Accepted for/Published in: JMIR Human Factors
Date Submitted: Dec 1, 2021
Date Accepted: Nov 9, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The acceptability and feasibility of a low-cost device for gestational age assessment in a low resources setting: A qualitative assessment
ABSTRACT
Background:
Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with Artificial Intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal trans-cerebellar diameter and head circumference.
Objective:
In this study we assess perceptions of pregnant women, their families and health care workers regarding feasibility and acceptability of this device in an appropriate setting.
Methods:
A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (n=52) and 18 in-depth interviews.
Results:
Overall, TraCer was found to be highly acceptable to women, their families and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers as well as save time and cost by reducing unnecessary referrals. It was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy towards the new technology indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of healthcare professional to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common with a tendency to over-estimate the diagnostic capability and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily a GA.
Conclusions:
This study shows a positive attitude towards TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse.
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