Development of a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

Abstract

The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries.

The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences.

From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis.

Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations.

Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.