Exploring health practitioners’ acceptability of a prospective semi-quantitative pfHRP2 device to define severe malaria in the Democratic Republic of Congo

Abstract

BackgroundA rapid diagnostic tool is being developed to discern severely ill children with severe malaria from children who are ill with alternative febrile diseases but have coincidental peripheral blood parasitaemia. The device semi-quantitatively measures plasma pfHRP2 and has the potential to reduce mortality in children with severe febrile illnesses by improving diagnosis. The aim of this study is to identify contributing and inhibiting factors that affect healthcare practitioners’ acceptability of this prospective diagnostic device in a high malaria transmission setting in the Democratic Republic of Congo.MethodsData were collected qualitatively by conducting semi-structured interviews with a purposeful sample of health professionals in Kinshasa, capital of Democratic Republic of Congo. In total, 11 interviews were held with professionals at four different institutes.ResultsFour key findings emerged: (1) Congolese practitioners perceive the semi-quantitative pfHRP2 device as a welcome intervention as they recognize the limited reliability of their current diagnostic and therapeutic approaches to severe febrile illnesses; (2) compatibility of the semi-quantitative pfHRP2 device with clinical equipment and competences of Congolese health practitioners is considered to be limited, especially in rural settings; (3) a formal training programme is crucial for correct understanding and application of the semi-quantitative pfHRP2 device; and, (4) provision of evidence to practitioners, and support from health authorities would be important to establish confidence in the semi-quantitative pfHRP2 device.ConclusionsCongolese practitioners perceive the prospective semi-quantitative pfHRP2 device as a welcome addition to their clinical equipment. The device could improve current diagnostic work-up of severe febrile illness, which might consequently improve treatment choices. However, despite this recognized potential, several hurdles and drivers need to be taken into account when implementing this device in DR Congo.

Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis

“…For example, De Haan and al. [ 46 ] measured the acceptability of a tool only after giving the participants an information sheet that explained the device. The second stage, the “tangible” (or concrete) time, is a measure of acceptability after having physically presented the innovation but before it was used and integrated into practices.…”

“…Perceived disadvantages are the amount of effort, risk and cost perceived to be associated with an innovation and its use. These disadvantages can be very diverse, such as increased clinical costs per febrile illness episode [ 46 ], painfulness [ 48 ], concerns about the safety and hygiene of the device [ 50 ], increased administrative constraints [ 53 ], increased workload [ 55 ], etc. All these disadvantages are distinct from the complications linked to the complexity of using the innovation (perceived complexity).…”

“…The influence of health authority support was also sometimes highlighted as a positive influence, in contrast to technology manufacturers’ discourse: "Governmental endorsement […] was deemed crucial to acceptability. Congolese practitioners would not perceive evidence provided by other parties, such as manufacturers, as reliable" [ 46 ]. Peer influence also plays a role: "Some health workers are not regularly using the CDSS [clinical decision support system] during patient care, which demoralizes other providers who are using the system" [ 60 ].…”

“…This dimension is, therefore, necessarily linked directly to the context. In some studies, the influence of the adequacy between the technology introduced and the setting of its introduction has indeed been highlighted: "the device is considered to have limited compatibility with equipment and competences of Congolese practitioners, especially of those active in rural settings" [ 46 ]. Here, the lack of compatibility between the technology introduced and the skills and case management possibilities influence the acceptability of the innovation negatively.…”

“…Using MAP at home during outreach strategies was perceived more cautiously (average of 60.2%)" [ 44 ]. Other elements related to the form of intervention, such as the role played by the monitoring team and the emphasis placed on the quality assurance program throughout the study [ 48 ], whether the intervention was included in a grant program [ 46 ], how the technology training was carried out and by whom [ 32 ], the quality of the instructions given both to health workers [ 54 ] and patients [ 54 ] before using the technology, the level of supervision of the intervention [ 53 ], etc., can all influence acceptability.…”