Medical stakeholder perspectives on implementing a computerized battery to identify neurocognitive impairments among
Amelia E Van Pelt1,2,3, Elizabeth D Lowenthal1,2,4, Onkemetse Phoi5
1Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Pediatric neurocognitive impairment due to HIV is a concern in Sub-Saharan Africa. The Penn Computerized Neurocognitive Battery (PennCNB) shows promise for screening, with implementation strategies identified to overcome barriers.
Area of Science:
- Neuroscience
- Public Health
- Implementation Science
Background:
- Pediatric neurocognitive impairment is linked to HIV infection and in utero exposure, prevalent in Sub-Saharan Africa.
- Cognitive screening is crucial for identifying these impairments but is underutilized in the region.
- The Penn Computerized Neurocognitive Battery (PennCNB) is an evidence-based tool adapted for Botswana.
Purpose of the Study:
- To explore key stakeholder perspectives on the successful implementation of the PennCNB in Botswana's clinical settings.
- To identify barriers and facilitators for the uptake of cognitive screening tools in resource-limited environments.
- To inform pre-implementation strategies for integrating the PennCNB into healthcare and educational sectors.
Main Methods:
- Conducted 20 semi-structured interviews with key stakeholders.
- Employed an integrated analytic approach using the Consolidated Framework for Implementation Research and modified grounded theory.
- Focused on eliciting factors influencing the adoption of the PennCNB.
Main Results:
- Stakeholders recognized the need for cognitive screening and found the PennCNB acceptable.
- Key barriers include time and resource limitations.
- Facilitators involve established procedures for introducing new tools and training.
Conclusions:
- Integrating the PennCNB into existing workflows and across medical and educational sectors is recommended.
- Targeted selection of children for assessment can optimize resource use.
- This pre-implementation research aims to bridge the research-to-practice gap for effective neurocognitive impairment identification.
Abstract:
HIV infection and in utero exposure, common in Sub-Saharan Africa, are associated with pediatric neurocognitive impairment. Cognitive screening can identify impairments, but it is rarely used in this setting. The Penn Computerized Neurocognitive Battery (PennCNB), an evidence-based cognitive screening tool, was adapted for use in Botswana. To facilitate future implementation, 20 semi-structured interviews were conducted to elicit key stakeholders' perspectives on factors likely to be related to successful uptake of the PennCNB in clinical settings. An integrated analytic approach combining constructs from the Consolidated Framework for Implementation Research and modified grounded theory was used. Results underscore the need for cognitive screening in Botswana and the acceptability of the PennCNB. Implementation barriers include limited time and resources, whereas facilitators include standard procedures for introducing new tools into medical settings and for training implementers. Recommended implementation strategies include integrating screening into the existing workflow, implementing the tool in the medical and educational sectors, and targeting selection of children for assessment. This research addresses the research-to-practice gap by engaging in pre-implementation inquiry and designing for implementation. Results will inform the development of strategies to maximize the likelihood of successful implementation of the PennCNB to identify neurocognitive impairment in children in this high-need setting.
