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

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.

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Training needs for Ugandan primary care health workers in management of respiratory diseases: a cross sectional survey

10.21203/rs.2.15713/v3 ◽

2020 ◽

Author(s):

Rebecca Nantanda ◽

Gerald Kayingo ◽

Rupert Jones ◽

Frederik van Gemert ◽

Bruce Kirenga

Keyword(s):

Primary Care ◽

Respiratory Diseases ◽

Health Workers ◽

Cross Sectional ◽

Respiratory Illnesses ◽

Knowledge And Skills ◽

Chronic Respiratory Diseases ◽

Primary Care Health ◽

Service Training ◽

Care Health

Abstract Background Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes. This survey assessed gaps in knowledge and skills among healthcare workers in managing respiratory illnesses. Methods A cross sectional study was conducted among primary care health workers, specialist physicians and healthcare planners to assess gaps in knowledge and skills and, training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians and nurses. Survey Monkey was used to collect data and descriptive statistical analysis was undertaken for quantitative data, while thematic content analysis techniques were utilized to analyze qualitative data. Results A total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialist clinicians and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of the patients in their clinics presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared health workers to manage respiratory diseases. The patients were unsatisfied with the care in primary care and reported that they were often treated for the wrong illnesses. Conclusions Respiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended. Key words: respiratory diseases, primary care, health workers, knowledge, skills

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Training needs for Ugandan primary care health workers in management of respiratory diseases: a cross sectional survey

10.21203/rs.2.15713/v1 ◽

2019 ◽

Author(s):

Rebecca Nantanda ◽

Gerald Kayingo ◽

Rupert Jones ◽

Frederik van Gemert ◽

Bruce Kirenga

Keyword(s):

Primary Care ◽

Respiratory Diseases ◽

Health Workers ◽

Respiratory Illnesses ◽

Knowledge And Skills ◽

Chronic Respiratory Diseases ◽

Primary Care Health ◽

Care Facilities ◽

Service Training ◽

Care Health

Abstract Background Acute and chronic respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention to chronic respiratory diseases in the health programmes. This survey assessed the gaps in knowledge and skills, among healthcare workers in managing respiratory illnesses. Methods A mixed methods study was conducted among primary care health workers, physicians and healthcare planners to assess gaps in knowledge and skills, and training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians, nurses and midwives. Survey Monkey was used to collect survey data. Descriptive analysis was undertaken for quantitative data and content analysis for qualitative data. Results A total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialist clinicians and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of the patients in their clinics presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in diagnosing and managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The clinicians indicated that the pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared them to manage respiratory diseases. The patients were unsatisfied with the care in primary care facilities and reported that they were often treated for the wrong illnesses. Conclusions Respiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended.

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Training needs for Ugandan primary care health workers in management of respiratory diseases: a cross sectional survey

10.21203/rs.2.15713/v2 ◽

2019 ◽

Author(s):

Rebecca Nantanda ◽

Gerald Kayingo ◽

Rupert Jones ◽

Frederik van Gemert ◽

Bruce Kirenga

Keyword(s):

Primary Care ◽

Respiratory Diseases ◽

Health Workers ◽

Cross Sectional ◽

Respiratory Illnesses ◽

Knowledge And Skills ◽

Chronic Respiratory Diseases ◽

Primary Care Health ◽

Service Training ◽

Care Health

Abstract Background Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention to chronic respiratory diseases in the health programmes. In general, there is limited capacity and clinical experience for chronic illness. This survey assessed the gaps in knowledge and skills, among healthcare workers in managing respiratory illnesses.Methods A cross sectional study was conducted among primary care health workers, specialist physicians and health care planners to assess gaps in knowledge and skills as well as training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians, nurses and midwives. Survey Monkey was used to collect survey data. Descriptive statistical analysis was undertaken for quantitative data, and thematic content analysis for qualitative data.Results A total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialists and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of their patients presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in diagnosing and managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The clinicians indicated that the pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared them to manage respiratory diseases. The patients were unsatisfied with the care in primary care facilities and reported that they were often treated for the wrong illnesses.Conclusions Respiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended.

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A cross-sectional study of the income sources of primary care health workers in the Democratic Republic of Congo

Human Resources for Health ◽

10.1186/s12960-017-0185-4 ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Rishma Maini ◽

David R. Hotchkiss ◽

Josephine Borghi

Keyword(s):

Primary Care ◽

Democratic Republic ◽

Health Workers ◽

Democratic Republic Of Congo ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Income Sources ◽

Primary Care Health ◽

Care Health

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No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study

BMC Health Services Research ◽

10.1186/s12913-020-05984-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jesper Kjærgaard ◽

◽

Thomas Nørrelykke Nissen ◽

Elvira Isaeva ◽

Nguyen Nhat Quynh ◽

...

Keyword(s):

Primary Care ◽

Healthcare Workers ◽

Health Workers ◽

Clinical Performance ◽

Contextual Factors ◽

Middle Income ◽

Middle Income Countries ◽

Primary Care Health ◽

Care Health ◽

Asthma In Children

Abstract Background Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms. Methods Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations. Results Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen’s d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen’s d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam. Discussion and conclusion The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training.

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