Bridging the digital implementation gap: identifying determinants for the adoption of source-grounded living evidence in low- and middle-income primary care
1
Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A969
ABSTRACT
BACKGROUND:
Current data suggests that even when adaptive methodologies are applied in the Global South, they are often narrow in scope, focusing almost exclusively on isolated health priorities (e.g., COVID-19) to the detriment of broader clinical needs [1]. While the theory of living evidence is promising, its feasibility in low-resource settings remains poorly understood [1]. This implementation gap creates a two-tiered system of medical knowledge, where some regions benefit from real-time updates while others rely on obsolete documentation.
METHODS:
This research investigates the practical realities of primary care in South Africa to identify localized facilitators of digital evidence adoption. We utilize the NASSS Framework (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) to evaluate the complexity of transitioning from a linear "Reference Library" model to an active "Precision Clinical Guidance" model [2, 3]. Unlike static digital documents, this platform intervention provides direct shortcuts to clinical logic by highlighting relevant sections within authoritative evidence to maintain user trust. The framework evaluates factors such as connectivity, digital literacy, and administrative structures to identify obstacles that prevent clinicians from interacting with dynamic tools [2, 4].
RESULTS:
Preliminary evaluation indicates that a source-grounded approach addresses the 10:1 paper-to-digital usage ratio identified in South African clinics by aligning with clinical workflows rather than serving as digital replicas of print media [4]. Furthermore, the platform enables syndromic surveillance by capturing anonymized geospatial data on clinical queries. This provides a mechanism for identifying emerging disease clusters and regional training gaps while ensuring regulatory compliance with the Protection of Personal Information Act (POPIA) [5].
CONCLUSIONS:
Bridging the implementation gap requires a system that respects both global standards and local realities. Establishing a responsive digital infrastructure is essential for empowering local health systems and ensuring that clinical knowledge is accessible, current, and relevant for everyone, regardless of geography [6].
Current data suggests that even when adaptive methodologies are applied in the Global South, they are often narrow in scope, focusing almost exclusively on isolated health priorities (e.g., COVID-19) to the detriment of broader clinical needs [1]. While the theory of living evidence is promising, its feasibility in low-resource settings remains poorly understood [1]. This implementation gap creates a two-tiered system of medical knowledge, where some regions benefit from real-time updates while others rely on obsolete documentation.
METHODS:
This research investigates the practical realities of primary care in South Africa to identify localized facilitators of digital evidence adoption. We utilize the NASSS Framework (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) to evaluate the complexity of transitioning from a linear "Reference Library" model to an active "Precision Clinical Guidance" model [2, 3]. Unlike static digital documents, this platform intervention provides direct shortcuts to clinical logic by highlighting relevant sections within authoritative evidence to maintain user trust. The framework evaluates factors such as connectivity, digital literacy, and administrative structures to identify obstacles that prevent clinicians from interacting with dynamic tools [2, 4].
RESULTS:
Preliminary evaluation indicates that a source-grounded approach addresses the 10:1 paper-to-digital usage ratio identified in South African clinics by aligning with clinical workflows rather than serving as digital replicas of print media [4]. Furthermore, the platform enables syndromic surveillance by capturing anonymized geospatial data on clinical queries. This provides a mechanism for identifying emerging disease clusters and regional training gaps while ensuring regulatory compliance with the Protection of Personal Information Act (POPIA) [5].
CONCLUSIONS:
Bridging the implementation gap requires a system that respects both global standards and local realities. Establishing a responsive digital infrastructure is essential for empowering local health systems and ensuring that clinical knowledge is accessible, current, and relevant for everyone, regardless of geography [6].
| eISSN: | 2654-1459 |
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