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Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial

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dc.contributor.authorOuyang, Menglu
dc.contributor.authorAnjum, Anila
dc.contributor.authorGonzalez, Francisca
dc.contributor.authorWasay, Mohammad
dc.contributor.authorMa, Lu
dc.contributor.authorHu, Xin
dc.contributor.authorChen, Xiaoying
dc.contributor.authorMalavera, Alejandra
dc.contributor.authorLi, Xi
dc.contributor.authorMunoz Venturelli, Paula
dc.contributor.authorDe Silva, Asita
dc.contributor.authorNguyen Huy Thang
dc.contributor.authorWahab, Kolawole
dc.contributor.authorPandian, Jeyaraj
dc.contributor.authorPontes-Neto, Octavio
dc.contributor.authorAbanto, Carlos
dc.contributor.authorCano-Nigenda, Venessa
dc.contributor.authorArauz, Antonio
dc.contributor.authorYou, Chao
dc.contributor.authorJan, Stephen
dc.contributor.authorSong, Lili
dc.contributor.authorAnderson, Craig
dc.contributor.authorLiu, Hueiming
dc.contributor.authorINTERACT3 Investigators
dc.date.accessioned2025-08-20T19:42:44Z
dc.date.available2025-08-20T19:42:44Z
dc.date.issued2024
dc.description.abstractThe third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target <140mmHg), glucose control (target 6.1-7.8 mmol/L in those without diabetes and 7.8-10.0 mmol/L in those with diabetes), anti-pyrexia treatment (target body temperature ≤37.5°C), and the rapid reversal of warfarin-related anticoagulation (target international normalized ratio <1.5). An embedded process evaluation was conducted to allow a better understanding of how the Care Bundle was implemented in different countries to enhance the transferability of this evidence in the international context. This study used a mixed-methods approach involving interviews, focus group discussions, and surveys to evaluate the implementation outcomes included fidelity, dose, reach, acceptability, appropriateness, adoption, and sustainability. Interviews (n = 27), focus group discussions (n = 3), and quantitative surveys (n = 48) were conducted in 7 low- and middle-income countries (LMICs) and 1 high-income country during 2019-2022. The Care Bundle was generally delivered as planned and well accepted by stakeholders, although some difficulties were reported in reaching the SBP and glycemic targets. Contextual factors including staff shortage, limited availability of antihypertensive drugs, and delayed systems of care processes, were common barriers to implementing the Care Bundle. Facilitating factors included good communication and collaboration with staff in emergency departments, the development of pathways within available resources, and regular training and monitoring. Our process evaluation provides useful insights into the contextual barriers which need to be addressed for effective scale up of the Care Bundle implementation in a global context. Trial registration: INTERACT3 is registered at Clinicaltrials.gov (NCT03209258) and the Chinese Clinical Trial Registry (ChiCTR-IOC-17011787).
dc.description.versionVersión Publicada
dc.identifier.citationOuyang M, Anjum A, Mc Cawley FG, Wasay M, Ma L, Hu X, Chen X, Malavera A, Li X, Venturelli PM, Silva HA, Thang NH, Wahab KW, Pandian JD, Pontes-Neto OM, Abanto C, Cano-Nigenda V, Arauz A, You C, Jan S, Song L, Anderson CS, Liu H; INTERACT3 Investigators. Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial. PLOS Glob Public Health. 2024 Dec 19;4(12):e0003711. doi: 10.1371/journal.pgph.0003711
dc.identifier.doihttps://doi.org/10.1371/journal.pgph.0003711
dc.identifier.urihttps://hdl.handle.net/11447/10199
dc.language.isoen
dc.subjectIntracerebral hemorrhage
dc.subjectCare intracerebral hemorrhage
dc.subjectINTERACT3 trial
dc.titleImplementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourcePLOS global public health
dspace.entity.typePublication
relation.isAuthorOfPublication77bec604-0a16-4d85-aaee-734c326e253a
relation.isAuthorOfPublication.latestForDiscovery77bec604-0a16-4d85-aaee-734c326e253a

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