Clinicians' perspectives on wearable sensor technology as an alternative bedside monitoring tool in two West African countries.

OBJECTIVE: Healthcare facilities in low- and middle-income countries (LMICs), especially in Africa, suffer from a lack of continuous bedside monitoring capability, adversely affecting timely detection of hemodynamic deterioration and the opportunity for life-saving intervention. Wearable device technologies can overcome many of the challenges of conventional bedside monitors and could be viable alternatives. We assessed clinicians' perspectives on the use of a novel experimental wearable device ("biosensor") to improve bedside monitoring of pediatric patients in two West African LMICs. METHODS: Focus groups were conducted in 3 hospitals (2 in Ghana and 1 in Liberia), in both urban and rural settings and of variable size, to elucidate clinicians' attitudes about the biosensor and to identify potential implementation needs. The focus group sessions were coded using a constant comparative method. Deductive thematic analysis was applied to pair themes with Consolidated Framework for Implementation Research (CFIR) contextual factors and domains. RESULTS: Four focus groups were conducted in October 2019, and included 9 physicians, 20 nurses, and 20 community health workers. Fifty-two codes in four thematic areas were linked to 3 CFIR contextual factors and 9 domains. Key themes were durability and cost of the biosensor, hospital setting, and staffing concerns, which were related to the "Inner Setting" and "Characteristics of the Intervention" CFIR contextual factors. Participants, who recognized the limitations of current vital sign monitoring systems, further identified 21 clinical settings in which a biosensor could potentially be useful and expressed willingness to implement the biosensor. CONCLUSION: Clinicians who provide care to pediatric patients in two West African LMICs suggested multiple uses of a novel experimental wearable biosensor and expressed willingness to use it for continuous bedside vital sign monitoring. They identified device design (e.g., durability, cost), hospital setting (rural vs urban), and staffing as important factors to consider during further development and implementation.

Design and evaluation of a subcutaneous contraceptive implant training simulator.

OBJECTIVE: To design and fabricate a subcutaneous contraceptive implant insertion simulator, and to characterize the performance of nursing students trained with and without the simulator. METHOD: A cross-sectional study was conducted on nursing students in Ghana who had no previous training in the insertion of contraceptive implants. They were given standardized training in insertion of implants from 25 April to 26 April, 2016, and then were randomly assigned to an intervention or control group. The control group watched insertions of live implants while the intervention group practiced using the simulator. Local materials were used to fabricate the simulator. The performance of both groups was assessed after the training. RESULTS: The participants consisted of 50 nursing students. Those in the intervention group were more likely to: insert the implant accurately (95.2% vs 78.4%, P<0.001); take less time to complete an insertion (mean of 33.6 seconds vs 42.2 seconds, P<0.001); and commit fewer errors (1.9 vs 2.5, P=0.005) compared to the control group. In addition, participants rated the simulator high on 11/11 of the product requirements with the teaching (93.2%), learning (91.4%), and skill acquisition (88.6%) requirements being the highest rated. CONCLUSION: A low-cost, locally fabricated simulator is an effective tool for augmenting the current training protocol by improving insertion skills of contraceptive implants.