual factors influencing bubble continuous positive airway pressure implementation for paediatric respiratory distress in low-income and middle-income countries: a realist review
Year: 2024
Type: review
Study design: Systematic Review
Abstract: BACKGROUND: Bubble continuous positive airway pressure (bCPAP) is a low-cost, non-invasive respiratory support therapy for children with respiratory distress, but its effectiveness is dependent on the context. We aimed to understand contextual factors influencing bCPAP implementation for children aged 1-59 months in low-income and middle-income countries (LMICs) and to develop a theory explaining how these factors influence implementation outcomes. METHODS: In this realist review, we generated an initial programme theory comprising candidate context-mechanism-outcome configurations (CMOCs) via review of key references and team discussion. On July 25, 2023, we conducted a search for peer-reviewed and grey literature, without date restrictions, describing bCPAP use for paediatric respiratory distress in LMICs. We included references describing related contexts, mechanisms, or outcomes. We coded statements from the literature supporting each CMOC, iteratively revising and adding CMOCs using inductive and deductive logic. We assembled an international, interdisciplinary panel of 22 bCPAP stakeholders to refine CMOCs using iterative surveys, focus groups, and interviews until we reached thematic saturation. This realist review is registered with PROSPERO (CRD42023403584). FINDINGS: Of 1640 peer-reviewed references and eight grey literature references retrieved, 38 peer-reviewed articles and two grey literature documents were deemed eligible for inclusion after removal of duplicates and screening. After four rounds of expert surveys and three focus groups, we identified 18 CMOCs. CMOCs were synthesised into a final programme theory operating at five levels to influence implementation feasibility, fidelity, and sustainability: (1) the bCPAP device, (2) local partnerships and infrastructure, (3) clinical and technical teams, (4) caregivers and the community, and (5) institutional practices. INTERPRETATION: Using realist methods with a diverse, international stakeholder panel, we generated a theory that could explain how bCPAP therapy works in different contexts. This theory could be leveraged to enhance the rigour of future bCPAP implementation trials. FUNDING: Yale National Clinician Scholars Program, US National Center for Advancing Translational Science (TL1TR001864), and National Heart, Lung, and Blood Institute (T32HL155000).
Source: The Lancet Global Health
Authors: Nadir Ijaz, Marie Nader, Matthew Ponticiello, Ashlee J Vance, Brittney J van de Water, Melissa C Funaro, Qalab Abbas, John Adabie Appiah, Mohammod Jobayer Chisti, Walter Commerell, Suiyven Elvis Dzelamunyuy, Rudimar Martinez Fernandez, Anjelica L Gonzalez, Cintia Johnston, Evance Luckson Kaiwe, Manjinder Kaur, Hans-Joerg Lang, Eric D McCollum, José Marcos González Moraga, Jayashree Muralidharan, Kelsey Renning, Herng Lee Tan, Laura Alejandra Vélez Ruiz Gaitán, Sebastián González-Dambrauskas, Patrick T Wilson, Brenda M Morrow, J Lucian Davis
Institutions: Yale University, Henry Ford Health, Boston College, Aga Khan University, Komfo Anokye Teaching Hospital, International Centre for Diarrhoeal Disease Research, Technische Hochschule Ulm, Mengo Hospital, Mubende Hospital, KK Women's and Children's Hospital, Universidade de São Paulo, Queen Elizabeth Central Hospital, Kamuzu University of Health Sciences, Post Graduate Institute of Medical Education and Research, Alliance for International Medical Action, Heidelberg Institute of Global Health, Johns Hopkins University, Johns Hopkins Medicine, Hospital Regional Rancagua, World Health Organization, Universidad de la República de Uruguay, Centro Hospitalario Pereira Rossell, University of Colorado Anschutz, University of Colorado Denver, University of Cape Town
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,780
Awards: G1888109088, Understanding the role of bilevel positive airway pressure (BPAP) in pediatric acute asthma exacerbations: A prospective, randomized, double blind, controlled trial., G6427572733, Training in Implementation Science Research and Methods, Bilevel positive airway pressure (BPAP) for severe pediatric asthma exacerbations: A randomized, controlled trial., Understanding the role of bilevel positive airway pressure (BPAP) in pediatric acute asthma exacerbations: A prospective, randomized, double blind, controlled trial., J. NRSA Training Core
OpenAlex ID: W4405311006