Understanding the factors that influence CT utilization for mild traumatic
brain injury in a low resource setting - a qualitative study using the
Theoretical Domains Framework
Dublin Core
Title
Understanding the factors that influence CT utilization for mild traumatic
brain injury in a low resource setting - a qualitative study using the
Theoretical Domains Framework
brain injury in a low resource setting - a qualitative study using the
Theoretical Domains Framework
Subject
Mild traumatic head injury
Computerized tomography utilization
Imaging referrers
Decision making
Theoretical Domain Framework
Low resource setting
Computerized tomography utilization
Imaging referrers
Decision making
Theoretical Domain Framework
Low resource setting
Description
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 evidencebased 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.
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 evidencebased 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.
Creator
Harriet Nalubega Kisembo a,b,*
, Richard Malumba c
, Henry Sematimba c
, Racheal Ankunda c
,
Irene Dorothy Nalweyiso b
, Elsie-Kiguli Malwadde d
, Elizeus Rutebemberwa e
, Simon Kasasa f
,
Dina Husseiny Salama g
, Michael Grace Kawooya c
, Richard Malumba c
, Henry Sematimba c
, Racheal Ankunda c
,
Irene Dorothy Nalweyiso b
, Elsie-Kiguli Malwadde d
, Elizeus Rutebemberwa e
, Simon Kasasa f
,
Dina Husseiny Salama g
, Michael Grace Kawooya c
Source
https://pdf.sciencedirectassets.com/280685/1-s2.0-S2211419X24X00026/1-s2.0-S2211419X24000120/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjELj%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJGMEQCICnEtN0WCoClKuVlT8gDpaFPZVsQTu94uE%2F7WzvJqB3CAiBdenRfioLVvEx%2BItnEkRm1Qrcqs9O0GnXVHZ9zLtZmRSq7BQih%2F%2F%2F%2F%2F%2F%2F%2F%2F%2F8BEAUaDDA1OTAwMzU0Njg2NSIMbJ3Efvj6UfRU2FTxKo8FFkDOv3l20Kmcy6KpQ2VILoMj%2B5XdSWmWpXzgQzGHpbaulu5lVdMHGezk49HxHfY9vk%2FuRc3lnjQ0AiReUBsYYBQJNs5pzqNqJl%2BvwJN1fgFQnvjj3%2B2ve%2BgqPBOJPGBQI3DA9gK9Te5B7%2F45OAxWbs%2FmYh6YJztLoYoxsumgxnIu5P1ZFFnWAMWd%2FrWKtYAKFQ8P3vM6DIUf3BM78qHp7Ndj8dK2O04Rk31vRq0TlujpBiOH6Lcal0IF0Wn6Sct1Zf1a73cvMp%2BO3I8qJ%2BVrQFhxlPhjd%2B7YKQA2OlhFm1CtX7AUUgU6KoOIeNXi0WNmi18JvtxHOqC%2B8g62v7LHY%2F5OQKkdjv%2BHB4PJ4fMeFj6BVgGSWmQa1YAjtDBqr8mwQxOYw%2BQHZqJUWv%2Bd%2FMGN4cLLbsFXZdFj8oDouM3ArSmbW0wD%2FGUnnGjjZcPbsy2yuY5By7XplrOb72aJkFrq0lLVt3PmvIg01cTabk9FRqhd4YfRcwxcp%2Bv%2BPNtTGxU5NG9VHEHVEhoOr9ItY3gIFx2PYD0P43X0MmjJ3can0HQbDi%2BWom%2BK2%2BFQVz8naKrQAOkVyZyZfUy1eeqhmhi5BsWNsvuKSdphw0x714uIWsh9abnpXlwBEX216i4kyj4ipEcE5pm61uM13x0wmDYxCOcIyYbkwAcySP4Cx6JDOl8iY7Ii3Eyqz5%2FbvigpYN%2FvbG0o8YdB6QrZcGnD2ucEPYg9pQhlF7NXxwnB6%2FWcSHyTVCEx0TioJfAnprGZgD%2FjWl5SZs73CYxwsGwcnq7ADRWZV3iGAEojwqg7AAU7WEsZ8ZjDBOo4sbOZMGPHhN54nsyEZBqfiywUt%2B72fv8fStQ9KPPBBdeWfnLKDfDBOjDM%2Fs7CBjqyAX20I0zMeyTzSCqAzAw74LD78Hz1fsmotRyrRTP%2B4JOOm4DfxnEB%2FqxJ1Dtyfgy0%2ByPa6qfsNatis1Uq1ZUZ6r%2B3yRYUTqStrjF2uJurjRfGeU4bWtSZr0yZp1YFekeoMRcnbQDIACAo1CM0cxA2b%2BbQkSzRA41tsPTWA7iDgIGYfcZ2OsP0j%2FDshb5IxnGNAqoYqXfZm8iQwMes%2BjiLTddW5OYb2lKNnhK%2Balk05ck3WrM%3D&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20250619T075422Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYQLOUDYIY%2F20250619%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=bf165f092bbaaf04034555a7bbce3658932a7b3d66555c8be4dbb9641fc7f4d9&hash=744a92b25fa6007b3ed59d7685120a596ed445fd589580da4210f352feedb7a6&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2211419X24000120&tid=spdf-8e5723bc-ea42-4679-85c2-a20fbe3680df&sid=00688b7b811b2744bd985b7238466a2c58a0gxrqb&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=13025d5356515051565057&rr=9521754048624ab4&cc=id
Publisher
a Makerere University, College of Health Sciences, School of Medicine b Department of Radiology, Mulago National Referral and Teaching Hospital, Kampala, Uganda c Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda d African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda e School of Public Health, Department of Health Policy & Management, Makerere University, Kampala, Uganda f Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda g National Center for Radiation Research and Technology, Cairo, Egypt
Date
18 april 2024
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Citation
Harriet Nalubega Kisembo a,b,*
, Richard Malumba c
, Henry Sematimba c
, Racheal Ankunda c
,
Irene Dorothy Nalweyiso b
, Elsie-Kiguli Malwadde d
, Elizeus Rutebemberwa e
, Simon Kasasa f
,
Dina Husseiny Salama g
, Michael Grace Kawooya c , “Understanding the factors that influence CT utilization for mild traumatic
brain injury in a low resource setting - a qualitative study using the
Theoretical Domains Framework,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9561.
brain injury in a low resource setting - a qualitative study using the
Theoretical Domains Framework,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9561.