Caregivers’ and nurses’ perceptions of the Smart Discharges Program for children with sepsis in Uganda: A descriptive qualitative study

Sepsis arises when the body’s response to infection results in organ dysfunction. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions of the caregivers and nurses of children enrolled into the Smart Discharges Program. We conducted a descriptive qualitative study that used a phenomenological approach. We conducted in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: ([1][1]) Facilitators and barriers to follow-up care after discharge; ([2][2]) Changed behavior following discharge; and ([3][3]) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Resource constraints and negative experiences during post-discharge care seeking were reported as the most prominent barriers to post-discharge follow up. When provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, which was reported as improved engagement in care, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement MOW and NKM received funding (#TTS-1809-1939) for this study from Grand Challenges Canada (GCC). The views expressed are those of the authors and not necessarily those of GCC. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Makerere University School of Public Health, Research and Ethics Committee (SPH-REC # 691) and the Uganda National Council for Science and Technology (UNCST SS #5047) approved this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data generated and analyzed during the current study, which include participant interview and focus group discussion transcripts, are not publicly available due to their potentially directly and indirectly identifiable nature. Furthermore, the open sharing of the qualitative data was not included in the study’s approved protocol nor included in the participant consent forms. Principal investigators can work with interested parties to re-analyze any of the original data if there are queries that are not sufficiently addressed in the manuscript. Reasonable requests can be made to Walimu via corresponding author Dr. Nathan Kenya-Mugisha. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3