Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation

Tiffany Gooden; Jingya Wang; Alessandra Carvalho  Goulart; Ana C Varella; Meihui  Tai; Vethanayagan Antony  Sheron; Hui Zhang; Jiaoyue  Zhong; Balachandran Kumarendran; Krishnarajah Nirantharakumar; Rajendra  Surenthirakumaran; Isabela M Benseñor; Yutao Guo; Gregory Lip; G Neil Thomas; Semira Manaseki-Holland; Wang Hao

doi:10.1080/16549716.2023.2231763

Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation

Tiffany Gooden, Jingya Wang, Alessandra Carvalho Goulart, Ana C Varella, Meihui Tai, Vethanayagan Antony Sheron, Hui Zhang, Jiaoyue Zhong, Balachandran Kumarendran, Krishnarajah Nirantharakumar, Rajendra Surenthirakumaran, Isabela M Benseñor, Yutao Guo, Gregory Lip, G Neil Thomas^*, Semira Manaseki-Holland^*, Wang Hao

^*Corresponding author for this work

Applied Health Research

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking.

Objective: To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka.

Methods: Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country.

Results: The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka.

Conclusions: Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.

Original language	English
Article number	2231763
Number of pages	11
Journal	Global Health Action
Volume	16
Issue number	1
Early online date	19 Jul 2023
DOIs	https://doi.org/10.1080/16549716.2023.2231763
Publication status	Published - 31 Dec 2023

Keywords

Early diagnosis
continuity of care
mixed-methods
cascade of care
pathways of care
Brazil
China
Sri Lanka

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/16549716.2023.2231763Licence: Creative Commons: Attribution (CC BY)

GoodenT2023GeneralisabilityFinal published version, 1.76 MBLicence: Creative Commons: Attribution (CC BY)

NIHR Global Research Group on Atrial Fibrillation
Lasserson, D., Manaseki-Holland, S., Cheng, K., Moore, D., Jolly, K., Greenfield, S., Jowett, S., Brocklehurst, P., Nirantharakumar, K., Szmigin, I., Kirchhof, P., Gough, R. & Thomas, N.
NIHR CENTRAL COMMISSIONING FACILITY
1/04/18 → 30/09/22
Project: Other Government Departments

Cite this

Gooden, T., Wang, J., Goulart, A. C., Varella, A. C., Tai, M., Sheron, V. A., Zhang, H., Zhong, J., Kumarendran, B., Nirantharakumar, K., Surenthirakumaran, R., Benseñor, I. M., Guo, Y., Lip, G., Thomas, G. N., Manaseki-Holland, S., & Hao, W. (2023). Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation. Global Health Action, 16(1), Article 2231763. https://doi.org/10.1080/16549716.2023.2231763

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title = "Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation",

abstract = "Background: Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking.Objective: To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka.Methods: Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country.Results: The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka.Conclusions: Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.",

keywords = "Early diagnosis, continuity of care, mixed-methods, cascade of care, pathways of care, Brazil, China, Sri Lanka",

author = "Tiffany Gooden and Jingya Wang and Goulart, {Alessandra Carvalho} and Varella, {Ana C} and Meihui Tai and Sheron, {Vethanayagan Antony} and Hui Zhang and Jiaoyue Zhong and Balachandran Kumarendran and Krishnarajah Nirantharakumar and Rajendra Surenthirakumaran and Bense{\~n}or, {Isabela M} and Yutao Guo and Gregory Lip and Thomas, {G Neil} and Semira Manaseki-Holland and Wang Hao",

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doi = "10.1080/16549716.2023.2231763",

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Gooden, T , Wang, J, Goulart, AC, Varella, AC, Tai, M, Sheron, VA, Zhang, H, Zhong, J, Kumarendran, B , Nirantharakumar, K, Surenthirakumaran, R, Benseñor, IM, Guo, Y, Lip, G , Thomas, GN , Manaseki-Holland, S & Hao, W 2023, 'Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation', Global Health Action, vol. 16, no. 1, 2231763. https://doi.org/10.1080/16549716.2023.2231763

TY - JOUR

T1 - Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation

AU - Gooden, Tiffany

AU - Wang, Jingya

AU - Goulart, Alessandra Carvalho

AU - Varella, Ana C

AU - Tai, Meihui

AU - Sheron, Vethanayagan Antony

AU - Zhang, Hui

AU - Zhong, Jiaoyue

AU - Kumarendran, Balachandran

AU - Nirantharakumar, Krishnarajah

AU - Surenthirakumaran, Rajendra

AU - Benseñor, Isabela M

AU - Guo, Yutao

AU - Lip, Gregory

AU - Thomas, G Neil

AU - Manaseki-Holland, Semira

AU - Hao, Wang

PY - 2023/12/31

Y1 - 2023/12/31

N2 - Background: Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking.Objective: To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka.Methods: Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country.Results: The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka.Conclusions: Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.

AB - Background: Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking.Objective: To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka.Methods: Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country.Results: The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka.Conclusions: Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.

KW - Early diagnosis

KW - continuity of care

KW - mixed-methods

KW - cascade of care

KW - pathways of care

KW - Brazil

KW - China

KW - Sri Lanka

U2 - 10.1080/16549716.2023.2231763

DO - 10.1080/16549716.2023.2231763

M3 - Article

C2 - 37466418

SN - 1654-9716

VL - 16

JO - Global Health Action

JF - Global Health Action

IS - 1

M1 - 2231763

ER -

Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation

Abstract

Keywords

UN SDGs

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Projects

NIHR Global Research Group on Atrial Fibrillation

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