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  1. Home
  2. Understanding Pulse Oximetry Adoption In Primary Healthcare Facilities In Nigeria: A Realist Process Evaluation Of The Inspiring-lagos Stabilisation Room Project.
  1. Home
  2. Understanding Pulse Oximetry Adoption In Primary Healthcare Facilities In Nigeria: A Realist Process Evaluation Of The Inspiring-lagos Stabilisation Room Project.

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Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of

Omotayo Emmanuel Olojede1, Adegoke G Falade1,2, Ayobami Adebayo Bakare3,4

  • 1Department of Paediatrics, University College Hospital, Ibadan, Nigeria.

BMJ Public Health
|November 5, 2025

View abstract on PubMed

Summary
This summary is machine-generated.
Keywords:
Public HealthPublic Health PracticeTranslational Science, Biomedical

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Low pulse oximetry use in Nigerian primary healthcare facilities hindered pneumonia treatment. Barriers included insufficient training reach, perceived extra workload, lack of institutional support, and technical issues, preventing effective adoption.

Area of Science:

  • Public Health
  • Pediatrics
  • Health Systems Strengthening

Background:

  • The Integrated Sustainable Childhood Pneumonia and Infectious diseases Reduction in Nigeria-Lagos project aimed to improve pneumonia care in primary healthcare facilities (PHCs) by introducing pulse oximetry and oxygen.
  • Impact evaluation revealed minimal improvements in treatment and referral practices, primarily due to low pulse oximetry utilization among healthcare workers (HCWs).

Purpose of the Study:

  • To investigate the factors influencing the adoption and utilization of pulse oximetry within the 'stabilisation room' intervention in Lagos State, Nigeria.
  • To understand the contextual mechanisms through which the intervention succeeded or failed to improve pulse oximetry practices for children with pneumonia.

Main Methods:

  • A preplanned mixed-methods realist evaluation was employed, guided by an initial program theory.
  • Quantitative data from the impact evaluation were combined with qualitative data from training observations, monitoring records, site reports, and interviews with HCWs.
  • Inductive content analysis and iterative triangulation of themes with process data were used to generate and test theories of change.
  • Main Results:

    • Four themes explained low pulse oximetry adoption: insufficient reach of training to frontline HCWs due to staff turnover and competing demands.
    • Pulse oximetry was perceived as extra work, requiring external motivation and supervision, and was not integrated into usual PHC practice.
    • Lack of institutional norms and perceived self-efficacy led to selective use of pulse oximetry.
    • Technical challenges and equipment malfunction, coupled with a lack of troubleshooting support, demotivated HCWs.

    Conclusions:

    • Successful implementation of pulse oximetry in primary care requires a clear definition of its role and strong normative guidance.
    • Close support and supervision are crucial during the initial adoption phase to overcome barriers and foster sustained use.