TY - JOUR
T1 - The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania
T2 - Lessons Learned Using Intervention Mapping
AU - van Pelt, Sandra
AU - Massar, Karlijn
AU - Shields-Zeeman, Laura
AU - de Wit, John B. F.
AU - van der Eem, Lisette
AU - Lughata, Athanas S.
AU - Ruiter, Robert A. C.
N1 - Funding Information:
This work was supported by funds raised through the African Woman Foundation. The Woman Centered Care Project was supported financially through Triple Jump Funds. During the time of data collection and writing of the manuscript, SP was supported by Maastricht University through the department of Work and Social Psychology.
Funding Information:
1Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands, 2Department of Mental Health and Prevention, Netherlands Institute for Mental Health and Addiction, Utrecht, Netherlands, 3Department of Interdisciplinary Social Science, International Public Health, Utrecht University, Utrecht, Netherlands, 4Woman Centered Care Project, A Project of the African Woman Foundation, Magu, Tanzania
Funding Information:
We would like to thank all healthcare workers who collaborated during the development and implementation of the Nurse Assistant App. We thank the local field team of the African Woman Foundation's Woman Centered Care Project and the Magu District Council for their assistance with local logistics. Special appreciation goes to the software developers of ICT Healthcare Technology Solutions (formerly Buro Medische Automatisering B.V.) for their friendly and patient collaboration. Funding. This work was supported by funds raised through the African Woman Foundation. The Woman Centered Care Project was supported financially through Triple Jump Funds. During the time of data collection and writing of the manuscript, SP was supported by Maastricht University through the department of Work and Social Psychology.
Publisher Copyright:
© Copyright © 2021 van Pelt, Massar, Shields-Zeeman, de Wit, van der Eem, Lughata and Ruiter.
PY - 2021/5/20
Y1 - 2021/5/20
N2 - It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.
AB - It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.
KW - maternal health
KW - antenatal care
KW - digital health
KW - electronic clinical decision and support system
KW - intervention mapping
KW - healthcare worker performance
KW - implementation
KW - HEALTH-WORKERS
KW - STRATEGIES
KW - EDUCATION
KW - PROGRAM
U2 - 10.3389/fpubh.2021.645521
DO - 10.3389/fpubh.2021.645521
M3 - Article
C2 - 34095055
SN - 2296-2565
VL - 9
JO - Frontiers in Public Health
JF - Frontiers in Public Health
M1 - 645521
ER -