Dear HIFA colleagues,
Below are the citation, key findings and extracts of a new paper in Global Health: Science and Practice. This reminds me of some important work by Geoff Royston, which I describe in my comment below.
CITATION: A Novel Approach to Assessing the Potential of Electronic Decision Support Systems to Improve the Quality of Antenatal Care in Nepal
Biraj Man Karmacharya, Seema Das, Abha Shrestha, Abha Shrestha, Sulata Karki, Rajani Shakya, Emma Radovich, Loveday Penn-Kekana, Clara Calvert, Oona M.R. Campell and Ona L. McCarthy
Global Health: Science and Practice January 2025, https://doi.org/10.9745/GHSP-D-23-00370
Key Findings
Electronic decision support systems (EDSSs) are tools that can improve health care providers’ decision-making, promote adherence to evidence-based guidelines, and support clinical tasks.
We assessed the effect of implementing 2 EDSSs in improving the quality of antenatal care (ANC) in select facilities in Nepal by improving provider’s adherence to ANC guidelines and ability to detect and manage higher-risk pregnancies.
Although some changes in clinical provision were observed, some ANC components were not consistently provided during visits or at the right time.
Possible reasons for the lack of improved quality of care include inadequate staff training, inflexibility of the EDSS design, contextual factors, and inadequate integration with existing health systems.
Extracts
'The EDSS required more time than usual, if we do it from the start to counseling, it takes 1 hour for a patient. And then, ANC clients become impatient. Therefore, ANC was organized as per ANC clients’ demand. —ANM, in-depth interview
'A 3-day training for 1 person in each facility with 1 month of onsite support appeared to be insufficient to generate a sense of responsibility among staff to use the EDSS and an appreciation of its potential.'
'The EDSS design did not reflect how ANC staff made personalized decisions about pregnant women’s needs.'
COMMENT (NPW):
A few years ago HIFA Steering Group member Geoff Royston presented a paper and poster on 'Assessing mobile healthcare applications in low-resource settings', at the Appropriate Health Technolgoy Conference, Oxford (2016) and Digital Health 2017 Conference, London (2017). The work had input from the Mobile HIFA working group and HIFA members.
https://www.hifa.org/sites/default/files/publications_pdf/mHIFA_poster.pdf
The main conclusion of Geoff's work is: 'Valuable insights into the likely practical impact of mHealth information apps can be obtained, even without field-based evaluation, from a criterion-based assessment of their features'.
I suspect that the lessons of this work have not been widely appreciated, and that multiple digital interventions are being deployed at great expense, and failing, in field-based studies that might have been avoided with basic criterion-based assessment.
The above paper in Global Health: Science and Practice, may be an example where preliminary assessment might have avoided wasted effort.
All publications relating to HIFA's work in mobile health can be accessed here: https://www.hifa.org/projects/mobile-hifa-mhifa
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
