Medical stakeholder perspectives on implementing a computerized battery to identify neurocognitive impairments among youth in Botswana

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.

KEYWORDS:

• Neurocognitive assessment
• implementation science
• youth
• Sub-Saharan Africa

Acknowledgements

The authors would like to thank the research assistant for his support of this research.

Disclosure statement

Dr. Beidas receives royalties from Oxford University Press. Dr. Beidas has provided consultation to the Camden Coalition of Healthcare Providers and currently provides consultation to United Behavioral Health. Dr. Beidas serves on the Clinical and Scientific Advisory Committee for Optum Behavioral Health.

Additional information

Funding

This research was supported by the National Institute of Child Health and Human Development (F31 HD101346) and the Children’s Hospital of Philadelphia Carole Marcus Mid-Career Award to Promote Career Development and Mentoring in Pediatric Research. This publication was made possible in part through core services and support from the Penn Center for AIDS Research (CFAR) and the Penn CFAR ISPHERE Scientific Working Group, an NIH-funded (P30 AI 045088) program.