Felix Sukums1, Nathan Mensah2, Rose Mpembeni3, Siriel Massawe4, Els Duysburgh5, Afua Williams6, Jens Kaltschmidt7, Svetla Loukanova8, Walter E Haefeli9, Antje Blank10. 1. Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar es Salaam, Tanzania. Electronic address: felix@muhas.ac.tz. 2. Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana. Electronic address: mensahnathan@yahoo.com. 3. Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, Department of Epidemiology and Biostatistics, P.O. Box 65015, Dar es Salaam, Tanzania. Electronic address: rcmpembeni@yahoo.com. 4. Muhimbili University of Health and Allied Sciences (MUHAS), School of Medicine, Department of Gynaecology and Obstetrics, P.O. Box 65001, Dar es Salaam, Tanzania. Electronic address: snanzia@gmail.com. 5. International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185, UZP114, 9000 Ghent, Belgium. Electronic address: els.duysburgh@ugent.be. 6. Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana. Electronic address: afuawilliams@yahoo.com. 7. Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: jens.kaltschmidt@med.uni-heidelberg.de. 8. Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, 69120 Heidelberg, Germany. Electronic address: svetla.loukanova@urz.uni-heidelberg.de. 9. Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: walter.emil.haefeli@med.uni-heidelberg.de. 10. Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: antje.blank@med.uni-heidelberg.de.
Abstract
BACKGROUND: The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. OBJECTIVES: This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. METHODS: This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. RESULTS: All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. CONCLUSION: Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care.
BACKGROUND: The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. OBJECTIVES: This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. METHODS: This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. RESULTS: All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. CONCLUSION: Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care.
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