Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience

In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients’ perceptions of care and providers’ experience with ultrasound implementation during labour...

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Autores principales:	Nathan Isabirye, Rose Kisa, Nicole Santos, Sachita Shah, Jude Mulowooza, Dilys Walker, Peter Waiswa
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/65e2ddf6bf8f48c88d4da0ba637c45e8
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spelling	oai:doaj.org-article:65e2ddf6bf8f48c88d4da0ba637c45e82021-11-25T06:11:04ZUltrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience1932-6203https://doaj.org/article/65e2ddf6bf8f48c88d4da0ba637c45e82021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589172/?tool=EBIhttps://doaj.org/toc/1932-6203In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients’ perceptions of care and providers’ experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives’ experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby’s condition. For the midwives’ perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers’ clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.Nathan IsabiryeRose KisaNicole SantosSachita ShahJude MulowoozaDilys WalkerPeter WaiswaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nathan Isabirye Rose Kisa Nicole Santos Sachita Shah Jude Mulowooza Dilys Walker Peter Waiswa Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
description	In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients’ perceptions of care and providers’ experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives’ experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby’s condition. For the midwives’ perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers’ clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.
format	article
author	Nathan Isabirye Rose Kisa Nicole Santos Sachita Shah Jude Mulowooza Dilys Walker Peter Waiswa
author_facet	Nathan Isabirye Rose Kisa Nicole Santos Sachita Shah Jude Mulowooza Dilys Walker Peter Waiswa
author_sort	Nathan Isabirye
title	Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
title_short	Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
title_full	Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
title_fullStr	Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
title_full_unstemmed	Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience
title_sort	ultrasound at labour triage in eastern uganda: a mixed methods study of patient perceptions of care and providers’ implementation experience
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/65e2ddf6bf8f48c88d4da0ba637c45e8
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Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience

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