Understanding community-level medical device implementation

One of the products BEMPU has recently developed is a smart cradle, called CareCradle, that monitors high-risk babies for complications at home. Using a simple app that requires just one button push, parents send four videos per day of their baby to clinical staff, who review them for visually-identifiable complications and connect parents to skilled care if required. A pilot investigation with the cradle is currently being conducted in Shimoga, a district in northern Karnataka, to understand CareCradle’s feasibility and acceptability in home settings.

One of my personal areas of interest is community-based public health interventions, so while I’m not on the team working on this project, I’ve been following the progress of the CareCradle implementation. I spoke with one of our product designers, Sailee Adhao—who is working on the pilot—to learn more about what it’s like to implement this device at the community level. A few of our team members, including Sailee, have visited Shimoga multiple times to bring devices, train staff and join them on home visits, and to overall oversee implementation. I was interested in hearing particularly about the process of introducing a new medical device in a rural setting, and how families and communities respond to such an intervention.

First, the process of providing the cradle to a family: When the team identifies (usually with the help of a doctor) a family whose high-risk baby is being discharged from the district hospital NICU, or neonatal intensive care unit, the team meets with them in the hospital to explain what the device is, provide training, and take informed consent if the family agrees to participate in the pilot. Our team has noticed that parents often respond more positively to the device if a doctor is involved, for example in making the introduction to the BEMPU team. There are set training instructions, but Sailee noted that parents often have widely-varying perceptions about the device and service, and it’s difficult to predict what extended family members at home will think about the device when providing training for parents at the hospital.

The device has been designed for use in a low-resource setting and to be appropriate for parents with low health literacy—for example, intuitive cues were added to demonstrate how to properly position the baby in the cradle. It also includes toys to make it baby-friendly and less intimidating than a typical medical device. While mothers, the typical users of the device, report that the device is easy to use, interestingly our team has noted that soliciting constructive feedback from families has been difficult. When asked for feedback, mothers often cite user error and rarely offer any sort of criticism of the device or service. Sailee suggested that this population, largely low-income, rural families, may not be used to being asked for feedback; however, this can make it difficult for BEMPU to make changes or improvements based on users’ experiences. Another important takeaway is that while the CareCradle can be useful in identifying complications and suggesting corrective action, ultimately it is up to parents to seek care for their infants should it be necessary. Most of the families using CareCradle face barriers to seeking care—including significant distance from health facilities, lack of transportation, and others—that place limits on their abilities to access health services even when complications are identified. It is crucial that interventions such as CareCradle are integrated with existing healthcare delivery and social support systems to help address these additional barriers.

One of the most incredible things our field team has witnessed, Sailee mentioned, is just how dedicated mothers are to their babies’ health, despite often facing their own health problems and needing to adjust to the responsibility of caring for a critically ill infant. She noted that mothers are often still experiencing post-delivery discomfort or other issues at the time the team is working with them to provide training on CareCradle; yet, they sit attentively through the instructional session and demonstrate their commitment to caring for their baby. Part of the objective of the CareCradle system is to promote parents’ improved awareness of neonatal health issues, and to keep them actively engaged in understanding changes in their baby’s health. We hope that CareCradle will not only help detect and address complications for infants, but will also offer a learning opportunity that empowers parents to provide the best care possible for their baby.

Abby graduated from the University of Wisconsin-Madison in May 2016 with a double major in Biology and Gender and Women’s Studies and a Certificate in Global Health. As a student, she worked as a research assistant on projects examining gendered causes of health disparities, volunteered as a health coach at a community health center, and worked with the Wisconsin Department of Health Services to develop a policy to address physician shortages in rural areas of the state. She has spent the last year as a Maternal Child Health Coordinator with the National Health Corps Pittsburgh, an AmeriCorps program, working with high-risk women and families to provide health education and case management services. In summer 2016, she completed a research internship with the Public Health Foundation of India in Gurgaon, where she worked on a project studying treatment for anemia in pregnancy. She is excited to be returning to India to work on a public health project with Bempu!

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