‘DISSEMINATE’: a roadmap for facilitating adoption of affordable surgical innovations in low and middle-income countries

Abstract

ImportanceAffordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose.MethodsThe roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science.Results and conclusionThe proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations:Designof the innovation;Innovateby combining the IDEAL (Idea,Development,Exploration,Assessment andLong-term follow-up) surgical innovation framework with local multidisciplinary expertise;Substantiateavailable evidence;Scale upapplication of evidence in surgical practice;Shareknowledge on multidisciplinary platforms;Sustainability;Endorsementof the innovation by local catalysts;Mediapromotion;Identifyearly adopters;Improveand refine the innovation;Improviseduring setbacks;Implementationscience methods;Navigatethrough barriers;Aspirationalaffordability;Advocacyfor the value of ASIs;Toolsfor scalability and adoption;Evaluateimpact of dissemination; andExtenduse of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.

Advocacy for surgeons: Ensuring excellence in patient care

“…27 In a utopian world, advocacy could be concentrated towards various national surgical academic associations to scrutinize, validate and endorse accepted solutions. 28…”

Ten lessons for global surgery researchers

“…Our surgery-specific 'DISSEMINATE' roadmap provides structure for effective dissemination and adoption to overcome this knowdo gaps in the use of ASIs in LMICs. It showcases the actions needed to achieve this goal (Table 3) 14 .…”