Assessment of Point-of-Care Testing Accuracy in Rural Healthcare Facilities

Thesis Abstract

Point-of-care testing (POCT) has become an essential component of diagnostic services in rural healthcare settings, offering rapid results that facilitate timely clinical decision-making and improve patient outcomes. However, concerns persist regarding the accuracy and reliability of POCT devices in resource-limited environments, where factors such as operator skill, environmental conditions, and device maintenance may influence test performance. This study aims to comprehensively assess the accuracy of POCT in rural healthcare facilities and identify determinants of test performance, thereby contributing to improved diagnostic quality and patient care in such settings. The primary objectives are to evaluate the concordance between POCT results and laboratory-based reference tests, examine factors influencing POCT accuracy, and recommend strategies for quality assurance. The study adopts a cross-sectional empirical design, combining quantitative and qualitative approaches to generate a robust understanding of POCT performance. The target population comprises healthcare workers operating POCT devices and their corresponding patient test records within rural clinics across a specified region. A sample size of 300 patients, selected through stratified random sampling to ensure representation of various demographic groups and disease categories, is used, with healthcare workers involved through purposive sampling to include practitioners with varying levels of experience. Data collection involves the use of standardized data extraction forms to record POCT results, laboratory reference test outcomes, and contextual factors such as device maintenance records, environmental parameters, operator training levels, and adherence to testing protocols. The validity and reliability of data are ensured through pre-testing of data collection instruments, calibration of POCT devices, and training sessions for data collectors. Quantitative data are analyzed using statistical techniques such as paired t-tests and Bland-Altman plots to assess agreement, regression analysis to identify predictors of test accuracy, and ANOVA for comparing performance across different facilities and operator profiles. Qualitative data drawn from focus group discussions with healthcare workers are subjected to thematic analysis to explore perceptions, challenges, and suggestions for improving POCT quality. Expected findings indicate that while the majority of POCT results demonstrate acceptable agreement with laboratory standards, variability exists influenced by operator experience, environmental conditions, and device maintenance practices. Several factors, including inadequate training and lack of routine quality control measures, are anticipated to negatively impact accuracy. The study also expects to identify specific thresholds for environmental parameters that compromise device performance. These findings contribute new insights into the contextual determinants of POCT accuracy in rural settings, addressing gaps in existing literature that predominantly focus on urban or well-resourced environments. The study's contribution extends to policy and practice by informing the development of targeted interventions such as standardized training modules, maintenance protocols, and quality assurance frameworks tailored for resource-constrained rural healthcare facilities. It also advances the theoretical understanding of diagnostic accuracy from a systems perspective, integrating the Technology Acceptance Model with environmental and human factors theories. In conclusion, the study underscores the importance of contextually appropriate quality assurance strategies to enhance POCT reliability. It recommends regular training for operators, consistent device calibration, environmental controls, and routine quality checks as essential measures. Future research should explore longitudinal assessments of POCT performance and evaluate the impact of implemented interventions on diagnostic accuracy and patient outcomes. The findings aim to support policymakers, healthcare providers, and stakeholders in optimizing POCT deployment, ultimately improving healthcare delivery in rural areas.