No frugal innovation without frugal evaluation: the Global IDEAL Sub-Framework

• Published in: BMJ surgery, interventions, & health technologies Vol. 6; no. 1; p. e000248
• Main Authors: Bolton, William S, Aruparayil, Noel K, Cundill, Bonnie, McCulloch, Peter, Gnanaraj, Jesudian, Bundu, Ibrahim, Culmer, Peter R, Brown, Julia M, Scott, Julian, Jayne, David G
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-06-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Bibliometrics; Collaboration; Data analysis; Design; Device Evaluation; Innovations; Original Research; Polls & surveys; Qualitative research; Questionnaires; Researchers; Surgeons; United States > US; Device Evaluation
• ISSN: 2631-4940
• DOI: 10.1136/bmjsit-2023-000248

ObjectiveThe Global IDEAL Sub-Framework Study aimed to combine the intended effects of the 2009/2019 IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework recommendations on evaluating surgical innovation with the vision outlined by the 2015 Lancet Commission on Global Surgery to provide recommendations for evaluating surgical innovation in low-resource environments.DesignA mixture of methods including an online global survey and semistructured interviews (SSIs). Quantitative data were summarized with descriptive statistics and qualitative data were analyzed using the Framework Method.ParticipantsSurgeons and surgical researchers from any country.Main outcome measuresFindings were used to suggest the nature of adaptations to the IDEAL Framework to address the particular problems of evaluation in low-resource settings.ResultsThe online survey yielded 66 responses representing experience from 40 countries, and nine individual SSIs were conducted. Most respondents (n=49; 74.2%) had experience evaluating surgical technologies across a range of life cycle stages. Innovation was most frequently adopted based on colleague recommendation or clinical evaluation in other countries. Four themes emerged, centered around: frugal innovation in technological development; evaluating the same technology/innovation in different contexts; additional methodologies important in evaluation of surgical innovation in low/middle-income countries; and support for low-income country researchers along the evaluation pathway.ConclusionsThe Global IDEAL Sub-Framework provides suggestions for modified IDEAL recommendations aimed at dealing with the special problems found in this setting. These will require validation in a stakeholder consensus forum, and qualitative assessment in pilot studies. From assisting researchers with identification of the correct evaluation stage, to providing context-specific recommendations relevant to the whole evaluation pathway, this process will aim to develop a comprehensive and applicable set of guidance that will benefit surgical innovation and patients globally.