Understanding the factors that influence CT utilization for mild traumatic brain injury in a low resource setting - a qualitative study using the Theoretical Domains Framework

• Published in: African Journal of Emergency Medicine 2024-06, Vol.14 (2), p.103-108
• Main Authors: Kisembo, Harriet Nalubega, Malumba, Richard, Sematimba, Henry, Ankunda, Racheal, Nalweyiso, Irene Dorothy, Malwadde, Elsie-Kiguli, Rutebemberwa, Elizeus, Kasasa, Simon, Salama, Dina Husseiny, Kawooya, Michael Grace
• Format: Article
• Language: English
• Subjects: Computerized tomography utilization; Decision making; Imaging referrers; Low resource setting; Mild traumatic head injury; Original; Theoretical Domain Framework
• ISSN: 2211-419X; 2211-4203; 2211-419X
• DOI: 10.1016/j.afjem.2024.04.004

In low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs). The primary objective was to explore IRs' beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored. In-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF. Eleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.Identified factors within domain involved IRs' clinical assessment and decision-making abilities, while beliefs about and encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The domain addressed the availability of CT scanners and financial constraints. The domain elicited IRs' understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For domain, IRs adherence to guidelines and intentions to order CT scans were cited. Using TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others.