Published in PLOS One on 2026-09-25, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Spencer F. Sumner, Francis M. Sakita, Kelvin F. Haukila, Lisa Wanda, Godfrey L. Kweka, Jerome J. Mlangi, Pankrasi Shayo, Tumsifu G. Tarimo, Simran Khanna, Claire Wang, Abigail Pyne, Preeti Manavalan, Nathan M. Thielman, Janet P. Bettger, Julian T. Hertz
Source: PLOS One • DOI 10.1371/journal.pone.0357564
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Acute myocardial infarction (AMI) is an increasing cause of morbidity and mortality in Sub-Saharan Africa (SSA) but is often underdiagnosed and undertreated. To address this gap, the Multicomponent Intervention to Improve Myocardial Infarction Care (MIMIC) was developed and implemented to improve evidence-based AMI care. The aim of this study was to explore stakeholder perceptions of the acceptability of MIMIC following its implementation.
This qualitative study involved in-depth interviews with 20 key stakeholders (physicians, nurses, administrators, and patients diagnosed with AMI) who participated in MIMIC during the first year of implementation in the emergency department (ED) of a regional referral center in northern Tanzania. Purposive sampling was used to recruit diverse participants. Interviews were guided by a semi-structured interview guide informed by the Theoretical Framework of Acceptability (TFA). Interview transcripts were thematically analyzed by a team of coders using an inductive, grounded theory approach guided by the seven TFA domains.
Nineteen major themes emerged across all TFA domains. Overall, participants described MIMIC as acceptable, minimally burdensome, and well-aligned with professional and ethical values. Perceived effectiveness was most emphasized, with staff citing improvements in AMI recognition, electrocardiogram (ECG) and troponin testing, and use of evidence-based therapies. Most components were described as effective and easily integrated into existing workflows. Patients valued the educational pamphlet for improving knowledge and self-efficacy, though staff expressed concerns about distributing it during acute care, contributing to inconsistent delivery. Champions were viewed as key in promoting adherence and sustaining implementation.
MIMIC was found to be acceptable in all seven TFA domains among ED providers and patients, with perceived effectiveness driving positive attitudes across stakeholder groups. MIMIC’s co-design approach likely contributed to high intervention acceptability. Patient education strategies may require adaptation to improve fidelity. These findings support continued implementation and targeted adaptation of MIMIC.
Introduction
The leading cause of death globally is ischemic heart disease [1]. The incidence of acute myocardial infarction (AMI) is increasing in Sub-Saharan Africa (SSA), [2] where a growing body of evidence has highlighted opportunities to improve AMI care [3]. In northern Tanzania, prior work by our group has shown that AMI is frequently misdiagnosed and inadequately treated, driven by factors including inadequate provider training, insufficient diagnostic resources, and inefficient emergency department systems [4,5]. These gaps in evidence-based AMI care are associated with high mortality, with 30-day mortality exceeding 40% in some reports from the region, compared to single-digit mortality rates in high-income countries [6,7]. Poor AMI outcomes in low-resource settings are further compounded by delayed symptom recognition, delays in seeking care, and barriers to healthcare access—which shape the pathways through which patients reach emergency services [8,9]. Nevertheless, among patients who do present for emergency care, important opportunities remain to improve AMI recognition and treatment through interventions targeting provider knowledge, diagnostic evaluation, and evidence-based management.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Spencer F. Sumner, Francis M. Sakita, Kelvin F. Haukila, Lisa Wanda, Godfrey L. Kweka, Jerome J. Mlangi, Pankrasi Shayo, Tumsifu G. Tarimo, Simran Khanna, Claire Wang, Abigail Pyne, Preeti Manavalan, Nathan M. Thielman, Janet P. Bettger, Julian T. Hertz. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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