{
  "abstract": "Introduction Hypoxaemia is an important contributor to child mortality, particularly in low-resource settings where diagnostic tools are scarce. The Améliorer l'Identification des détresses Respiratoires chez l'Enfant project introduced pulse oximeters (POs) into 202 primary healthcare centres (PHCs) in Burkina Faso, Guinea, Mali and Niger, integrating them into the Integrated Management of Childhood Illness guidelines. This initiative aimed to strengthen diagnostic capacities for identifying hypoxaemia and to improve care management for critically ill children under 5. This study examined how healthcare workers (HCWs) adopted POs and explored the contexts and mechanisms influencing their adoption.Methods We conducted a realist evaluation to analyse adoption patterns, focusing on interactions between the Intervention, Contexts, Actors, Mechanisms and Outcomes (ICAMO configurations). Data collection included 299 interviews with HCWs, patients’ families and institutional actors, conducted in 16 selected PHCs, at the institutional level and in district hospitals, complemented by site observations. Analysis was performed using NVivo software, identifying ICAMO configurations as demi-regularities to explain variations in PO use and adoption.Results Training enabled HCWs to recognise the utility of POs, further motivating their use. Support-focused supervision fostered a sense of support, while control-focused approaches sometimes resulted in mechanical use driven by external pressure. In contexts of high workloads and children’s agitation, difficulties in using POs were observed. In settings with limited diagnostic tools, POs increased HCWs’ diagnostic confidence, encouraging adoption and improving decision-making. Observing or knowing the benefits of POs on children’s health provided HCWs with a sense of relief and pride, further reinforcing PO adoption. However, structural barriers and challenges related to institutional adoption may threaten long-term use.Conclusions This study sheds light on the contexts and mechanisms that influence the use and adoption of the PO in PHCs. While widely used by HCWs, 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.",
  "authors": [
    {
      "affiliations": [
        "University of Lille, CNRS, UMR 8019, CLERSE - Centre Lillois d’Études et de Recherches Sociologiques et Économiques, F-59000 Lille, France"
      ],
      "name": "Sarah Louart"
    },
    {
      "affiliations": [
        "African Center of Excellence for the Prevention and Control of Communicable Diseases (CEA-PCMT), Université Gamal Abdel Nasser, Conakry, Guinea"
      ],
      "name": "Habibata Balde"
    },
    {
      "affiliations": [
        "Faculté de Médecine et d’Odontostomatologie, Bamako, Mali",
        "IRL 3189, Santé, Environnement, Sociétés (USTTB - Bamako, UCAD - Dakar, CNR - France, CNST -Ouagadougou), Bamako, Mali"
      ],
      "name": "Abdourahmane Coulibaly"
    },
    {
      "affiliations": [
        "Université Abdou Moumouni, Niamey, Niger"
      ],
      "name": "Abdoua Elhadji Dagobi"
    },
    {
      "affiliations": [
        "Institut de Recherche en Science de la Santé du Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou, Burkina Faso"
      ],
      "name": "Kadidiatou Kadio"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Kessièdé Gildas Boris Hedible"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Valériane Leroy"
    },
    {
      "affiliations": [
        "École nationale d'administration publique (ENAP), Montréal, Quebec, Canada"
      ],
      "name": "Emilie Robert"
    },
    {
      "affiliations": [
        "Université Paris Cité and Université Sorbonne Paris Nord, IRD, Inserm, Ceped, F-75006 Paris, France",
        "⁠Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal"
      ],
      "name": "Valéry Ridde"
    },
    {
      "affiliations": [],
      "name": "For the AIRE study group"
    }
  ],
  "title": "Understanding health innovation adoption: a realist evaluation of pulse oximeter implementation in primary care for children under 5 in four West African countries",
  "uid": "571a8648-6642-5b49-9612-93686a301d6b"
}