Health workers’ perspectives of a mobile health tool to improve diagnosis and management of paediatric acute respiratory illnesses in Uganda: a qualitative study

Abstract

ObjectivesMobile health tools have potential to improve the diagnosis and management of acute lower respiratory illnesses (ALRI), a leading cause of paediatric mortality worldwide. The objectives were to evaluate health workers’ perceptions of acceptability, usability and feasibility of Acute Lower Respiratory Illness Treatment and Evaluation (ALRITE), a novel mobile health tool to help frontline health workers diagnose, treat and provide education about ALRI in children <5 years.DesignA qualitative study including semistructured interviews with health facility administrators and focus groups with primary care health workers.SettingTwo federally funded Ugandan primary care health facilities, one peri-urban and one rural.ParticipantsWe enrolled 3 health administrators and 28 health workers (clinical officers and nurses).InterventionThe ALRITE smartphone application was developed to help frontline health workers adhere to ALRI guidelines and differentiate wheezing illnesses from pneumonia in children under 5 years of age. ALRITE contains a simple decision tree, a partially automated respiratory rate counter, educational videos and an adapted respiratory assessment score to determine bronchodilator responsiveness. We performed a demonstration of ALRITE for participants at the beginning of interviews and focus groups. No participant had used ALRITE prior.ResultsThemes impacting the potential implementation of ALRITE were organised using individual-level, clinic-level and health-system level determinants. Individual-level determinants were acceptability and perceived benefit, usability, provider needs and provider–patient relationship. Clinic-level determinants were limited resources and integration within the health centre. Systems-level determinants included medication shortages and stakeholder engagement.ConclusionsIncorporation of these themes will ready ALRITE for field testing. Early engagement of end users provides insights critical to the development of tailored mHealth decision support tools.

Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa

“…Detailed background research provided first-hand information about the problem—such as an illness—to be tackled in the community as well as how best to handle it ( 47 ). Furthermore, the implementers of these user-centered digital initiatives ensured to acquire as much information about the community health workers, location, need, opportunities, and other information relevant to the implementation and acceptability of the solution ( 46 , 48 , 49 ). These included pre and post evaluation of the knowledge of health care workers and feedback from test users ( 50 , 51 ).…”

“…These included pre and post evaluation of the knowledge of health care workers and feedback from test users ( 50 , 51 ). The questions addressed topics about the design and usability of the application as well as pertinent issues concerning potential blockades to its mass adoption ( 48 , 52 , 53 ). They sought to gain knowledge from the successes and failures of past implementers.…”

Digital auscultation as a novel childhood pneumonia diagnostic tool for community clinics in Sylhet, Bangladesh: protocol for a cross-sectional study

“…First, the guidelines were developed when access to vaccines was limited and child pneumonia mortality was high, so the guidelines intentionally prioritised sensitivity over specificity to ensure children with possible bacterial disease received antibiotics 8 10. Thus, the IMCI algorithm overdiagnoses many children with pneumonia who do not require antibiotics and they may have different treatable diseases 16 17. Second, the WHO guidelines do not include lung auscultation in their pneumonia definition for frontline healthcare workers despite lung auscultation serving as the cornerstone for pneumonia diagnosis in most ambulatory, well-resourced settings staffed by clinicians trained to perform lung auscultation 10.…”

Performance and usability of a new mobile application for measuring respiratory rate in young children with acute lower respiratory infections

“…We were concerned that such a short measurement duration might lead to inaccuracies in infants and young children given physiologic RR variability. Therefore, we designed a smartphone app with an embedded RR counter, the acute lower respiratory illness treatment and evaluation (ALRITE) 21 . The RR counter determines RR in 30–60 s, with the goal of optimizing accuracy without sacrificing improved efficiency of shorter count times.…”

“…Therefore, we designed a smartphone app with an embedded RR counter, the acute lower respiratory illness treatment and evaluation (ALRITE). 21 The RR counter determines RR in 30-60 s, with the goal of optimizing accuracy without sacrificing improved efficiency of shorter count times.…”