Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

Abstract

Background Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.

A pre-implementation study on the experience of ultrasound scanning in selected healthcare facilities of Lusaka, Zambia: the perspectives of pregnant women and male partners

“…Similar to the ndings of a study conducted in Kenya [47] on experiences of USS among women, our ndings indicate the motivating factors that will create demand for the USS intervention which will in turn make the USS intervention patient centred and could possibly increase the uptake of antenatal care. Consistent with our ndings from systematic reviews conducted in LMICs [18,28] and various literature from African Countries [20,29] , including Zambia [32][33][34][35] feasibility of healthcare interventions are appraised by healthcare workers who feel that, such interventions enhances their capacity skills which ultimately increase their professional relevance. The strength of our study was the focus on the voices of pregnant women and male partners of which are important for acceptability, adequate implementation and sustainability of any maternal health intervention.…”

“…Other previous studies from sub-Saharan Africa highlight high acceptance levels of new technological interventions in health [38,50] including USS scanning implemented by Midwives [36,47] . Similar to other ndings from LMICs [29] , our ndings show strength in amplifying perceptions by the participants who predict that addressing facility barriers could reduce psychological effects such as anger, anxiety, fear frustration, shame, and suicidal thoughts which makes them shun health care interventions including USS. More so, it was also predicted that addressing the facility barriers could boost the healthcare workers' professional self-image.…”

“…More importantly, one ultrasound scan is recommended for pregnant women before 24 weeks gestation because it allows for accurate and consistent use of the estimated delivery date and, as a result, has a high potential to reduce preterm and stillbirths [1,26,27] . According to a number of authors [18,28] and various literature from African countries [20,29] , including Zambia [30][31][32][33][34][35] , for health interventions to be effective, they must improve implementers' skills, promote user interaction, be relevant, appropriately inform users, and be accessible, inexpensive, culturally and socially appropriate, and sustainable. Despite the [25] recommendations for reducing perinatal mortalities, Zambia faces a signi cant challenge in effectively preventing and managing preterm birth and stillbirths due to the lack of an accurate, consistently applied estimated date of delivery (EDD) for each pregnant woman, which is obtained through ultrasound scanning.…”

“…Despite the [25] recommendations for reducing perinatal mortalities, Zambia faces a signi cant challenge in effectively preventing and managing preterm birth and stillbirths due to the lack of an accurate, consistently applied estimated date of delivery (EDD) for each pregnant woman, which is obtained through ultrasound scanning. Studies from LMICs show that USS interventions delivered by midwives are highly feasible and acceptable [29,36,37]. Despite these ndings, there are still no known studies describing how ultrasound scanning is used in Zambia to decrease preterm and stillbirths.…”