Acceptability of the routine use of pulse oximeters into the Integrated Management of Childhood Illness guidelines at primary health centers in West Africa: a mixed-methods study.

IntroductionTo better identify illnesses with severe hypoxemia in children aged under-5 years, the AIRE project has implemented the routine use of a Pulse Oximeter (PO) into the Integrated Management of Childhood Illness (IMCI) guidelines at primary health centers (PHC) in Burkina Faso, Guinea, Mali, and Niger. We aimed to measure and understand the acceptability among healthcare workers (HCW) and childrens families (CF) of using PO in these contexts. MethodsBased on an original conceptual framework, we conducted a convergent mixed methods study to assess HCWs and CFs acceptability. We used quantitative questionnaires based on the Likert scale to conduct four repeated cross-sectional studies among all HCW on duty in the 202 PHC involved in the AIRE project before the intervention (before and after PO use training), six months after the introduction of the PO, and two months after project completion. We also conducted semi-structured interviews with HCW (n=102) and CF (n=59). ResultsFrom March 2021 to December 2022, 486, 537, 538 and 476 HCW completed the four acceptability surveys. Overall, 31% of HCW had mitigated feelings about PO use before the training, 46% found it rather 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 HCW acceptability. HCW found many advantages in using PO, such as improved care for children, more accurate diagnosis, and a boost in their confidence in childcare management. Nevertheless, perceived increased workload and consultation time, as well as difficulties in referring children to hospital remain challenging. CF did not necessarily understand the new devices purpose, but their opinions of the technology were generally positive. ConclusionThe PO use, integrated into IMCI consultations, seems to be accepted by HCW and CF, although sustainable challenges remain. What is already known on this topicO_LIEven if PO effectiveness is well-known, integration of new medical technologies in primary health care settings in low-resource countries often faces challenges, including acceptability among healthcare workers and families. C_LIO_LIPrevious studies that have looked at the acceptability of PO were mostly hospital-based and did not use a comprehensive methodology to investigate acceptability in depth. C_LI What this study addsO_LITo our knowledge, this is the first study to examine the acceptability of a healthcare innovation to HCW and CF, based on a comprehensive theoretical framework, combining a quantitative and qualitative approach, and using an innovative acceptability score. C_LIO_LIThis study provides empirical evidence on the high acceptability of PO use for HCW and CF at a decentralized level in Burkina Faso, Guinea, Mali, and Niger. C_LIO_LITraining and supervision significantly improved HCW acceptability of PO use, with increased confidence in childcare management. However, challenges such as increased workload and consultation time, as well as referral difficulties, persist despite the overall positive opinion. C_LI How this study might affect research, practice or policyO_LIThe findings support the need for comprehensive training and supervision programs to enhance acceptability among HCW. C_LIO_LIPolicymakers should work towards addressing the operational challenges identified, especially those related to the referral of children, which could hinder the sustainability of PO use. C_LIO_LIResearch aiming to evaluate acceptability should be based on conceptual frameworks or theories that allow for an in-depth exploration of the different dimensions of acceptability. C_LI