Publications
My academic publications fits four broad themes, namely sense-making, education, emergency care, and community based response systems.
Using the SenseMaker® tool
This article is a collaborative effort to guide researchers when using the SenseMaker tool for research, for capturing and sense-making of attitudes, perceptions and experience, as well as for monitoring and evaluation.
Van der Merwe SE, Biggs R, Preiser R, Cunningham C, Snowden DJ, O’Brien K, Jenal M, Vosloo M, Blignaut S, Goh Z. Making sense of complexity: using SenseMaker as a research tool. Systems. 2019 May 1;7(2):25.
Sense-making in the ED
In this article we share some research findings from my PhD studies that explored how collective interprofessional sense-making occurs. Using the SenseMaker tool to capture 84 stories.
Cunningham C, Vosloo M, Wallis LA. Interprofessional sense-making in the emergency department: A SenseMaker study. PLOS one. 2023 Mar 9;18(3):e0282307.
Sense-making using narratives
The article presents a study on the narratives shared by emergency department staff in Cape Town, exploring themes related to their experiences and the organizational culture within these high-pressure environments.
Cunningham C, Vosloo M, Wallis L. It’s a battlefield! A thematic analysis of narratives shared in Cape Town emergency departments. Emergency Medicine Journal. 2025 Jan 1;42(1):3-8.
First responder/community
This study was conducted in Zambia with community members and healthcare workers. The objective was to identify interventions needed to improve the Zambian Emergency Care System by exploring community member experiences. We did 21 focus groups with 183 participants. The conclusion was that community education initiatives can strengthen the formal emergency care system.
Broccoli, M; Cunningham, C; Twomey, M; Wallis, L. ‘Community-based perceptions of emergency care in Zambia’, Emergency Medical Journal, June 2016 (0) 1-6
First responder/community
This study continues building on community response systems by assessing the WHO Community First Aid Responder program in Kinshasa, DRC. Focus group discussions was held with participants doing the course, and they were satisfied with the content and teaching methods. Developing community response systems can form a key component of strengthening systems in resource- constrained settings.
Diango K, Mafuta E, Wallis L, Cunningham C, Hodkinson P. Implementation and Evaluation of a Pilot WHO Community First Aid Responder training in Kinshasa, DR Congo: A mixed method study. African Journal of Emergency Medicine. 2023, 13 (4), pp258 -264
First responder/community
The Hout Bay Volunteer Ambulance Service, is a community based ambulance service in South Africa. In this article we describe an analysis of electronic Computer-Aided Dispatch records over 5 years. The findings support the benefit of developing community-based ambulance services, especially in remote areas – which could be due to distance or topography.
Cunningham C, Rosenberg M, Kahle J. The activities and impacts of a community-based volunteer ambulance service in Cape Town, South Africa. African Journal of Emergency Medicine. 2022, September, 12 (3) pp 236 -241
Interprofessional teamwork in the ED
This editorial piece was written building reflecting on literature about interprofessional sense-making between doctors and nurses referring to differences in agency and structure.
Cunningham, C. ‘GAMING’ communication between doctors and nurses: Understanding the interactions in the Emergency Department. International Emergency Nurse. 58 (2021) pp 101065
Education: RPL
Short courses for vocationally trained out of hospital providers was discontinued in 2018 in South Africa. This descriptive literature review analysed the use of Recognition of Prior Learning (RPL) as an access option to higher education by vocational learners in emergency care. The data has been used to develop additional support for RPL students in the Division of Emergency Medicine
Winstanley D, Cunningham C. A Descriptive Literature Review of Recognition of Prior Learning for Vocational Learners in Emergency Medical Care in South Africa. South African Journal of Higher Education. 2023, Sep 1; 37 (4) pp 322-33
Education: RPL
Vocational learning has been critical in shaping the South African workforce, especially in emergency responder systems. In the past decade the vocational short course training for paramedics has been phased out. Using a Recognition of Prior Learning (RPL) program as access option these learners has been able to transition into Post-Graduate education at UCT. In this paper we describe the support needs of vocational paramedics during the transition.
Groome D, Cunningham C. From vocational to graduation: A mixed methods study of support needs for vocational learners pursuing post-graduate education in South Africa. African Journal of Emergency Medicine. 2024 Dec 1;14(4):263-7.
First Responder/Community
We used curriculum mapping and blueprinting to adapt the EFAR (Emergency First Aid Responder) program developed in South Africa to be applicable to the Zambian context. The study highlighted the importance of tailoring medical education to local context.
Pigoga JL, Cunningham C, Kafwamfwa M, et al. Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting.
First Responder/healthcare workers
We implemented the World Health Organisation’s Basic Emergency Care program to improve formal emergency care training. We evaluated knowledge and self-efficacy in emergency care after the training with a multidisciplinary cohort. Surveys were completed by 137 participants, followed by focus group discussions with 74 participants. Short courses may address a significant gap in health worker training in basic emergency care in Sub-Saharan Africa. We concluded that open educational resources could be used as an adjunct, but there is some technological and cost barriers.
Pre-course online cases for the world health organization’s basic emergency care course in Uganda: A mixed methods analysis. African Journal of Emergency Medicine. 12, (2),2022.pp 148-153,
First Responder
The article presents a qualitative study assessing the acceptability and need for a Community First Aid Responder program to enhance out-of-hospital emergency care capacity in Kinshasa, Democratic Republic of Congo. The study identifies barriers to emergency care systems in the DRC, while proposing a community-based first responder program to enhance out-of-hospital emergency care capacity.
Diango K, Pigoga J, Mafuta E, Yangongo J, Wallis L, Cunningham C, Hodkinson P. Needs assessment and Acceptability of a Community First Aid Responder programme to increase Out-of-hospital capacity in Kinshasa, Democratic Republic of Congo: A qualitative study. African Journal of Emergency Medicine. 2025 Mar 1;15(1):526-34.
COVID/Communication
In this qualitative exploratory design using semi-structured interviews we found communication challenges during COVID-19 was aggravated by the unpredictability of the illness as well as restrictions on family visiting the patient and being prepared for bad news.
Cunningham C, Mayers P, Giddy J, De Swardt M, Hodkinson P. ‘I am afraid the news is not good’–Breaking bad news in the time of COVID: Experiences from a field hospital. African Journal of Primary Health Care & Family Medicine. 2024 Feb 23;16(1):4256.
Emergency Medicine
I worked as research manager for the project. We used a hybrid type 11 implementation science design to assess implementation outcomes and clinical effectiveness of the implementation of a simplified prehospital bundle of trauma care using a peer-to-peer rapid training format.
Mould-Millman N, Dixon J, Beaty BL, Suresh K, De Vries S, Bester B, Moreira F, Cunningham C, Moodley K, Cermak R, Schauer S, Maddry JK, Bills C, Havranek E, Bebarte V, Ginde A. Improving Prehospital Traumatic Shock Care – Implementation and Clinical Effectiveness of a Pragmatic Quasi-Experimental Trial in a Resource-Constrained South African Setting. BMJ Open 13e060338. Doi:10.1136/bmjopen-2021-060338
Emergency Medicine
I worked as research manager for the project. We considered how an education bundle designed for out of hospital providers in a resource-limited setting can change clinical outcomes of critically injured patients. We used quasi-experimental educational implementation method. The study involved 198 providers who treated 770 severe trauma patients.
Nee-Kofi Mould-Millman, Julia M Dixon; Bradley van Ster; Fabio Moreira; Beatrix Bester; Charmaine Cunningham; Shaheem de Vries; Brenda Beaty; Krithika Suresh; Steven G Schauer; Joseph K Maddry; Lee A Wallis; Vikhyat S Bebarta; Adit A Ginde. Clinical Impact of a Prehospital Trauma Shock Bundle of Care in South Africa. African Journal of Emergency Medicine. 2022, March, 12 (1) pp 19-26
Emergency Nursing/Education
An opinion piece about the use of low-fidelity manikens when training nurses in Africa to improve emergency care. Briefly refers to simulation training.
Cunningham C. Resuscitation training for emergency nurses in Africa. Emergency Nurse. 2015 Mar 1;22(10).
Emergency Medicine/ Triage
We validated a revised version of the peadiatric South African Triage Scale (SATS) against admission as a reference standard. A total of 2014 children were included in both state and private healthcare facilities in South Africa. We concluded that the SATS is a safe and robust tool for triage.
Twomey M, Cheema B, Cohen K, De Sa A, Louw P, Ismail M, Finlayson H, Cunningham C, Westwood A. Vital signs for children at triage: a multicentre validation of the revised South African Triage Scale (SATS) for children. South African Medical Journal. 2013 Apr 30;103(5):304-8.
Emergency Nursing/Education
A nursing working group developed a guiding document to improve nursing skills in Sub-Saharan Africa. We used the guiding document to develop a context-specific short course. The success of the short course has led to the development of a global mentorship program.
Cunningham C, Brysiewicz P, Sepeku A, White L, Murray B, Lobue N, Sawe H. Developing an emergency nursing short course in Tanzania. African Journal of Emergency Medicine. 2017 Dec 1;7(4):147-50.
In the media
I used the peer-reviewed article about Hout Bay Volunteer Ambulance Service to write an article The Conversation. The concept of community based emergency response made main stream media and I was invited to speak about it on mainstream media, below is clips of me speaking on SABC News and Newsroom Africa.