Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study

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Abstract

Background

Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization.

Objective

This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting.

Methods

We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software.

Results

Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies.

Conclusions

Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2019-035184

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Most cited references 18

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Using thematic analysis in psychology

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

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Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Is Open Access

Immediate Kangaroo Mother Care and Survival of Low Birth Weight Infants

(2021)

Background: Kangaroo Mother Care initiated after stabilization reduces mortality in infants with birthweight <2.0 kg, but the majority of deaths occur before stabilization. The safety and efficacy of Kangaroo Mother Care initiated soon after birth is uncertain. Methods: We conducted a randomized controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Infants with birth weight between 1.0 and <1.8 kg were randomly assigned to immediate Kangaroo Mother Care (intervention) or to conventional care until stabilization, and Kangaroo Mother Care thereafter (control). The primary outcomes were deaths in the neonatal period (first 28 days of life) and in the first 72 hours of life. The study was stopped early on the recommendation of the DSMB owing to reduced neonatal mortality with the intervention. Results: A total of 3211 infants and their mothers were randomly allocated (1609 intervention, 1602 control group). The median daily duration of skin-to-skin contact in neonatal intensive care units was 16.9 hours (IQR 13.0–19.7) in the intervention and 1.5 hours (IQR 0.3–3.3) in control group. Neonatal death occurred in 191 infants (12.0%) and 249 (15.7%) infants, respectively (RR 0.75; 95% CI 0.64–0.89; p=0.001);death in the first 72 hours of life occurred in 74 infants (4.6%) and 92 infants (5.8%), respectively (RR 0.77, 95% CI 0.58–1.04; p=0.09). Conclusion: In infants with birthweight between 1.0 and <1.8 kg, immediate Kangaroo Mother Care (versus conventional care) resulted in a significant reduction in neonatal mortality, but not in mortality within the first 72 hours.

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Author and article information

Contributors

Mai-Lei Woo Kinshella:

ORCID: https://orcid.org/0000-0001-5846-3014

Department of Obstetrics and GynecologyBritish Columbia Children’s and Women’s Hospital and The University of British ColumbiaV344 - 950 W 28th AveVancouver, BC, V5Z 4H4Canada1 6048752253maggie.kinshella@cw.bc.ca

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: October 2021

Publication date (Electronic): 28 October 2021

Volume: 23

Issue: 10

Electronic Location Identifier: e29755

Affiliations

[1 ] UW Clinical Trial Center University of Washington Seattle, WA United States

[2 ] Department of Obstetrics and Gynecology British Columbia Children’s and Women’s Hospital and The University of British Columbia Vancouver, BC Canada

[3 ] Centre for International Child Health BC Children’s Hospital Vancouver, BC Canada

[4 ] School of Arts and Sciences Moi University Eldoret Kenya

[5 ] Department of Anesthesiology The University of British Columbia Vancouver, BC Canada

[6 ] Department of Pediatrics Aga Khan University Nairobi Kenya

[7 ] Evaluation of Technologies for Neonates in Africa Nairobi Kenya

Author notes

Corresponding Author: Mai-Lei Woo Kinshella maggie.kinshella@ 123456cw.bc.ca

Author information

Amy Sarah Ginsburg https://orcid.org/0000-0002-2291-2276

Mai-Lei Woo Kinshella https://orcid.org/0000-0001-5846-3014

Violet Naanyu https://orcid.org/0000-0003-0182-1719

Jessica Rigg https://orcid.org/0000-0003-3728-2163

Dorothy Chomba https://orcid.org/0000-0002-0038-7896

Jesse Coleman https://orcid.org/0000-0002-3601-7854

Bella Hwang https://orcid.org/0000-0001-6519-1563

Roseline Ochieng https://orcid.org/0000-0002-3818-7486

J Mark Ansermino https://orcid.org/0000-0001-8427-2035

William M Macharia https://orcid.org/0000-0002-4428-862X

Article

Publisher ID: v23i10e29755

DOI: 10.2196/29755

PMC ID: 8587184

PubMed ID: 34709194

SO-VID: faf9bc23-3c82-43ad-a052-1f2b9d020902

Copyright © ©Amy Sarah Ginsburg, Mai-Lei Woo Kinshella, Violet Naanyu, Jessica Rigg, Dorothy Chomba, Jesse Coleman, Bella Hwang, Roseline Ochieng, J Mark Ansermino, William M Macharia. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.10.2021.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 19 April 2021

Date revision requested : 28 June 2021

Date revision received : 1 July 2021

Date accepted : 27 July 2021

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