JMIR Publications

ABSTRACT

Background:

Sepsis, a life-threatening condition resulting from a dysregulated immune response to infection, disproportionately affects children in low and middle-income countries (LMICs). Septic children in LMICs face high mortality rates, with early detection and clinical monitoring posing a significant challenge to effective management. There is great potential for digital technologies, such as wearable biosensor devices and mobile health (mHealth) clinical decision support (CDS) tools, together referred to as a clinical decision support system (CDSS), to enable closer monitoring and more prompt recognition of children at risk of advanced sepsis and death. However, little is known about healthcare providers’ (HCPs) perceptions of introducing new digital health tools for pediatric sepsis care in LMICs.

Objective:

The objective of this study was to assess HCPs’ understanding, perceptions, and recommendations regarding the design and implementation of digital CDSS for pediatric sepsis care in Bangladesh.

Methods:

Between February and May 2024, 18 individual semi-structured in-depth interviews were conducted with HCPs (nurses and physicians) at three urban Bangladeshi hospitals. The data was transcribed, translated from Bangla to English, and analyzed using a Framework Matrix Analysis approach. Participants were asked about familiarity with digital health tools, feedback on CDSS design, perceptions of the system’s utility, and barriers and facilitators to use of similar tools in clinical settings in Bangladesh.

Results:

Participants reported overall positive perceptions toward the potential implementation of a CDSS for pediatric sepsis care in Bangladesh. Some key priorities for the design of a CDSS were durability, reusability, cost considerations, reliability, and accuracy. Clinicians desired the CDS tool to also have customizable alarm parameters and include additional functions such as glucose monitoring. Many favored audio (ringtone) or visual (light) alarms to alert changes in captured vital signs. HCPs believed a CDSS could enhance patient care by allowing greater staff capacity to monitor patients, reducing management time, and aiding in faster clinical decision-making, with some suggesting it could lower mortality rates. Concerns regarding implementation included internet availability, affordability of the wearable devices, and trust in the CDSS outputs compared to expert clinician judgement.

Conclusions:

These findings highlight HCP’s perceptions towards the potential of wearable biosensor devices and a CDS tool (a CDSS) to improve pediatric sepsis outcomes in LMICs, while highlighting the need to address implementation challenges to ensure their effective integration into healthcare systems.