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

Thesis Abstract

Access to accurate diagnostic testing is critical for effective healthcare delivery, particularly in rural settings where laboratory infrastructure and skilled personnel are often limited, leading to reliance on point-of-care testing (POCT) devices. Despite their widespread adoption due to rapidity and convenience, the diagnostic accuracy of POCT in rural healthcare facilities remains inadequately evaluated, raising concerns about potential misdiagnoses and subsequent patient management errors. This study aims to systematically evaluate the accuracy of POCT devices used in rural clinics, with specific objectives to compare POCT results against laboratory-based gold standard methods, identify factors influencing test accuracy, and assess the impact of operator training and site-specific variables on testing outcomes. Employing a cross-sectional analytical research design, the study targeted a population of 15 rural healthcare facilities within a defined geographic region, selected through stratified random sampling to ensure representativeness. A total of 300 patients presenting with diagnostic indications for selected tests—namely blood glucose, hemoglobin, malaria parasites, and lipid profiles—were consecutively sampled over a six-month period. Data collection instruments included standardized data extraction forms for test results, structured observation checklists for operator performance, and questionnaires assessing operator training levels and equipment maintenance. The validity and reliability of these instruments were established through pilot testing, expert validation, and calculation of Cronbach’s alpha coefficients exceeding 0.8. Data analysis was conducted using SPSS version 26.0. Descriptive statistics summarized demographic and operational characteristics. Paired t-tests and Bland-Altman plots evaluated the agreement between POCT results and laboratory standards, while multivariate regression analysis identified predictors of test accuracy. Analytical frameworks grounded in the Theory of Planned Behavior and the Health Belief Model informed the interpretation of operator performance and contextual factors impacting accuracy. Expected findings include identifying significant discrepancies between POCT and laboratory results, with particular tests (such as lipid profiles) demonstrating lower concordance. Factors such as limited operator training, suboptimal device calibration, and high workload are hypothesized to negatively influence test accuracy. The study anticipates revealing that well-trained operators and regular device maintenance significantly improve POCT reliability. These findings are expected to contribute novel empirical evidence regarding the validity of POCT in low-resource settings and elucidate operational factors affecting diagnostic accuracy, thereby filling existing gaps in the literature where prior studies predominantly focused on urban versus rural comparisons without detailed operational analyses. The study’s main contribution lies in its comprehensive evaluation of the performance of POCT devices within actual rural healthcare contexts, providing policymakers and healthcare practitioners with evidence-based insights to optimize diagnostic strategies. The conclusions are expected to advocate for standardized operator training programs, routine calibration protocols, and quality assurance procedures tailored to rural health settings to enhance test accuracy and ultimately improve patient outcomes. Recommendations will include targeted capacity-building initiatives, integration of POCT quality management frameworks, and further longitudinal studies to assess the impact of implemented interventions over time. This research delineates critical pathways for strengthening diagnostic services in resource-limited rural environments, thereby advancing the overarching goal of equitable healthcare access and quality.