Provider attitudes towards quality improvement for myocardial infarction care in northern Tanzania

PLOS Glob Public Health. 2024 Apr 4;4(4):e0003051. doi: 10.1371/journal.pgph.0003051. eCollection 2024.

Abstract

Introduction: Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence of MI in sub-Saharan Africa is rising, but uptake of evidence-based care in northern Tanzania is low. There are currently no published quality improvement interventions from the region. The objective of this study was to determine provider attitudes towards a planned quality improvement intervention for MI care in northern Tanzania.

Methods: This study was conducted at a zonal referral hospital in northern Tanzania. A 41-question survey, informed by the Theoretical Framework for Acceptability, was developed by an interdisciplinary team from Tanzania and the United States. The survey, which explored provider attitudes towards MI care improvement, was administered to key provider stakeholders (physicians, nurses, and hospital administrators) using convenience sampling.

Results: A total of 140 providers were enrolled, including 82 (58.6%) nurses, 56 (40.0%) physicians, and 2 (1.4%) hospital administrators. Most participants worked in the Emergency Department or inpatient medical ward. Providers were interested in participating in a quality improvement project to improve MI care at their facility, with 139 (99.3%) strongly agreeing or agreeing with this statement. All participants agreed or strongly agreed that improvements were needed to MI care pathways at their facility. Though their facility has an MI care protocol, only 88 (62.9%) providers were aware of it. When asked which intervention would be the single-most effective strategy to improve MI care, the two most common responses were provider training (n = 66, 47.1%) and patient education (n = 41, 29.3%).

Conclusion: Providers in northern Tanzania reported strongly positive attitudes towards quality improvement interventions for MI care. Locally-tailored interventions to improve MI should include provider training and patient education strategies.

Grants and funding

This study received funding from the US National Institutes of Health under grant K23-HL155500, awarded to JTH. The authors acknowledge the support provided by the Biostatistics, Epidemiology and Research Design (BERD) Methods Core, which is funded through Grant Award Number UL1TR002553 from the National Center for Advancing Translational Sciences (NCATS), a division of the National Institutes of Health (NIH). The views expressed in this work are solely those of the authors and do not necessarily reflect the official views of the NIH. The funder had no role in study design, data collection, data analysis, decision to publish, or preparation of the article.