Acceptability of the routine use of pulse oximetry by healthcare workers and caregivers within primary healthcare in West Africa: mixed-methods study

Abstract

Introduction: To better identify severe hypoxaemia as a major risk factor for specific illnesses in children aged under 5 years, the Améliorer l'Identification des détresses Respiratoires chez l'Enfant (AIRE) project implemented routine use of pulse oximetry within implementation of Integrated Management of Childhood Illness (IMCI) guidelines at primary health centres (PHCs) in Burkina Faso, Guinea, Mali and Niger. We aimed to measure and understand the acceptability of pulse oximeter (PO) use among healthcare workers (HCWs) and children's families (CFs).

Methods: Based on an original conceptual framework, we conducted a convergent mixed methods study to assess acceptability. We conducted repeated cross-sectional studies among all HCWs on duty within the 202 PHCs involved in the AIRE project, using quantitative Likert-scale questionnaires. These were administered at four key time points: (1) just before the PO use training, (2) immediately after the training, (3) 6 months after the introduction of PO devices in PHCs and (4) 2 months after the completion of all AIRE project activities. We also conducted semistructured interviews with HCWs (n=100) and CFs (n=59). Quantitative data were analysed using descriptive statistics and multivariable ordinal logistic regression. Qualitative data were thematically analysed with NVivo, and both were interpreted in light of the conceptual framework to explore convergence and divergence across acceptability dimensions.

Results: From March 2021 to December 2022, 486, 537, 538 and 476 HCWs completed the four acceptability surveys. Overall, 31% of HCWs had mixed feelings about PO use before the training, 46% found it somewhat acceptable and 23% strongly acceptable. At the end of the project, it was respectively 15%, 34% and 51%. PO training was consistently associated with greater HCWs acceptability. HCWs reported many advantages in using PO, such as a more accurate diagnosis and a boost in their confidence in sick child management. Nevertheless, challenges reported by HCWs included perceived increased workload and consultation time, as well as difficulties in referring children to hospital. CFs did not necessarily understand the device's purpose, but their opinions of the technology were generally positive.

Conclusion: PO use, integrated into IMCI consultations, was reported to be accepted by HCWs and CFs, although sustainable challenges in implementation remain.

Keywords: Child health; Cross-sectional survey; Diagnostics and tools; Qualitative study; Respiratory infections.

Figure 1. Timeline of data collection phases and number of participants. CF, children’s families; HCW, healthcare workers.