Implementation of a digital clinical decision support tool for pediatric respiratory illnesses in 2 outpatient facilities in Uganda and qualitative analysis of challenges and opportunities

Background Acute lower respiratory illnesses (ALRI) are the leading cause of mortality in young children, the greatest burden in sub-Saharan Africa. We developed the ALRITE digital clinical decision support (CDS) tool to aid healthcare workers (HCWs) in diagnosing and managing ALRI in children, with a focus on wheezing illness/asthma. The objective was to evaluate ALRITE implementation and understand barriers/facilitators from HCW and caregiver perspectives. Methods This was a prospective implementation study of ALRITE deployment at 2 health centers in Uganda over 3 months. Medical officers and clinical officers were eligible to participate. ALRITE metrics included use, time per encounter, and clinical data. We performed one focus group discussion (FGD) with HCWs and 2 FGDs with caregivers. We analyzed qualitative data using content analysis. Codes were aggregated into major themes and subthemes and organized post hoc using the Consolidated Framework for Implementation Research (CFIR). Results We enrolled all eligible HCWs ( n = 7 clinical officers). Median age was 39 (IQR 28–42) years. Six (86%) were male. We enrolled 23 caregivers with median age 36 (IQR 29–43) years;19 (83%) were female. There were 1,129 clinical consultations among children aged 2–59 months presenting with acute respiratory complaints: Upper respiratory infections (URI) (50%) and pneumonia (47%) were the most common diagnoses. Asthma was rarely diagnosed (0.35%). ALRITE was used in 159 (14%) clinical consultations. Median ALRITE encounter duration was 4 (IQR 3–7) minutes. We defined themes in alignment with the CFIR: (1) ALRITE is accurate, well-organized, and improves HCW confidence and care for children with wheezing illnesses but requires optimization in efficiency, flexibility and comprehensive care (intervention characteristics); (2) successful ALRITE implementation requires improving communication between HCWs and caregivers (individuals) (3) equipment shortages, insecure technology infrastructure, and limited staffing are significant barriers to pediatric respiratory care and implementing new technologies (inner/outer setting); and (4) engaging caregivers early in implementation, improving HCW training, and incorporating performance reviews and incentives may also enhance adoption (process). Conclusions ALRITE remains a promising tool to improve ALRI management and increase awareness of wheezing but requires improved design, community engagement, and integration into clinical care.