A mobile health tool to guide diagnosis and management of acute pediatric respiratory illnesses in Uganda: Implementation strategies for primary care settings

Background: ALRI is a heterogenous group of diseases without a diagnostic gold standard. Case management remains challenging, especially in resource-constrained settings. Wheezing illnesses in particular are underdiagnosed and go untreated. We developed the Acute Lower Respiratory Treatment and Evaluation (ALRITE) tool as a smartphone-based decision support tool for frontline health workers. ALRITE leverages the WHO Integrated Management of Childhood Illness (IMCI) on management of respiratory illnesses. We piloted ALRITE in clinical care and identified challenges with health system integration. The objective of this study was to identify promising solutions to improve ALRITE integration using a human-centered, implementation approach. Methods: Mixed methods design with healthcare workers at 8 primary care centers in Jinja District, Uganda. We conducted focus group discussions (FGDs) at each site, using nominal group technique to list all barriers impacting health workers’ ability to care for children with respiratory illnesses and implement ALRITE in clinical care. The healthcare workers then ranked barriers by a) importance and b) frequency (how common). We identified the top 5 barriers using go-zone plots and then conducted a second FGD per site whereby health workers brainstormed solutions to address each barrier. The solutions were ranked by a) importance and b) feasibility, using similar techniques as FGD#1. Results: Sixty-six health workers participated from 8 sites. The majority (36%) were registered nurses, 26% were clinical officers, 12% were medical officers, and 26% were technicians/midwives. The top 5 barriers were 1) limited resources for treatment of ALRI, 2) limited ALRITE scope 3) training needs (clinical and technical knowledge), 4) ALRITE integration into workflow, and 5) caregiver acceptability concerns. Examples of linked solutions are found in Table 1. Conclusions: We prioritized addressable barriers to ALRITE use and identified viable solutions. Next steps include ALRITE optimization and evaluation of the refined ALRITE tool in Ugandan health centers.