Fostering deliberation and action in context: an analysis of implementation research among healthcare professionals in LMICs from a post-digital perspective

Abstract

Strengthening health systems through workforce development is central to combating health crises and inequalities in some of the world's poorest countries (Agyeman-Manu et al., 2023) and is a key objective for implementation research (IR). Workforce development programmes often include blended and online modalities, offering the means to reach relevant communities at scale, removing barriers in accessing lifelong learning opportunities (see Frenk et al., 2022). However, approaches that privilege issues of access, reach and scale are overlooking critical problems, such as the persistent gap between ‘what one knows’ and ‘what one practises’ (Penkunas et al., 2021; Davis et al., 2003). In this paper we describe the implementation of an EdTech innovation situated within a technology-supported health workforce development programme in two distinct public health systems: Nepal and Ghana. This work focused on the challenge of Antimicrobial Resistance (AMR), a critical area of health practice related to the burden of bacterial infections. We report on an embedded multiple case study of a health workforce development programme across participating health facilities (n=12; 6 in each country). Taking a postdigital positionality (Jandrić et al., 2018) and using critical analysis guided by Helfrich et al.’s (2007) adapted Framework for Complex Innovations, we examine contextual factors that facilitated or impeded implementation. We used an iterative process to collect and analyse qualitative data generated by healthcare workers (HCWs) leading implementation activities in their organisations. By bringing in the relevance of the health field perspectives on the EdTech, the analysis illustrates the impact on implementation climate and the fit between the innovation and the values of participants. It provides evidence of how the innovation supported HCWs in organising new spaces of action to negotiate wider work and learning arrangements and facilitate the move of knowledge into their practice, hence offering a potential pathway to address the ‘know-do’ gap. The paper offers a significant contribution in understanding and conducting EdTech implementation research in professional settings in complex, resource-constrained settings