The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings

Abstract

BackgroundVital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device.MethodsEvaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach.ResultsMost healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device’s accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period.ConclusionThe CRADLE device was well accepted by healthcare workers from a range of countries and levels of facility, including those with no previous vital signs measurement experience. The device motivated women to attend primary care and encouraged them to accept treatment and referral.

The challenge of measuring blood pressure in low-resource settings

“…7 Preliminary qualitative studies indicated that both users and patients approved of the device. 8 The ultimate step in the development was determining in the present study whether the use of the device in low-resource centres improved outcomes. The study design was a stepped-wedge, cluster-randomised controlled trial.…”

A Prospective Case Control Study To Evaluate The CRADLE Vital Signs Alert Device For Detection Of Patients With Clinically Important Malaria In Refugee Settings

“…Previous work in India, Mozambique and South Africa has shown that unskilled community health workers perceive the CRADLE VSA as easy-to-use 14 and it meets the speci c WHO requirements for use in low income settings, being affordable (£15 GBP), robust, portable with low power requirements. 15…”

Maternal critical care in resource-limited settings. Narrative review

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