Improving child health care with human-centered design and multimodal devices

Accurate triage and diagnosis are critical for providing the best medical care for children under 5 years, especially those with febrile illnesses and respiratory distress. While febrile cases often resolve on their own, pneumonia, a major contributor to child mortality, presents challenges due to similar symptoms with other respiratory conditions, and the potential for hypoxemia. In resource-limited settings, where relying solely on clinical assessments can result in missing up to 40 percent of cases, there’s an urgent need for more efficient interventions.

Health systems in low-resource settings grapple with severe shortages in personnel, medical equipment, and other resources, necessitating strategic and innovative solutions. There is a growing awareness and recognition of the vast potential of emerging technologies such as artificial intelligence to revolutionize health care access, quality, and cost.

Pulse oximeters and other vital sign measurement tools are instrumental in identifying major causes of illness and death in children and are commonly available in most high-income primary care settings. The introduction of new integrated vital sign measurement tools, specifically designed to meet the unique needs of health care workers and the constraints of low-resource settings, has the potential to greatly enhance the screening and triage of ill children. These new tools, coupled with emerging and mobile technologies, offer an exciting opportunity not only to optimize existing resources and address workforce shortages in primary health care facilities but also to significantly improve health care delivery and outcomes.

Research and development efforts are underway to create next-generation multimodal devices that integrate multiple clinical measurements and features. Despite this progress, there is a notable gap in evidence regarding the performance and operational feasibility of these devices in primary health care settings in low- and middle-income countries, especially within Integrated Management of Childhood Illness (IMCI) care practices.

PATH initiated a series of human-centered design workshops in India, Kenya, Senegal, and Tanzania for primary care providers, caregivers, and other stakeholders involved in managing childhood illnesses. The goal was to gather diverse perspectives on the use of multimodal devices and smartphone-enabled tools in IMCI through activities such as administration of questionnaires; strengths, weaknesses, opportunities, and threats analysis; focus group discussions; and priority ranking.

Stakeholders emphasized the need for multimodal devices to function both as spot-checking and continuous monitoring tools, to provide quick vital sign assessments during triage and facilitate ongoing patient monitoring throughout each visit. Efficiency was a major concern, with stakeholders advocating for results within one minute. Smartphone integration was also explored, prioritizing respiratory rate, blood oxygen saturation, and temperature as crucial parameters for early detection with the more innovative smartphone-enabled health technologies. Existing methods for measuring respiratory rates were criticized for their unreliability, and new user-friendly tools to support health workers would be a welcome improvement.

After synthesizing the content generated through the various focus groups, surveys and prioritization activities, the following recommendations were highlighted:

Future multimodal devices

• Strategic introduction: Implement devices at triage or consultation stages within IMCI workflows.
• User-centric approach: Introduce devices using a bottom-up approach, emphasizing human-centered design principles and comprehensive training for seamless integration.
• Evidence-based introduction: Support device introduction with evidence-based research, including facility-based piloting.
• Infrastructure leverage: Capitalize on existing health care infrastructure to ensure smooth integration.
• Feature alignment: Align device features with priority parameters identified by stakeholders for enhanced usability.
• Community education: Conduct health talks to educate the community on the device’s purpose and use for widespread acceptance.

Smartphone use in IMCI

• Training programs: Implement training programs to enhance health care providers’ proficiency in utilizing smartphones for IMCI.
• Clinical judgment emphasis: Emphasize maintaining clinical judgment alongside smartphone use to prevent over-reliance on technology.
• Data privacy alignment: Design solutions aligned with country-specific data privacy and security guidelines.
• Community education: Educate the community on the purpose and use of smartphones in IMCI to garner widespread acceptance and support.

Click here for details of these findings.

The Tools for Integrated Management of Childhood Illness project’s exploration into next-generation pulse oximeters through human-centered design workshops in diverse low- and middle-income countries provides invaluable insights. The integration of multimodal devices and the potential use of smartphones in childhood illness management offers promising avenues for improved health care outcomes. The recommendations serve as a comprehensive guide for the strategic introduction and utilization of these technologies, emphasizing evidence-based practices and community engagement. Successful collaboration between health care providers, caregivers, and stakeholders is pivotal for the effective implementation of next-generation pulse oximeters in primary care settings globally.

• Bill & Melinda Gates Foundation
• Ifakara Health Institute
• India Ministry of Health
• Kenya Ministry of Health
• Kenya Paediatric Research Consortium
• King George’s Medical University
• Senegal Ministry of Health
• Swiss Tropical and Public Health Institute
• Tanzania Ministry of Health
• Unisanté
• Unitaid
• Université Cheikh Anta Diop
• University of Nairobi