Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

Riaz, Atif; Cambaco, Olga; Ellington, Laura E.; Lenahan, Jennifer L.; Munguambe, Khátia; Mehmood, Usma; Lamorte, Alessandro; Qaisar, Sana; Baloch, Benazir; Kanth, Neel; Nisar, Muhammad Imran; Volpicelli, Giovanni; Bassat, Quique; Ginsburg, Amy Sarah

doi:10.1136/bmjopen-2020-042547

Cited by 11 publications

(13 citation statements)

References 29 publications

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“…POC-LUS is thought to refine clinical hypothesis or reduce doubts based on a chest X-ray alone (eg, characterising pleural effusions). This streamlining of the workflow is consistent with previous qualitative findings in a paediatric setting 9. Its lack of radiation also makes it an interesting technique for pregnant women and children 18…”

Section: Discussionsupporting

confidence: 87%

“…In our study setting, there was a clear need for an affordable lung imaging technique using low maintenance materials. This is consistent with qualitative findings from studies in Pakistan, Mozambique and Kenya 9 10. POC-LUS is integrated in clinical reasoning at the bedside and can speed up a first diagnostic orientation even when chest X-ray is available.…”

Section: Discussionsupporting

confidence: 85%

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Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

et al. 2023

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ObjectivesOwing to its ease-of-use and excellent diagnostic performance for the assessment of respiratory symptoms, point-of-care lung ultrasound (POC-LUS) has emerged as an attractive skill in resource-low settings, where limited access to specialist care and inconsistent radiology services erode health equity.To narrow down the research to practice gap, this study aims to gain in-depth insights in the perceptions on POC-LUS and computer-assisted POC-LUS for the diagnosis of lower respiratory tract infections (LRTIs) in a low-income and middle-income country (LMIC) of sub-Saharan Africa.Design and settingQualitative study using face-to-face semi-structured interviews with three pneumologists and five general physicians in a tertiary centre for pneumology and tuberculosis in Benin, West Africa. The center hosts a prospective cohort study on the diagnostic performance of POC-LUS for LRTI. In this context, all participants started a POC-LUS training programme 6 months before the current study. Transcripts were coded by the interviewer, checked for intercoder reliability by an independent psychologist, compared and thematically summarised according to grounded theory methods.ResultsVarious barriers− and facilitators+ to POC-LUS implementation were identified related to four principal categories: (1) hospital setting (eg, lack of resources for device renewal or maintenance−, need for POC tests+), (2) physician’s perceptions (eg, lack of opportunity to practice−, willingness to appropriate the technique+), (3) tool characteristics (eg, unclear lifespan−, expedited diagnosis+) and (4) patient’s experience (no analogous image to keep−, reduction in costs+). Furthermore, all interviewees had positive attitudes towards computer-assisted POC-LUS.ConclusionsThere is a clear need for POC affordable lung imaging techniques in LMIC and physicians are willing to implement POC-LUS to optimise the diagnostic approach of LRTI with an affordable tool. Successful integration of POC-LUS into clinical routine will require adequate responses to local challenges related to the lack of available maintenance resources and limited opportunity to supervised practice for physicians.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 85%

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

et al. 2023

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“…While use of ultrasound in patient care was viewed favorably by the overwhelming majority of survey respondents, a minority of respondents did note some reservation, specifically regarding fear of potential misdiagnosis. A study evaluating the feasibility, usability, and acceptability of lung ultrasound for the diagnosis of pediatric pneumonia among healthcare providers and caregivers in Mozambique and Pakistan also demonstrated an overall positive attitude toward ultrasound with few exceptions 46 . Interviewed healthcare providers and caregivers favored ultrasound for its rapid results, lack of ionizing radiation, and potential for improved diagnostic accuracy and streamlined workflow.…”

Section: Discussionmentioning

confidence: 96%

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

Ginsburg

Liddy

Khazaneh

et al. 2023

Sci Rep

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Point-of-care ultrasound has the potential to help inform assessment, diagnosis, and management of illness in low- and middle-income countries (LMIC). To better understand current ultrasound use, barriers and facilitators to use, and perceptions and practices in LMIC, we conducted an anonymous online global survey targeting healthcare providers training and using ultrasound in LMIC. A total of 241 respondents representing 62 countries participated and most were physicians working in publicly-funded urban tertiary hospitals in LMIC. Most had received ultrasound training (78%), reported expertise (65%) and confidence (90%) in ultrasound use, and had access to ultrasound (88%), utilizing ultrasound most commonly for procedures and for evaluations of lungs, heart, and trauma. Access to an ultrasound machine was reported as both the top barrier (17%) and top facilitator (53%); other common barriers included access to education and training, cost, and competition for use and other common facilitators included access to a probe, gel, and electricity, and acceptance by healthcare providers, administrators, and patients. Most (80%) noted ultrasound access was important and 96% agreed that ultrasound improves quality of care and patient outcomes. Improving access to low-cost ultrasound equipment is critical to increasing ultrasound use among those who are trained.

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“…Previous studies conducted in sub-Saharan Africa highlight the positive attitude toward new technological innovations in health [ 24 - 26 ]. Despite little previous experience, HCWs showed high levels of acceptance toward new technologies owing to expectations that new tools would be easy to use, make work easier, and take less time [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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

Koech,

Musitia,

Mwashigadi

et al. 2022

JMIR Hum Factors

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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.

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Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

Cited by 11 publications

References 29 publications

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

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

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