TY - JOUR
T1 - Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings
T2 - A qualitative study
AU - Riaz, Atif
AU - Cambaco, Olga
AU - Ellington, Laura Elizabeth
AU - Lenahan, Jennifer L.
AU - Munguambe, Khatia
AU - Mehmood, Usma
AU - Lamorte, Alessandro
AU - Qaisar, Sana
AU - Baloch, Benazir
AU - Kanth, Neel
AU - Nisar, Muhammad Imran
AU - Volpicelli, Giovanni
AU - Bassat, Quique
AU - Jehan, Fyezah
AU - Ginsburg, Amy Sarah
N1 - Funding Information:
Acknowledgements We thank the dedicated study staff at Manhiça District Hospital in Manhiça, Mozambique and Sindh Government Children’s Hospital– Poverty Eradication Initiative in Karachi, Pakistan for implementing the study and providing patient care. We thank Cayetana Verastegui and Carla Pinto in Manhiça, Mozambique for their contributions to the study. We also thank the trial participants, their caregivers and the local community in Manhiça, Mozambique and Karachi, Pakistan for their participation and support. CISM is supported by the Government of Mozambique and the Spanish Agency for International Development. ISGlobal receives support from the Spanish Ministry of Science and Innovation through the 'Centro de Excelencia Severo Ochoa 2019-2023' Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. Contributors JLL and ASG designed the study and data collection instruments with input from AR, KM, AL, MIN, GV, QB and FJ. AL and GV provided lung ultrasound training and support. JLL and ASG coordinated and supervised data collection from the sites and NK, MIN, FJ and QB supervised their respective sites. AR, OC, KM, UM, SQ, BB and MIN acquired and managed the data. AR, OC and KM analysed and interpreted the data and produced study reports. LEE analysed and interpreted the data using information from the study reports and wrote the manuscript with critical input from JLL and ASG. All authors worked collaboratively to review and approve the final manuscript.
Funding Information:
Funding This work was supported by grants from the Bill and Melinda Gates Foundation (OPP1105080) and Save the Children.
Publisher Copyright:
©
PY - 2021/3/11
Y1 - 2021/3/11
N2 - Objectives Paediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia. Design Prospective qualitative study using semistructured interviews Setting Two referral hospitals in Mozambique and Pakistan Participants A total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled. Results HCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-Term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS. Conclusions This was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation. Trial registration number NCT03187067.
AB - Objectives Paediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia. Design Prospective qualitative study using semistructured interviews Setting Two referral hospitals in Mozambique and Pakistan Participants A total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled. Results HCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-Term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS. Conclusions This was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation. Trial registration number NCT03187067.
KW - international health services
KW - paediatric thoracic medicine
KW - public health
KW - qualitative research
KW - respiratory infections
KW - ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=85102516908&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-042547
DO - 10.1136/bmjopen-2020-042547
M3 - Article
C2 - 33707268
AN - SCOPUS:85102516908
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e042547
ER -
