‘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.