Apredictive monitoring system for criticaly ill children in Malawi. A mixed methods usability and implentation research
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Date
2022-03-22
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Abstract
Type of Research: This study will employ qualitative and quantitative research methods from the
social sciences and human-centred design to assess the usability and implementation determinants of a
predictive vital sign monitoring system for critically ill children in Queen Elizabeth Central and Zomba
Central hospitals in Malawi.
The problem: Each year in low-income countries, millions of children die because high-quality
healthcare is not provided. Many of these deaths result from poverty-related diseases that are
recognized too late. The monitoring of vital signs is essential to detect critical illness promptly. However,
the monitoring systems widely and effectively used in high-resource settings are not suitable for lowincome
settings because of their high up-front and ongoing costs, and limited adaptation to the socioeconomic
background, working conditions and workflows.
To address this problem, a consortium of Malawian and European researchers is developing an
affordable, durable, and user-friendly monitoring system (IMPALA) for hospitalised children in lowincome
countries. The IMPALA system combines innovative sensors, predictive machine learning
algorithms, and point-of-care biomarkers within a simple monitoring system that enables health
workers to detect and predict critical illness quickly. The implementation and usability research will run
prior to and in parallel with clinical research on the IMPALA system.
The setting often complicates the implementation and ultimate impact of health interventions:
even interventions that may seem simple, such as the mass rollout of malaria rapid diagnostic tests, can
fail to deliver the desired effects and have unintended consequences. Usability and implementation
research seeks to examine the acceptability, accessibility, feasibility, and appropriateness of
interventions in real-life circumstances and the factors (barriers and drivers) that influence their impact.
Such research hence enables health interventions such as IMPALA to maximize the desired impact, in
this case, improving critical care for children and their health outcomes.
The objectives: The study's broad aim is to explore the (healthcare system, social and cultural)
context-related factors to be considered in the design and implementation of the IMPALA system to
optimise its feasibility, usability and impact on clinical care.
The methodology: A mixed-methods approach, combining qualitative and quantitative methods from
the social sciences and user-centered design, will be used. The study comprises three stages (pre-
IMPALA, IMPALA 2.0 and IMPALA 3.0). During pre-IMPALA, the current context of care for critically ill
children in Zomba Central Hospital will be studied. In stage 2.0, alongside clinical research on the
IMPALA system 2.0 (described in a separate protocol), the implementation of the monitoring system will
be studied. Stage 3.0 focuses on the updated IMPALA system with monitoring based on predictive
algorithms.
Methods include questionnaire-based surveys, in-depth interview, focus group
discussions/co-design sessions, cognitive walkthroughs, heuristic evaluation, analysis of de-identified
routine monitoring data and medical records, and ethnographic and structured observations. Data will
be collected with healthcare providers, support staff, and the parents/guardians of critically ill children.
Expected findings: The study results will be used to adapt the system during its ongoing
development and make recommendations to ensure that its implementation has the desired impact on
clinical practice and the health outcomes of critically ill children.
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Research Subject Categories::IMPLEMENTATION SCIENCE