@article{fdi:010095834,
  title = {{U}nderstanding health innovation adoption : a realist evaluation of pulse oximeter implementation in primary care for children under 5 in four {W}est {A}frican countries},
  author = {{L}ouart, {S}. and {B}alde, {H}. and {C}oulibaly, {A}. and {D}agobi, {A}. {E}. and {K}adio, {K}. and {H}edible, {K}. {G}. {B}. and {L}eroy, {V}. and {R}obert, {E}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {H}ypoxaemia is an important contributor to child mortality, particularly in low-resource settings where diagnostic tools are scarce. {T}he {A}m{\'e}iorer l'{I}dentification des d{\'e}tresses {R}espiratoires chez l'{E}nfant project introduced pulse oximeters ({PO}s) into 202 primary healthcare centres ({PHC}s) in {B}urkina {F}aso, {G}uinea, {M}ali and {N}iger, integrating them into the {I}ntegrated {M}anagement of {C}hildhood {I}llness guidelines. {T}his initiative aimed to strengthen diagnostic capacities for identifying hypoxaemia and to improve care management for critically ill children under 5. {T}his study examined how healthcare workers ({HCW}s) adopted {PO}s and explored the contexts and mechanisms influencing their adoption.{M}ethods {W}e conducted a realist evaluation to analyse adoption patterns, focusing on interactions between the {I}ntervention, {C}ontexts, {A}ctors, {M}echanisms and {O}utcomes ({ICAMO} configurations). {D}ata collection included 299 interviews with {HCW}s, patients' families and institutional actors, conducted in 16 selected {PHC}s, at the institutional level and in district hospitals, complemented by site observations. {A}nalysis was performed using {NV}ivo software, identifying {ICAMO} configurations as demi-regularities to explain variations in {PO} use and adoption.{R}esults {T}raining enabled {HCW}s to recognise the utility of {PO}s, further motivating their use. {S}upport-focused supervision fostered a sense of support, while control-focused approaches sometimes resulted in mechanical use driven by external pressure. {I}n contexts of high workloads and children's agitation, difficulties in using {PO}s were observed. {I}n settings with limited diagnostic tools, {PO}s increased {HCW}s' diagnostic confidence, encouraging adoption and improving decision-making. {O}bserving or knowing the benefits of {PO}s on children's health provided {HCW}s with a sense of relief and pride, further reinforcing {PO} adoption. {H}owever, structural barriers and challenges related to institutional adoption may threaten long-term use.{C}onclusions {T}his study sheds light on the contexts and mechanisms that influence the use and adoption of the {PO} in {PHC}s. {W}hile widely used by {HCW}s, addressing challenges related to training, supply chain logistics and referral systems to hospitals is essential to ensure long-term sustainability and improve child health outcomes.},
  keywords = {{D}iagnostics and tools ; {H}ealth {P}ersonnel ; {C}hild health ; {R}espiratory infections ; {O}ther study design ; {BURKINA} {FASO} ; {GUINEE} ; {MALI} ; {NIGER} ; {AFRIQUE} {SUBSAHARIENNE} ; {AFRIQUE} {DE} {L}'{OUEST}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {10},
  numero = {{S}uppl. 8},
  pages = {e017303 [14 p.]},
  ISSN = {2059-7908},
  year = {2025},
  DOI = {10.1136/bmjgh-2024-017303},
  URL = {https://www.documentation.ird.fr/hor/fdi:010095834},
}