abstract: 'Background: An emergency triage, assessment and treatment plus admission

  care (ETAT+) intervention was implemented in Rwandan district hospitals

  to improve hospital care for severely ill infants and children. Many

  interventions are rarely implemented with perfect fidelity under

  real-world conditions. Thus, evaluations of the real-world experiences

  of implementing ETAT+ are important in terms of identifying potential

  barriers to successful implementation. This study explored the

  perspectives of Rwandan healthcare workers (HCWs) on the relevance of

  ETAT+ and documented potential barriers to its successful

  implementation.

  Methods: HCWs enrolled in the ETAT+ training were asked, immediately

  after the training, their perspective regarding (i) relevance of the

  ETAT+ training to Rwandan district hospitals; (ii) if attending the

  training would bring about change in their work; and (iii) challenges

  that they encountered during the training, as well as those they

  anticipated to hamper their ability to translate the knowledge and

  skills learned in the ETAT+ training into practice in order to improve

  care for severely ill infants and children in their hospitals. They

  wrote their perspectives in French, Kinyarwanda, or English and

  sometimes a mixture of all these languages that are official in the

  post-genocide Rwanda. Their notes were translated to (if not already in)

  English and transcribed, and transcripts were analyzed using thematic

  content analysis.

  Results: One hundred seventy-one HCWs were included in our analysis.

  Nearly all these HCWs stated that the training was highly relevant to

  the district hospitals and that it aligned with their work expectation.

  However, some midwives believed that the ``neonatal resuscitation and

  feeding{''''} components of the training were more relevant to them than

  other components. Many HCWs anticipated to change practice by initiating

  a triage system in their hospital and by using job aids including

  guidelines for prescription and feeding. Most of the challenges stemmed

  from the mode of the ETAT+ training delivery (e.g., language barriers,

  intense training schedule); while others were more related to uptake of

  guidelines in the district hospitals (e.g., staff turnover, reluctance

  to change, limited resources, conflicting protocols).

  Conclusion: This study highlights potential challenges to successful

  implementation of the ETAT+ clinical practice guidelines in order to

  improve quality of hospital care in Rwandan district hospitals.

  Understanding these challenges, especially from HCWs perspective, can

  guide efforts to improve uptake of clinical practice guidelines

  including ETAT+ in Rwanda.'
affiliation: 'Hategeka, C (Corresponding Author), Rwanda Paediat Assoc, ETAT Program,
  Kigali, Rwanda.

  Hategeka, C (Corresponding Author), Univ British Columbia, Fac Med, Sch Populat
  \& Publ Hlth, Vancouver, BC, Canada.

  Hategeka, Celestin; Tuyisenge, Lisine, Rwanda Paediat Assoc, ETAT Program, Kigali,
  Rwanda.

  Hategeka, Celestin, Univ British Columbia, Fac Med, Sch Populat \& Publ Hlth, Vancouver,
  BC, Canada.

  Mwai, Leah, Int Dev Res Ctr, Maternal \& Child Hlth Program, Ottawa, ON, Canada.

  Mwai, Leah, Afya Res Afr, Nairobi, Kenya.

  Tuyisenge, Lisine, Univ Teaching, Hosp Kigali, Dept Pediat, Kigali, Rwanda.'
article-number: '256'
author: Hategeka, Celestin and Mwai, Leah and Tuyisenge, Lisine
author-email: celestin.hategeka@alumni.ubc.ca
author_list:
- family: Hategeka
  given: Celestin
- family: Mwai
  given: Leah
- family: Tuyisenge
  given: Lisine
da: '2023-09-28'
doi: 10.1186/s12913-017-2193-4
files: []
issn: 1472-6963
journal: BMC HEALTH SERVICES RESEARCH
keywords: 'Implementation; Clinical practical guidelines; ETAT; Healthcare worker;

  District hospital; Qualitative research; Rwanda'
keywords-plus: KNOWLEDGE; PROGRAM; KENYA
language: English
month: APR 7
number-of-cited-references: '42'
orcid-numbers: Hategeka, Celestin/0000-0001-7808-4652
papis_id: 1b5a0b8a135b771103d6f1d8e83016f6
ref: Hategeka2017implementingemergenc
times-cited: '27'
title: 'Implementing the Emergency Triage, Assessment and Treatment plus admission
  care (ETAT plus ) clinical practice guidelines to improve quality of hospital care
  in Rwandan district hospitals: healthcare workers'' perspectives on relevance and
  challenges'
type: article
unique-id: WOS:000398622000001
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '17'
web-of-science-categories: Health Care Sciences \& Services
year: '2017'