Shahil-Feroz Anam, Riaz Andaz, Yasmin Haleema, Saleem Sarah, Bhutta Zulfiqar, Seto Emily
Community Health Sciences Department, Aga Khan University, Karachi, Pakistan.
Dalla Lana School of Public Health, The University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.
Digit Health. 2024 Dec 10;10:20552076241292682. doi: 10.1177/20552076241292682. eCollection 2024 Jan-Dec.
In Pakistan, a smartphone-based telemonitoring (TM) program (Raabta) has been designed to support pregnant women with high risk for preeclampsia (HRPE) in Pakistan. However, implementing TM interventions is often challenging, particularly in low-resource settings, given the complexity of healthcare environments and variations in public and private health sectors. This study explores the potential barriers and facilitators for a sustained implementation of the Raabta program in public and private sector hospitals in Pakistan.
Using a qualitative description design, 57 semi-structured interviews with a diverse group of participants including patients from the public (15) and private sector hospitals (17), obstetricians from the public (5) and private sector hospitals (7), decision-makers (7) and telehealth experts (6). Participants were recruited using purposive and snowball sampling techniques. Interview transcripts were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) domains.
Based on the CFIR domains, the findings included: (1) Raabta being perceived as user-friendly even for patients with low digital and language literacy; (2) Outer settings: Limited health and digital literacy, poor language proficiency, and cultural norms can influence the willingness and ability of public sector patients to use the Raabta; (3) Inner settings: The private health sector is well-equipped for the Raabta implementation, while the public health sector faces challenges related to physical space, limited human and financial resources, and physician resistance; (4) Individual characteristics: Majority participants demonstrated positive attitudes toward the Raabta program and expressed confidence in using it (5) Process: Recommendations included adopting a nurse-led model for the private sector, leveraging paramedics for monitoring the Raabta dashboard, integrating Raabta with existing digital platforms, and establishing an advisory committee for program sustainability.
Raabta implementation may be more feasible in the private sector due to patient demographics, health and digital literacy, cultural norms, financial resources, physician readiness, and hospital infrastructure.
在巴基斯坦，已设计了一项基于智能手机的远程监测（TM）计划（Raabta），以支持该国患先兆子痫高风险（HRPE）的孕妇。然而，鉴于医疗环境的复杂性以及公共和私营卫生部门的差异，实施远程监测干预措施往往具有挑战性，尤其是在资源匮乏的环境中。本研究探讨了在巴基斯坦公共和私营部门医院持续实施Raabta计划的潜在障碍和促进因素。
采用定性描述设计，对包括公立（15名）和私立部门医院（17名）的患者、公立（5名）和私立部门医院（7名）的产科医生、决策者（7名）和远程医疗专家（6名）在内的不同参与者群体进行了57次半结构化访谈。使用目的抽样和滚雪球抽样技术招募参与者。使用实施研究综合框架（CFIR）领域对访谈记录进行演绎分析。
基于CFIR领域，研究结果包括：（1）即使对于数字和语言素养较低的患者，Raabta也被认为易于使用；（2）外部环境：健康和数字素养有限、语言能力差以及文化规范会影响公立部门患者使用Raabta的意愿和能力；（3）内部环境：私营卫生部门具备实施Raabta的良好条件，而公共卫生部门面临与物理空间、人力和财力资源有限以及医生抵触相关的挑战；（4）个人特征：大多数参与者对Raabta计划表现出积极态度，并对使用该计划表示有信心；（5）过程：建议包括为私营部门采用护士主导模式、利用护理人员监测Raabta仪表板、将Raabta与现有数字平台整合以及建立咨询委员会以确保计划的可持续性。
由于患者人口统计学、健康和数字素养、文化规范、财政资源、医生意愿和医院基础设施等因素，Raabta计划在私营部门的实施可能更可行。
