# Mapping integrated implementation of Adapted Resource and Implementation Application (ARIA) and REDCap version hospital-based pediatric cancer registry (HBCR) in Ethiopia: An implementation Study

## TL;DR

This study explores the feasibility of using digital tools ARIA and HBCR to improve pediatric cancer data and care in Ethiopian hospitals.

## Contribution

The study introduces a co-designed digital implementation strategy tailored to local hospital contexts in Ethiopia.

## Key findings

- Digital HBCR and ARIA were perceived as more effective than manual methods for managing pediatric oncology data.
- Facilitators in both inner and outer settings outweighed the barriers to implementation.
- Challenges included inconsistent power, unreliable internet, and logistic-supply issues.

## Abstract

This study presents the perceived implementability of the digital Hospital-Based Cancer Registry (HBCR) and the Adapted-Resource Implementation Application (ARIA) to enhance data systems and treatment standards at Pediatric Oncology unit (POU). A 2-year (2023–2025) implementation study on the integrated application of ARIA and HBCRs is being conducted at Jimma University Medical Center (JUMC) and St. Paul Hospital Millennium Medical College (SPHMMC). This article reports the formative assessment results, guided by the Consolidated Framework for Implementation Research (CFIR), involved eight focus group discussions, four in-depth interviews, and two co-design workshops with diverse healthcare providers and hospital management/leadership personnel. The integrated implementation of HBCR-ARIA was viewed as innovative and adaptable. Digital HBCR was perceived as more effective than manual methods for managing pediatric oncology data. Similarly, ARIA was perceived as effective and feasible for providing patient-specific standardized care. Workflows and responsibilities were co-defined separately for the respective POUs. The co-designed implementation strategy includes residents filling demographic and diagnostic information of patients’ on HBCR interim document and then cross-checked by the pediatric Hematology and Oncology (PHO) fellows. The Medical Monitor (PHO senior) approves the validity of the document before entry into REDCap by the data clerk. ARIA is filled by PHO fellows and approved by second PHO fellow or PHO seniors based on the availability. Facilitators in both the inner (hospital) and outer (external) settings outweighed the barriers. Facilities and motivated human resources are in place to implement the digital HBCR and ARIA strategies at the respective POU. However, challenges such as inconsistent electric power, unreliable internet services, and logistic-supply issues. The implementation strategies for digitized HBCR and ARIA, co-designed to fit the specific contexts of two POU, appear promising but require further evaluation.