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Table 2 Summary of the characteristics of papers included in the review

From: What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: a narrative synthesis of existing qualitative studies

First author Aims Country Methods Characteristics in relation to three CASP domains Extent it addresses CASP items
Aktintayo, O. A., 2012 [1] To explore the dissemination of the Ponseti method, inlcuding barriers and facilitators to its implementation. Nigeria Semi-structured interviews and focus groups with 25 healthcare providers practising the method, 6 newly trained practitioners, 42 parents of children with clubfoot 1) Aims and appropriateness Aims of the research clearly explained. 2) Design and conduct Triangulation used such that semi-structured interviews and focus groups were used to strengthen findings. Ethical considerations were not outlined. Little information given about how thematic analysis was conducted. 3) Clarity and value Grouping of themes provided clarity to presentation. Srengths and weakenesses were not discussed. Article makes clear how findings may be applied in the future. Partially
Boardman, A., 2011 [2] To explore the implementation of the Ponseti method, including barriers and facilitators. Chile, Peru, Guatemala Semi-structured interviews with 30 healthcare providers practising the Ponseti method. 1) Aims and appropriateness Aims of research clearly outlined. 2) Design and conduct Methods appropriate and ethical issues outlined. 3) Clarity and value Ambiguity in presentation of findings since primary data and author interpretations are integrated. Relationship of study to existing literature is discussed, along with the potential application of the research. Mainly
Gadhok, K., 2012 [3] To explore the implementation of Ponseti method, including barriers and facilitators. India Semi-structured interviews with 15 orthopaedic surgeons practising Ponseti method and 15 guardians of children receiving treatment. [As part of a mixed methods study] 1) Aims and appropriateness Objectives of research clearly outlined. 2) Design and conduct Range of methods used to strengthen findings., although it is unclear what each contributed. There is no description of how patients were sampled. Reasons for study setting are clea. Ethical issues have been discussed. There is ambiguity in how data analysis has been conducted. 3) Clarity and value Study findings are clear. The presentation of findings under dominant themes and outlined in a table contributed to this. Strengths and weaknesses are considered. However, there is a lack of discussion about how the work may be used to inform practice. Mainly
Jayawardena, A., 2013 [4] To explore the implementation of a ‘Train the Trainer’ approach to educating practitioners about the Ponseti method. Sri Lanka Interviews, focus groups and observations with 162 patients and healthcare providers involved with clubfoot care. 1) Aims and appropriateness Study aims clearly outlined. 2) Design and conduct Methods used appropriate for addressing study aims. No discussion of why participants or study setting were selected. Methods of data collection discussed in detail, along with ethical considerations. However, it is unclear why the study was exempt from ethics review. Methods of analysis are not fully outlined. 3) Clarity and value Study findings are clear. The presentation of findings under dominant themes and outlined in a table contributes to this. Strengths and weaknesses are considered. However, there is a lack of discussion about how work may be used to inform practice. Mainly
Jayawardena, A., 2011 [5] To explore the implementation of low bandwidth webconferencing to educate practitioners about the Ponseti method. Guatemala, Peru and Chile Semi-structured interviews and observations with 33 healthcare providers participating in webconferencing sessions. 1) Aims and appropriateness Study aims clear. 2) Design and conduct Methods used appropriate for addressing study aims although there is no discussion of why participants or the study setting were selected. Processes of collecting observational data are not described. Ethical issues are discussed and details of the ethical review board provided. Methods of analysis are clearly outlined. 3) Clarity and value Organisation of methods into key themes provides clarity. However, there is no discussion on strengths and weaknesses or how study contributes to existing literature. Areas of future research are not outlined. Mainly
Kingau, N. W., 2015 [6] To explore the implementation of the Ponseti method, including those faced by guardians and healthcare professionals. Kenya Semi-structured interviews with 10 service providers and 10 guardians involved in clubfoot care. 1) Aims and appropriateness Study aims clear. 2) Design and conduct Methods are dsecribed in detail including how data were collected and data saturation is discussed. Ethical considerations are not outlined. Data analysis is described in detail 3) Clarity and value Themes are clear and primary data is used to enhanced the presentation of findings. There is a consideration of strengths and weaknesses. The contribution of study to exsiting literature is discussed, along with a consideration of its potential application. Fully
Lu, N., 2010 [7] To explore the implementation of the Ponesti method, including the experiences of guardians and healthcare providers. China Semi-structured interviews and focus groups with 39 healthcare providers practising the Ponseti method and 8 sets of parents of children receiving Ponseti treatment. 1) Aims and appropriateness Study aims clearly outlined. 2) Design and conduct Methods appropriate to aims and objectives of the research. Reasons for selecting participants outlined, although there is no justification for research setting. Ethical issues are discussed, including informed consent and the ethical review board. Methods of data analysis have been outlined and independent coding has been undertaken by two members of the study team to enhance confidence in the findings. 3) Clarity and value Presentation of study findings is clear. There is no consideration of strengths and weaknesses. The potential application of findings is discussed. Mainly
Nogueira, M. P., 2013 [8] To evaluate barriers to bracing compliance. Brazil Semi-structured interviews with 45 orthopaedists delivering the Ponseti method. 1) Aims and appropriateness Study aims clearly outlined. 2) Design and conduct No justification of sampling strategy or why study setting was selected. Processes of data collection and analysis not discussed. 3) Clarity and value Study findings clearly outlined and weaknesses of study design considered. How the study contributes to wider literature has not been discussed but suggestions for service improvements based on study findings are presented. Partially
Owen, R. M., 2012 [9] Evaluation of implementation of 10 clubfoot treatment progammes. Democratic Republic Congo, Rwanda, Dominican Republic, Haiti, Honduras, Ethiopia, Laos, Malawi, Nepal, Paraguay, Tanzania, Zambia Semi-structured interviews and observations of clinics with 10 clubfoot programme coordinators, 7 programme planners, regional coordinators or trainers, 10 sets of parents attending clinics and 10 trained practitioners in Ethiopia or Laos. [As part of a mixed methods study] 1) Aims and appropriateness Clear statement of study aims. 2) Design and conduct Research methods appropriate for addressing research aims. Justification for choosing semi-structured interviews and advantages of triangulation of data included. However, unclear why Ethiopia and Laos were selected for observations. No discussion of the strategy used to recruit participants. Lack of detail on how interviews and observations carried out. Ethical considerations have been dicussed including anonymisation, data storage and informed consent. Processes of data analysis clearly outlined. 3) Clarity and value Findings clear and discussion included about the strengths and limitations of the study. Researcher discusses value of research and transferability of findings to other settings. Mainly
Palma, M., 2013 [10] To explore barriers to the implementation of the Ponseti method. Peru Semi-structured interviews with 25 healthcare providers practising the Ponseti method. 1) Aims and appropriateness Aims of study are clearly outlined in the main body of the text although they are not as clear in the abstract. 2) Design and conduct Methods of data collection are appropriate although the sampling strategy and justification of study setting are not discussed. Ethical issues are outlined including the ethical review board and anonymisation of participants. There is a lack of detail about processes of data analysis. 3) Clarity and value Presentation of findings is clear and divided into themes. Strengths and weaknesses are not discussed althoug the potential application of research findings is considered. Partially
Wu, V., 2012 [11] To explore the impact of the Ponseti method and challenges to its implementation, including the use of web-conferencing to educate practitioners. Vietnam Semi-structured interviews, focus groups and observations with 12 healthcare providers delivering Ponseti treatment and 99 parents of children with clubfoot and their extended family. [As part of a mixed methods study] 1) Aims and appropriateness Aims of research clearly outlined. 2) Design and conduct Methods chosen are appropriate for addressing research questions. Use of multiple methods of data collection to increase confidence in study findings discussed. Sampling strategy outlined although reasons for selecting participants or the choice of study setting are not discussed. Processes of data collection are not outlined. There is no discussion of ethical issues. 3) Clarity and value Presentation of findings clear and strengths and weaknesses discussed. There is a consideration of how findings may be used to inform service delivery, including a series of recommendations. Partially