Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project
Introduction The Integrated Sustainable Childhood Pneumonia and Infectious diseases Reduction in Nigeria-Lagos project introduced pulse oximetry and oxygen as part of a ‘stabilisation room’ intervention in primary healthcare facilities (PHCs) in Lagos state, Nigeria. However, impact evaluation found...
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2024-12-01
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| author | Hamish R Graham Adegoke G Falade Tim Colbourn Eric D McCollum Ayobami Adebayo Bakare Carina King Christine Cassar Agnese Iuliano Adamu Isah Adams Osebi Tahlil Ahmed Rochelle Ann Burgess Samy Ahmar Paula Valentine Ibrahim Haruna Abdullahi Magama Temitayo Folorunso Olowookere Matt MacCalla Obioma Uchendu Julius Salako Funmilayo Shittu Damola Bakare Omotayo Olojede Abiodun Sogbesan Omotayo Emmanuel Olojede Rochelle Anne Burgess |
| author_facet | Hamish R Graham Adegoke G Falade Tim Colbourn Eric D McCollum Ayobami Adebayo Bakare Carina King Christine Cassar Agnese Iuliano Adamu Isah Adams Osebi Tahlil Ahmed Rochelle Ann Burgess Samy Ahmar Paula Valentine Ibrahim Haruna Abdullahi Magama Temitayo Folorunso Olowookere Matt MacCalla Obioma Uchendu Julius Salako Funmilayo Shittu Damola Bakare Omotayo Olojede Abiodun Sogbesan Omotayo Emmanuel Olojede Rochelle Anne Burgess |
| collection | DOAJ |
| description | Introduction The Integrated Sustainable Childhood Pneumonia and Infectious diseases Reduction in Nigeria-Lagos project introduced pulse oximetry and oxygen as part of a ‘stabilisation room’ intervention in primary healthcare facilities (PHCs) in Lagos state, Nigeria. However, impact evaluation found minimal effects on treatment and referral practices for children with pneumonia, largely attributed to persistently low pulse oximetry use. We aimed to understand how the stabilisation room intervention worked (or did not work) to improve pulse oximetry practices, for whom, and in what contexts.Methods We conducted a preplanned mixed-methods realist evaluation. We used an initial programme theory to guide data collection and analysis, focusing on pulse oximetry adoption. We described oximetry adoption using quantitative data from the impact evaluation, then used training observations, monitoring data, quarterly site reports and qualitative interviews with purposefully selected healthcare workers (HCWs) to explore how pulse oximetry was perceived and adopted. We used inductive content analysis, iteratively triangulating emerging themes with process data to generate and test theories.Results We identified four inter-related themes explaining low adoption of pulse oximetry for children in this setting: (1) In contexts of frequent staff turnover and competing demands, oximetry training was desired, appreciated and may have increased HCW knowledge and skills, but largely failed to reach frontline HCWs. (2) Pulse oximetry was not perceived as a usual part of PHC practice. HCWs relied on external motivation to adopt a fundamentally new practice, seeing it as extra work and getting easily discouraged without external supervision or strong local leadership. (3) Without institutional norms and expectations regarding pulse oximetry, HCWs needed to be convinced they were capable (self-efficacy) and would typically only use pulse oximetry selectively. (4) Technical challenges and faulty equipment, in the absence of confident and accessible troubleshooters, were demotivating and discouraging to users.Conclusion Implementation of pulse oximetry for children in primary care facilities requires clarity on the intended role of oximetry in primary care, clear normative guidance and close support and supervision during the early adoption phase. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-d4a24a4dbb604c2ea72f7defdca0dbd02024-12-30T09:10:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-12-012210.1136/bmjph-2024-001211Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project Hamish R Graham0Adegoke G Falade1Tim Colbourn2Eric D McCollum3Ayobami Adebayo Bakare4Carina King5Christine Cassar6Agnese Iuliano7Adamu Isah8Adams Osebi9Tahlil Ahmed10Rochelle Ann Burgess11Samy Ahmar12Paula Valentine13Ibrahim Haruna14Abdullahi MagamaTemitayo Folorunso Olowookere15Matt MacCalla16Obioma Uchendu17Julius Salako18Funmilayo ShittuDamola Bakare19Omotayo OlojedeAbiodun SogbesanOmotayo Emmanuel Olojede20Rochelle Anne Burgess21Melbourne Children`s Global Health, Murdoch Children`s Research Institute, Melbourne, Victoria, AustraliaDepartment of Paediatrics, University College Hospital, Ibadan, NigeriaInstitute for Global Health, University College London, London, UKGlobal Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USADepartment of Global Public Health, Karolinska Institutet, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden8 Save the Children Fund, London, UK6 Institute for Global Health, University College London, London, UK7 Save the Children International, Abuja, FCT, Nigeria7 Save the Children International, Abuja, FCT, Nigeria8 Save the Children Fund, London, UK6 Institute for Global Health, University College London, London, UK8 Save the Children Fund, London, UK8 Save the Children Fund, London, UK9 Save the Children International, Abuja, Nigeria9 GlaxoSmithKline (GSK), Lagos, Nigeria10 GlaxoSmithKline (GSK), Brentford, UKCommunity Medicine Department, University of Ibadan College of Medicine, Ibadan, NigeriaDepartment of Paediatrics, University College Hospital, Ibadan, NigeriaDepartment of Paediatrics, University College Hospital, Ibadan, Nigeria2 Department of Paediatrics, University of Ibadan, Ibadan, Nigeria11 Institute for Global Health, UCL, London, UKIntroduction The Integrated Sustainable Childhood Pneumonia and Infectious diseases Reduction in Nigeria-Lagos project introduced pulse oximetry and oxygen as part of a ‘stabilisation room’ intervention in primary healthcare facilities (PHCs) in Lagos state, Nigeria. However, impact evaluation found minimal effects on treatment and referral practices for children with pneumonia, largely attributed to persistently low pulse oximetry use. We aimed to understand how the stabilisation room intervention worked (or did not work) to improve pulse oximetry practices, for whom, and in what contexts.Methods We conducted a preplanned mixed-methods realist evaluation. We used an initial programme theory to guide data collection and analysis, focusing on pulse oximetry adoption. We described oximetry adoption using quantitative data from the impact evaluation, then used training observations, monitoring data, quarterly site reports and qualitative interviews with purposefully selected healthcare workers (HCWs) to explore how pulse oximetry was perceived and adopted. We used inductive content analysis, iteratively triangulating emerging themes with process data to generate and test theories.Results We identified four inter-related themes explaining low adoption of pulse oximetry for children in this setting: (1) In contexts of frequent staff turnover and competing demands, oximetry training was desired, appreciated and may have increased HCW knowledge and skills, but largely failed to reach frontline HCWs. (2) Pulse oximetry was not perceived as a usual part of PHC practice. HCWs relied on external motivation to adopt a fundamentally new practice, seeing it as extra work and getting easily discouraged without external supervision or strong local leadership. (3) Without institutional norms and expectations regarding pulse oximetry, HCWs needed to be convinced they were capable (self-efficacy) and would typically only use pulse oximetry selectively. (4) Technical challenges and faulty equipment, in the absence of confident and accessible troubleshooters, were demotivating and discouraging to users.Conclusion Implementation of pulse oximetry for children in primary care facilities requires clarity on the intended role of oximetry in primary care, clear normative guidance and close support and supervision during the early adoption phase.https://bmjpublichealth.bmj.com/content/2/2/e001211.full |
| spellingShingle | Hamish R Graham Adegoke G Falade Tim Colbourn Eric D McCollum Ayobami Adebayo Bakare Carina King Christine Cassar Agnese Iuliano Adamu Isah Adams Osebi Tahlil Ahmed Rochelle Ann Burgess Samy Ahmar Paula Valentine Ibrahim Haruna Abdullahi Magama Temitayo Folorunso Olowookere Matt MacCalla Obioma Uchendu Julius Salako Funmilayo Shittu Damola Bakare Omotayo Olojede Abiodun Sogbesan Omotayo Emmanuel Olojede Rochelle Anne Burgess Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project BMJ Public Health |
| title | Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project |
| title_full | Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project |
| title_fullStr | Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project |
| title_full_unstemmed | Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project |
| title_short | Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project |
| title_sort | understanding pulse oximetry adoption in primary healthcare facilities in nigeria a realist process evaluation of the inspiring lagos stabilisation room project |
| url | https://bmjpublichealth.bmj.com/content/2/2/e001211.full |
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