Mwakawanga Dorkasi L, Chen Sanmei, Ogata Yhuko, Suzuki Minami, Kobayashi Yuryon, Toda Miyuki, Hirose Naoki, Shimpuku Yoko
Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2024 Dec 5;19(12):e0314812. doi: 10.1371/journal.pone.0314812. eCollection 2024.
Fetal monitoring in low-resource settings is often inadequate. A mobile cardiotocograph fetal monitoring device is a digital innovation that could ensure the safety of pregnant women at high risk and their fetuses through early detection and management of fetal distress. Research is scarce on factors that affect the implementation of fetal heart monitoring using the mobile cardiotocograph device in low-resource settings, including Tanzania. This study aimed to explore the barriers and facilitators of fetal monitoring with a mobile cardiotocograph device in Tanzania.
We adopted an exploratory qualitative study to analyze the barriers and facilitators of fetal monitoring using the mobile cardiotocograph device in primary healthcare facilities. Seventeen face-to-face in-depth interviews with healthcare providers and seven focus group discussions with women were conducted. Braun and Clarke's thematic analysis guided the data analysis. It included the following steps: familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.
Three themes emerged as barriers: individual-related ones, including inadequate knowledge and skills to use mobile cardiotocograph devices, institutional barriers attributed to limited referral infrastructures and staff shortage, and community-related barriers, such as myths and misconceptions that limit antenatal care checkups. Individual factors, including motives and desires of healthcare providers and community trust in the healthcare system, support systems related to training and mentorship opportunities for healthcare providers, and the availability of community-based health programs in the respective areas, were revealed as facilitators of mobile cardiotocograph devices.
Implementing iCTG in primary healthcare facilities is affected by several factors, from individual to institutional level. Providing user-friendly procedure manuals and training on the functions of the iCTG device and cardiotocograph interpretations could serve as potential solutions to improve the competence and confidence of healthcare providers. Moreover, the availability of supportive infrastructure, adequate human resources for health, and community sensitization were good points to start with when addressing institutional and community barriers. Nevertheless, multistakeholder engagement during the design and implementation of fetal monitoring using a mobile cardiotocograph device is warranted.
在资源匮乏地区，胎儿监测往往不足。移动胎心监护仪是一项数字创新技术，可通过早期发现和处理胎儿窘迫来确保高危孕妇及其胎儿的安全。在包括坦桑尼亚在内的资源匮乏地区，关于影响使用移动胎心监护仪进行胎儿心脏监测实施的因素的研究很少。本研究旨在探讨在坦桑尼亚使用移动胎心监护仪进行胎儿监测的障碍和促进因素。
我们采用探索性定性研究方法，分析在初级卫生保健机构中使用移动胎心监护仪进行胎儿监测的障碍和促进因素。对医疗保健提供者进行了17次面对面深入访谈，并与女性进行了7次焦点小组讨论。数据分析以布劳恩和克拉克的主题分析为指导。它包括以下步骤：熟悉数据、生成初始代码、寻找主题、审查主题、定义和命名主题以及撰写报告。
出现了三个障碍主题：与个人相关的障碍，包括使用移动胎心监护仪设备的知识和技能不足；机构障碍，归因于转诊基础设施有限和人员短缺；以及与社区相关的障碍，如限制产前检查的神话和误解。个人因素，包括医疗保健提供者的动机和愿望以及社区对医疗保健系统的信任、与医疗保健提供者培训和指导机会相关的支持系统，以及各自地区基于社区的健康项目的可用性，被揭示为移动胎心监护仪设备的促进因素。
在初级卫生保健机构中实施iCTG受到从个人到机构层面的几个因素的影响。提供用户友好的操作手册以及关于iCTG设备功能和胎心监护解读的培训，可能是提高医疗保健提供者能力和信心的潜在解决方案。此外，在解决机构和社区障碍时，支持性基础设施的可用性、充足的卫生人力资源以及社区宣传是很好的切入点。然而，在使用移动胎心监护仪进行胎儿监测的设计和实施过程中，多利益相关者的参与是必要的。
