Can technology help improve diarrhoea management?

Bhutta, Zulfiqar Ahmed

doi:10.1016/s2589-7500(20)30081-9

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Such concerns were due to the possible misuse of the app or that CHWs may not be able to adapt the app’s recommendations to unique cases. Further guidance and training in the use of the app and assessment of clinical signs may be important for the implementation of the app among CHWs and is in line with other recommendations that improving knowledge and skills is essential to improving the quality of care provided in LMICs [ 39 ].…”

Section: Discussionmentioning

confidence: 64%

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study

Rosen¹,

Garbern²,

Gainey³

et al. 2022

JMIR Hum Factors

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Background The availability of mobile clinical decision support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and apps. Although health care providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns have been raised, including perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective on the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle-income countries. Objective This study aims to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on the preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. Methods From November to December 2020, qualitative data were gathered through 8 web-based focus group discussions with physicians and nurses from 3 Bangladeshi hospitals. Each discussion was conducted in the local language—Bangla—and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo (version 12; QSR International), and applied thematic analysis was used to identify themes that explore the clinical utility of an mHealth app for assessing dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data; thematic memos were written and used for the final analysis. Results Of the 27 focus group participants, 14 (52%) were nurses and 13 (48%) were physicians; 15 (56%) worked at a diarrhea specialty hospital and 12 (44%) worked in government district or subdistrict hospitals. Participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 (SD 9.0) years. Key themes from the qualitative data analysis included current experience with CDS, overall perception of the app’s utility and its potential role in clinical care, barriers to and facilitators of app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. Participants felt that the tool would initially take time to use, but once learned, it could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. In addition, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. Conclusions Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to revise the mobile CDS tool. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

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Section: Discussionmentioning

confidence: 64%

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study

Rosen¹,

Garbern²,

Gainey³

et al. 2022

JMIR Hum Factors

View full text Add to dashboard Cite

show abstract

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study (Preprint)

Rosen¹,

Garbern²,

Gainey³

et al. 2021

Preprint

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BACKGROUND The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries. OBJECTIVE The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. METHODS From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis. RESULTS Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. CONCLUSIONS Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

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Can technology help improve diarrhoea management?

Abstract: Such technologies are clearly important in helping the world to face many new challenges; in this case, they might allow us to make preventable diarrhoea deaths history. 10 I declare no competing interests.

Cited by 2 publications

References 10 publications

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study

Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study (Preprint)

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