Table 4.
Barriers and facilitators to ultrasound use in low- and middle-income countries.
| Evaluation of individual potential barriers and facilitators | p-value* | Top choice barrier or facilitator | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Definitely a barrier N (%) | Somewhat a barrier N (%) | Neither barrier nor facilitator N (%) | Somewhat a facilitator N (%) | Definitely a facilitator N (%) | Not applicable N (%) | Top barrier**N (%) out of 162 | Top facilitator**N (%) out of 159 | ||
| Cost of equipment (N = 158) | 54 (34.2) | 39 (24.7) | 30 (19.0) | 7 (4.4) | 12 (7.6) | 16 (10.1) | < 0.001 | 14 (8.6) | 1 (0.6) |
| Ability to send images for remote expert interpretation (N = 159) | 33 (20.8) | 32 (20.1) | 25 (15.7) | 16 (10.1) | 32 (20.1) | 21 (13.2) | 0.13 | 2 (1.2) | 2 (1.3) |
| Access to expert support for ongoing mentoring/training (N = 159) | 28 (17.6) | 42 (26.4) | 15 (9.4) | 23 (14.5) | 42 (26.4) | 9 (5.7) | 0.73 | 22 (13.6) | 6 (3.8) |
| Access to education/training (N = 161) | 34 (21.1) | 37 (23.0) | 14 (8.7) | 21 (13.0) | 48 (29.8) | 7 (4.4) | 0.93 | 20 (12.4) | 11 (6.9) |
| Competition for use (N = 159) | 21 (13.2) | 37 (23.3) | 44 (27.7) | 11 (6.9) | 25 (15.7) | 21 (13.2) | 0.03 | 6 (3.7) | 0 (0.00) |
| Access to radiology consultants (N = 160) | 24 (15.0) | 37 (23.1) | 27 (16.9) | 25 (15.6) | 37 (23.1) | 10 (6.3) | 1.0 | 1 (0.6) | 4 (2.5) |
| Access to learning resources (N = 158) | 20 (12.7) | 40 (25.3) | 16 (10.1) | 31 (19.6) | 43 (27.2) | 8 (5.1) | 0.26 | 4 (2.5) | 5 (3.1) |
| Access to maintenance/repair (N = 160) | 36 (22.5) | 22 (13.8) | 21 (13.1) | 23 (14.4) | 47 (29.4) | 11 (6.9) | 0.33 | 16 (9.9) | 0 (0.00) |
| Policies/guidelines on use (N = 160) | 18 (11.6) | 40 (25.0) | 32 (20.0) | 19 (11.9) | 40 (25.0) | 11 (6.9) | 1.0 | 5 (3.1) | 4 (2.5) |
| Ability to generate high-quality images (N = 157) | 20 (12.7) | 34 (21.7) | 25 (15.9) | 21 (13.4) | 49 (31.2) | 8 (5.1) | 0.18 | 6 (3.7) | 2 (1.3) |
| Ability to interpret images (N = 160) | 19 (11.9) | 33 (20.6) | 18 (11.3) | 28 (17.5) | 54 (33.8) | 8 (5.0) | 0.012 | 2 (1.2) | 4 (2.5) |
| Access to probes (N = 161) | 21 (13.0) | 29 (18.0) | 7 (4.4) | 21 (13.0) | 71 (44.1) | 12 (7.5) | < 0.001 | 4 (2.5) | 1 (0.6) |
| Access to machines (N = 160) | 23 (14.4) | 27 (16.9) | 7 (4.4) | 20 (12.5) | 74 (46.3) | 9 (5.6) | < 0.001 | 27 (16.7) | 84 (52.8) |
| Exam time (N = 159) | 11 (6.9) | 34 (21.4) | 40 (25.2) | 26 (16.4) | 37 (23.3) | 11 (6.9) | 0.10 | 2 (1.2) | 2 (1.3) |
| Ability to refer based on ultrasound findings (N = 160) | 9 (5.6) | 30 (18.8) | 37 (23.1) | 17 (10.6) | 49 (30.6) | 18 (11.3) | 0.011 | 2 (1.2) | 2 (1.3) |
| Support of use by hospital administration (N = 159) | 18 (11.3) | 22 (13.8) | 27 (17.0) | 26 (16.4) | 59 (37.1) | 7 (4.4) | < 0.001 | 4 (2.5) | 7 (4.4) |
| Acceptance of use by healthcare providers (N = 159) | 5 (3.1) | 33 (20.75) | 31 (19.5) | 26 (16.4) | 54 (34.0) | 10 (6.3) | < 0.001 | 6 (3.7) | 7 (4.4) |
| Patient understanding (N = 159) | 12 (7.6) | 21 (13.2) | 66 (41.5) | 18 (11.3) | 29 (18.2) | 13 (8.2) | 0.15 | 1 (0.6) | 0 (0.0) |
| Access to gel (N = 159) | 3 (1.9) | 25 (15.7) | 27 (17.0) | 17 (10.7) | 73 (45.9) | 14 (8.8) | < 0.001 | 0 (0.0) | 2 (1.3) |
| Access to electricity/power (N = 160) | 7 (4.4) | 17 (10.6) | 24 (15.0) | 11 (6.9) | 84 (52.5) | 17 (10.6) | < 0.001 | 0 (0.0) | 4 (2.5) |
| Acceptance of use by patients (N = 161) | 3 (1.9) | 10 (6.2) | 52 (32.3) | 28 (17.4) | 51 (31.7) | 17 (10.6) | < 0.001 | 0 (0.0) | 3 (1.9) |
*p-value comes from combining definitely a barrier with somewhat a barrier and combining definitely a facilitator with somewhat a facilitator for each row, leaving out neither barrier nor facilitator and not applicable, and performing an exact binomial test to determine whether the proportion of barriers for each row is different from 0.50. Significant values are in bold.
**N reported includes not applicable (N/A) responses. For top barrier, 14 respondents answered N/A; for top facilitator, 7 respondents answered N/A.