Spencer F Sumner, Francis M Sakita, Kelvin F Haukila, Lisa Wanda, Godfrey L Kweka, Jerome J Mlangi, Pankrasi Shayo, Tumsifu G Tarimo, Simran Khanna, Claire Wang, Abigail Pyne, Preeti Manavalan, Nathan M Thielman, Janet P Bettger, Julian T Hertz
MIMIC was found to be acceptable in all seven TFA domains among ED providers and patients, with perceived effectiveness driving positive attitudes across stakeholder groups. MIMIC's co-design approach likely contributed to high intervention acceptability. Patient education strategies may require adaptation to improve fidelity. These findings support continued implementation and targeted adaptation of MIMIC.
BACKGROUND: Acute myocardial infarction (AMI) is an increasing cause of morbidity and mortality in Sub-Saharan Africa (SSA) but is often underdiagnosed and undertreated. To address this gap, the Multicomponent Intervention to Improve Myocardial Infarction Care (MIMIC) was developed and implemented to improve evidence-based AMI care. The aim of this study was to explore stakeholder perceptions of the acceptability of MIMIC following its implementation.
METHODS: This qualitative study involved in-depth interviews with 20 key stakeholders (physicians, nurses, administrators, and patients diagnosed with AMI) who participated in MIMIC during the first year of implementation in the emergency department (ED) of a regional referral center in northern Tanzania. Purposive sampling was used to recruit diverse participants. Interviews were guided by a semi-structured interview guide informed by the Theoretical Framework of Acceptability (TFA). Interview transcripts were thematically analyzed by a team of coders using an inductive, grounded theory approach guided by the seven TFA domains.
RESULTS: Nineteen major themes emerged across all TFA domains. Overall, participants described MIMIC as acceptable, minimally burdensome, and well-aligned with professional and ethical values. Perceived effectiveness was most emphasized, with staff citing improvements in AMI recognition, electrocardiogram (ECG) and troponin testing, and use of evidence-based therapies. Most components were described as effective and easily integrated into existing workflows. Patients valued the educational pamphlet for improving knowledge and self-efficacy, though staff expressed concerns about distributing it during acute care, contributing to inconsistent delivery. Champions were viewed as key in promoting adherence and sustaining implementation.
CONCLUSION: MIMIC was found to be acceptable in all seven TFA domains among ED providers and patients, with perceived effectiveness driving positive attitudes across stakeholder groups. MIMIC's co-design approach likely contributed to high intervention acceptability. Patient education strategies may require adaptation to improve fidelity. These findings support continued implementation and targeted adaptation of MIMIC.