scholarly journals The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

2021 ◽  
Vol 9 ◽  
Author(s):  
Sandra van Pelt ◽  
Karlijn Massar ◽  
Laura Shields-Zeeman ◽  
John B. F. de Wit ◽  
Lisette van der Eem ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Support System ◽  
Healthcare Workers ◽  
Digital Health ◽  
Intervention Mapping ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Maternal Deaths ◽  
Nurse Assistant

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.

scholarly journals “The nurse assistant app” to improve healthcare worker performance during antenatal care in Tanzania

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S van Pelt ◽  
K Massar ◽  
L van der Eem ◽  
L Shields-Zeeman ◽  
J B F de Wit ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Healthcare Workers ◽  
Digital Health ◽  
Intervention Mapping ◽  
Sub Saharan Africa ◽  
Systematic Evaluation ◽  
Future Research ◽  
Change Models ◽  
Nurse Assistant

Abstract Background The Nurse Assistant App (NAA) was developed to improve the quality of antenatal care in Magu District Tanzania by providing digital assistance to healthcare workers. The NAA guides healthcare workers step by step through all necessary antenatal care interventions and provides tailored advice and suggestions for follow-up actions. We used the Intervention Mapping framework to retrospectively evaluate the development of the NAA. Methods Desk research into the content, evidence base, and development of the NAA was performed combined with semi-structured interviews with two initial developers to fill in a planning tool consisting of 40 criteria for systematic evaluation of the data. Results Findings showed that the NAA was developed based on existing literature on antenatal care guidelines as well as the knowledge and experience of a broad variety of stakeholders and that five of the six steps of Intervention Mapping were performed. However, the development of the NAA lacked a theoretical foundation on behaviour change models. Future research will focus on the experiences of healthcare workers providing antenatal care using the NAA. Conclusions The NAA was developed in collaboration with relevant stakeholders and took practical matters as well as evidence from existing literature into account. However, we recommend that the responsibility and ownership of the NAA should be shared with the local government to increase the potential and sustainability of the NAA. Key messages The NAA was developed to improve the quality of antenatal care in rural Tanzania targeting healthcare workers. The current evaluation informs future digital health tool developers in sub-Saharan Africa about elements to take into account during the development phase such as systematic mapping of the process.

scholarly journals Healthcare workers’ and pregnant women’s perceptions of digital tools to improve antenatal care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S van Pelt ◽  
K Massar ◽  
L van der Eem ◽  
M van der Pijl ◽  
L Shields-Zeeman ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Healthcare Workers ◽  
Digital Health ◽  
Quality Of Healthcare ◽  
Care Services ◽  
Rural Tanzania ◽  
Women’S Perceptions

Abstract Background To reduce maternal mortality in rural Tanzania, the need to improve antenatal care remains an urgent priority. Digital health tools are seen as a promising instrument to increase the quality of healthcare in developing countries, but it remains unclear to what extent they are perceived as beneficial during the antenatal care visit. Therefore, the aim of this research was to identify factors that could improve the quality of antenatal care in rural Tanzania, and whether digital health tools would change healthcare workers' and pregnant women's perceptions of quality of care. Methods Semi-structured in-depth interviews were conducted with sixteen healthcare workers and nineteen pregnant women, recruited from various health facilities in Magu District, Tanzania. Results Both healthcare workers and pregnant women possess a positive attitude towards antenatal care and acknowledge its importance. However, they also expressed a need for (structural) improvements in antenatal care services, particularly increased availability of diagnostic tests, and increased performance and motivation of healthcare workers. In addition, healthcare workers indicated a need for more training and better supervision. While both groups expected quality of care to increase should a digital health tool be implemented, they placed more focus on investing in health infrastructure, like the availability of medication and other materials, than investments in digital health. Conclusions Infrastructural improvements, including better communication between healthcare workers and pregnant women, as well as training opportunities and supportive leadership, are necessary before a digital health tool can be expected to increase the quality of antenatal care. Key messages Both healthcare workers and pregnant women acknowledged the need for higher quality antenatal care. Both groups suggested a number of infrastructural improvements, among which the use of a digital health tool.

VP29 Designing A Mobile Clinical Decision Support System For Dementia

2019 ◽  
Vol 35 (S1) ◽  
pp. 83-83
Author(s):  
Noemí Robles ◽  
Carme Carrion i Ribas ◽  
Marta Aymerich
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Behavioral Interventions ◽  
Clinical Decision Support System ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Cognitive Therapies

IntroductionE-health offers the opportunity of supporting the management of several diseases, but most of these tools are far from being based on scientific evidence and demonstrating their effectiveness and efficacy. The PSICODEM Project aims to develop a mobile personalized clinical decision support system (CDSS) based on evidence for contributing to e-health interventions addressed to the management of dementia that require not only a pharmacological approach but also psychosocial interventions for improving patients’ quality of life and reducing emotional, cognitive and behavioral symptoms. The present communication focuses on the identification of the evidence on which the CDSS algorithm will be developed.MethodsThree systematic reviews were carried out in order to identify the existing scientific evidence published in relation to the effectiveness of behavioral, emotional and cognitive therapies addressing dementia (January 2009 to December 2017). The main databases were consulted (PubMed, Cochrane Library, PsychoInfo) and only randomized control trials (RCT) were considered. Articles were reviewed by two independent reviewers. The quality of the selected publications was assessed according to the SIGN criteria.ResultsForty-seven RCTs were selected for cognitive therapies, thirty-two for emotional ones and fifteen for behavioral interventions. Those therapies with more support of evidence were skills training for cognitive therapies and reminiscence interventions for emotional interventions; however, in behavioral interventions a variety of therapeutically approaches were found. Wide differences were found between studies in terms of types and levels of dementia, forms of intervention (number, length and frequency of sessions) and outcome measures.ConclusionsIn-depth analysis of evidence will allow the identification of those interventions more appropriate for each patient according to their symptoms and level of dementia. According to this evidence, the mobile CDSS algorithm will be developed. Additionally, these findings point out the gaps in psychosocial intervention research.

scholarly journals The NeoTree application: developing an integrated mHealth solution to improve quality of newborn care and survival in a district hospital in Malawi

2019 ◽  
Vol 4 (1) ◽  
pp. e000860 ◽  
Author(s):  
Caroline Crehan ◽  
Erin Kesler ◽  
Bejoy Nambiar ◽  
Queen Dube ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
District Hospital ◽  
Digital Health ◽  
Newborn Care ◽  
Clinical Decision ◽  
Evidence Based ◽  
Improve Quality ◽  
Usability Study ◽  
Resource Poor ◽  
Before And After

More than two-thirds of newborn lives could be saved worldwide if evidence-based interventions were successfully implemented. We developed the NeoTree application to improve quality of newborn care in resource-poor countries. The NeoTree is a fully integrated digital health intervention that combines immediate data capture, entered by healthcare workers (HCW) on admission, while simultaneously providing them with evidence-based clinical decision support and newborn care education. We conducted a mixed-methods intervention development study, codeveloping and testing the NeoTree prototype with HCWs in a district hospital in Malawi. Focus groups explored the acceptability and feasibility of digital health solutions before and after implementation of the NeoTree in the clinical setting. One-to-one theoretical usability workshops and a 1-month clinical usability study informed iterative changes, gathered process and clinical data, System Usability Scale (SUS) and perceived improvements in quality of care. HCWs perceived the NeoTree to be acceptable and feasible. Mean SUS before and after the clinical usability study were high at 80.4 and 86.1, respectively (above average is >68). HCWs reported high-perceived improvements in quality of newborn care after using the NeoTree on the ward. They described improved confidence in clinical decision-making, clinical skills, critical thinking and standardisation of care. Identified factors for successful implementation included a technical support worker. Coproduction, mixed-methods approaches and user-focused iterative development were key to the development of the NeoTree prototype, which was shown to be an agile, acceptable, feasible and highly usable tool with the potential to improve the quality of newborn care in resource-poor settings.

scholarly journals Repurposing Clinical Decision Support System Data to Measure Dosing Errors and Clinician-Level Quality of Care

2020 ◽  
Vol 44 (10) ◽  
Author(s):  
David L. Chin ◽  
Michelle H. Wilson ◽  
Ashley S. Trask ◽  
Victoria T. Johnson ◽  
Brittanie I. Neaves ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Decision Support ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
System Data

scholarly journals An implementation framework and a feasibility evaluation of a clinical decision support system for diabetes management in secondary mental healthcare using CogStack

2021 ◽  
Author(s):  
Dipen Patel ◽  
Yamiko Joseph Msosa ◽  
Tao Wang ◽  
Omar G Mustafa ◽  
Siobhan Gee ◽  
...  
Keyword(s):  
Mental Illness ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Diabetes Management ◽  
Digital Health ◽  
Mental Healthcare ◽  
Clinical Decision ◽  
Feasibility Evaluation

Abstract Background: Improvements to the primary prevention of physical health illnesses like diabetes in the general population have not been mirrored to the same extent in people with serious mental illness (SMI). This work evaluates the technical feasibility of implementing an electronic clinical decision support system (eCDSS) for supporting the management of dysglycaemia and diabetes in patients with serious mental illness in a secondary mental healthcare setting. Methods: A stepwise approach was taken as an overarching and guiding framework for this work. Participatory methods were employed to design and deploy a monitoring and alerting eCDSS. The eCDSS was evaluated for its feasibility. The initial part of the feasibility evaluation was conducted in an outpatient community mental health team. Thereafter, the evaluation of the eCDSS progressed to a more in-depth in silico validation. Results: A digital health intervention that enables monitoring and alerting of at-risk patients based on an approved diabetes management guideline was developed. The eCDSS generated alerts according to expected standards and in line with clinical guideline recommendations. Conclusions: It is feasible to design and deploy a functional monitoring and alerting eCDSS in secondary mental healthcare. Further work is required in order to fully evaluate the integration of the eCDSS into routine clinical workflows. By describing and sharing the steps that were and will be taken from concept to clinical testing, useful insights could be provided to teams that are interested in building similar digital health interventions.

Antenatal Care in Sudan: A Qualitative Study Into Accessibility and Quality of Maternal Health Services in Khartoum

2018 ◽  
Vol 8 (2) ◽  
pp. 77-86
Author(s):  
Rayan Mohamed-Ahmed ◽  
Muna Abdel Aziz ◽  
Richard Walker
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Cost Effective ◽  
Maternal Health Services ◽  
Modern Medicine ◽  
Group Discussions ◽  
Maternal Deaths ◽  
Physical Barriers

Antenatal care is shown to be a cost-effective intervention for reducing rates of maternal mortality. However, utilization of maternal health services in Sudan remains low and maternal deaths high. This study aims to investigate why Sudanese women do not attend antenatal care, satisfaction with services and views on improving uptake. Focus group discussions took place, with 30 women who had delivered in the past year, in five areas in Khartoum. Themes in transcripts were identified. Factors that can affect a woman’s choice to attend antenatal care extend beyond physical barriers and include misconceptions of it’s use, conflict between faith and modern medicine and dissatisfaction with previously used services. The care provider’s perceived lack of empathy, unpunctuality and lack of health promotion can also contribute to underutilization.

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