The Nurse Assistant App: development and evaluation of an electronic decision aid to improve the quality of antenatal care in Magu district, Tanzania

The Nurse Assistant App (NAA) is a tablet-based electronic decision aid that offers step-by-step guidance for healthcare workers providing antenatal care in rural health facilities in Tanzania. The thesis aims to assess whether the NAA might be a useful tool to improve the quality of antenatal care. Therefore, it investigated the interest in the NAA among healthcare workers and pregnant wome, assessed the quality of the systematic development of the App by using Intervention Mapping, and evaluated its impact on the comprehensiveness of essential antenatal care service provision using a mixture of quantitative and qualitative research methodologies. This thesis demonstrates that both healthcare workers and pregnant women possess a positive attitude towards the use of the NAA during antenatal care as they expected the aid to improve record keeping and the overall quality of care. However, the research could not confirm the hypothesis that the use of the NAA would increase the number of essential antenatal care interventions. In fact, health facilities where the NAA was used during antenatal care scored a lower completeness score for delivery of essential antenatal care services compared to control health facilities. A possible explanation for this unexpected result might be the extra burden for healthcare workers using the NAA as healthcare workers expressed that the NAA increased their workload, and took more time than using the standard paper-based registers.