RESUMO
Introduction: In low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs). Objectives: The primary objective was to explore IRs' beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored. Materials and Methods: In-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF. Results: Eleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.Identified factors within skills domain involved IRs' clinical assessment and decision-making abilities, while beliefs about capabilities and consequences encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The environmental context and resources domain addressed the availability of CT scanners and financial constraints. The knowledge domain elicited IRs' understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For memory, attention & decision processes domain, IRs adherence to guidelines and intentions to order CT scans were cited. Conclusion: Using TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others.
RESUMO
INTRODUCTION: Problem-based learning (PBL) has been reported to be a valuable student-centred learning approach across the globe. In PBL students first encounter a problem, which triggers discussion, followed by student-centred inquiry. Makerere University College of Health Sciences has been using PBL for radiography students since 2002. Over the years, the learning landscape may have changed, including the significant disruption of learning by the coronavirus disease 2019 global pandemic. The study aimed at exploring the perceptions of undergraduate radiography students about the PBL curriculum at Makerere University almost two decades after its introduction. METHODS: This exploratory qualitative study involved 18 radiography students sampled purposively, from whom data were gathered using focus group discussions. Thematic analysis was subsequently used. RESULTS: Three key themes emerged from the data: (1) quality of teaching, (2) curriculum efficiency, and (3) curriculum expectations and rating. All students were generally positive about the curriculum. Most agreed that the curriculum was efficient to a greater extent and had met their expectations and desired objectives. Students, however, faced challenges; for example, with limited learning resources during the learning process. CONCLUSION: This study highlights the significant role of PBL in enhancing student's problem-solving, critical thinking, literature search, and, most of all, their practical skills. Prioritization of teaching based on practical relevance and learning objectives is of great importance. The radiography students believed that their curriculum program was generally beneficial to them; however, it was affected by limited resources and limited availability of teaching personnel, which needs to be addressed.