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Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative
Justine Behan1, Olive Kabajaasi2, Brooklyn Derksen3
1Institute for Global Health, BC Children's Hospital and BC Women's Hospital + Health Centre, Vancouver, Canada.
Insights
The Smart Discharges Program improved pediatric post-discharge care in low-income countries. Mobile health interventions enhanced caregiver knowledge and male involvement, reducing mortality risks for children with sepsis.
Area of Science:
- Global Health
- Pediatrics
- Health Informatics
Background:
- Sepsis poses a significant mortality risk for children in low-income countries, with high post-discharge death rates.
- The Smart Discharges Program utilizes a mobile health (mHealth) platform to mitigate this risk by identifying high-risk children for enhanced care.
Purpose of the Study:
- To explore caregiver and nurse perceptions of the Smart Discharges Program.
- To assess the program's impact on pediatric post-discharge care in Uganda.
Main Methods:
- An exploratory qualitative study involving focus group discussions with 30 caregivers.
- Semi-structured interviews with 8 nurses from four Ugandan hospitals.
- Thematic analysis of collected qualitative data.
Main Results:
- Key themes identified: facilitators/barriers to follow-up care, changes in caregiver behavior, and increased male caregiver involvement.
- Facilitators included mHealth reminders and strong nurse-patient relationships; barriers involved resource constraints.
- Caregivers showed increased knowledge and improved care practices; male involvement and family communication were enhanced.
Conclusions:
- The Smart Discharges Program effectively improves pediatric post-discharge care and the hospital-to-home transition.
- mHealth strategies show promise for reducing post-discharge mortality in similar settings.
- Enhanced post-discharge support is crucial for vulnerable pediatric populations.
Abstract:
Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.
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