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PS-SAM: A Mixed Methods Study to Understand Current Practice and the Facilitators and Barriers to the Utilisation of
Mike Kalmus Eliasz1, Dolce Advani1, Melissa Gladstone1
1Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Merseyside, UK.
Insights
Psycho-social stimulation interventions improve child development but face implementation barriers in severe acute malnutrition (SAM) care. Addressing resource limitations and staff beliefs is crucial for wider adoption.
Area of Science:
- Child Development
- Public Health Interventions
- Implementation Science
Background:
- Psycho-social stimulation interventions are recommended for severe acute malnutrition (SAM) to enhance neurodevelopment and growth.
- Effective clinical trial interventions for SAM are often resource-intensive, posing implementation challenges in diverse settings.
- Understanding facilitators and barriers is key to integrating these interventions into routine SAM care.
Purpose of the Study:
- To explore facilitators, barriers, and current provision of psycho-social stimulation interventions for children with SAM.
- To identify practitioner perspectives on implementing evidence-based interventions in real-world SAM care programs.
Main Methods:
- A multi-country mixed-methods study combining a global survey of SAM practitioners with 12 semi-structured key informant interviews.
- Qualitative data analysis used a deductive approach based on the Consolidated Framework for Implementation Science Research (CFIR).
Main Results:
- Survey responses from 42 practitioners across 18 countries indicated heterogeneous implementation patterns.
- Key barriers included financial, resource limitations, prioritizing life-saving care, and staff beliefs.
- Facilitators comprised guideline inclusion, perceived enjoyment, and emerging evidence of benefits.
Conclusions:
- Significant challenges exist in implementing resource-intensive psycho-social stimulation interventions from research trials into SAM care.
- Pragmatic studies assessing implementation are needed to understand drivers of uptake for these vital interventions.
Abstract:
Psycho-social stimulation interventions, recommended in the WHO guidelines for severe acute malnutrition (SAM), have been demonstrated to improve neurodevelopment and growth. However, interventions which have proven effective in clinical trials are resource-intensive and may be challenging in many contexts. This study aimed to explore facilitators, barriers and the existing provision of psycho-social stimulation interventions. We undertook a survey targeting practitioners across the globe who are involved in SAM care and/or programme management. We then undertook 12 semi-structured key informant interviews with practitioners from diverse professional contexts. We transcribed and coded interviews using a deductive approach based on the Consolidated Framework for Implementation Science Research (CFIR). We gained 42 responses from 18 countries for our survey with 29 respondents including psycho-social stimulation interventions in their SAM programmes. Our 12 key informant interviews described several barriers (financial, physical, and human resource limitations, prioritisation of life-saving care, and staff beliefs) as well as some potential facilitators (inclusion in guidelines, enjoyment for staff and parents, and emerging evidence of benefits in terms of short and long-term outcomes). This multi-country mixed methods study revealed that there are very heterogeneous patterns around the implementation of psycho-social interventions in children with SAM. Our study has demonstrated the perceived challenges by professionals involved in SAM care of the feasibility of implementing interventions from research trials. Pragmatic studies are needed which also include an assessment of implementation to enhance an understanding of what might drive uptake. Limitations of our study include a potential respondent bias and small sample size.
