Abstract
BackgroundVital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device.MethodsEvaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach.ResultsMost healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device’s accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period.ConclusionThe CRADLE device was well accepted by healthcare workers from a range of countries and levels of facility, including those with no previous vital signs measurement experience. The device motivated women to attend primary care and encouraged them to accept treatment and referral.
Highlights
Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral
Evaluation in India and Mozambique was embedded in the Community Level Intervention for Pre-eclampsia (CLIP) Trial (NCT01911494) [18], a cluster randomised control trial evaluating a package of interventions including the CRADLE device, with evaluation in Nigeria being part of a process evaluation run alongside the trial
This study enabled better understanding of the facilitators and barriers to use of the CRADLE Vital Signs Alert (VSA)
Summary
Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Even when appropriate equipment is available, the level of training required to accurately measure and act on vital sign measurements (including blood pressure (BP) and pulse) is often lacking. These barriers contribute to avoidable maternal and perinatal mortality and morbidity, which are most prevalent in low-resource settings [2]. It meets the World Health Organization’s criteria for low-resource settings, being robust and portable, having low power requirements
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