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Okyere Boadu R, Adzakpah G, Kumasenu Mensah N, Okyere Boadu KA, Kissi J, Dziyaba C, Bermaa Abrefa R. Healthcare providers' perception towards utilization of health information applications and its associated factors in healthcare delivery in health facilities in Cape Coast Metropolis, Ghana. PLoS One 2024; 19:e0297388. [PMID: 38300933 PMCID: PMC10833587 DOI: 10.1371/journal.pone.0297388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. METHODS We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana, in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. RESULTS Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M) = 5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M = 5.11), frequent system downtime (M = 5.09), low system performance (M = 5.04), and inadequate staff training (M = 4.88) hindered IT utilization. Respondents slightly agreed that training (M = 5.56), technical support (M = 5.46), and changes in work procedures (M = 5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. CONCLUSIONS Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes towards IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.
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Affiliation(s)
- Richard Okyere Boadu
- Department of Health Information Management School of Allied Health Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Adzakpah
- Department of Health Information Management School of Allied Health Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Nathan Kumasenu Mensah
- Department of Health Information Management School of Allied Health Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwame Adu Okyere Boadu
- School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jonathan Kissi
- Department of Health Information Management School of Allied Health Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Christiana Dziyaba
- Health Information Management Unit, Adisadel Health Centre, Ghana Health Service, Accra, Ghana
| | - Rosemary Bermaa Abrefa
- Department of Health Information Management School of Allied Health Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
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Walle AD, Demsash AW, Adem JB, Wubante SM, Shibabaw AA, Mamo DN, Kebede SD, Muluneh AA, Mengiste MB, Gebeyew AS, Butta FW, Chereka AA, Dubale AT, Kassie SY, Ferede TA. Exploring facilitators and barriers of the sustainable acceptance of e-health system solutions in Ethiopia: A systematic review. PLoS One 2023; 18:e0287991. [PMID: 37561684 PMCID: PMC10414679 DOI: 10.1371/journal.pone.0287991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/17/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND eHealth is the use of information and communications technologies in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education knowledge and research, has the potential to improve the delivery and support of healthcare services by promoting information sharing and evidence-based health practice. Acceptance of e-health in Ethiopia using systematic review is uncertain. As a result, this study aimed to assess barriers and facilitators of the sustainable acceptance of e-health system adoption in Ethiopia through a systematic review of the literature. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to conduct this study. Relevant articles have been searched in Google Scholar, Medline, PubMed, Embrace, Web of Science, Scopus, Cochrane Library, and empirical research done in Ethiopia is the main emphasis of the search strategy. The total number of studies that satisfied the criteria for inclusion was ten. In this research, empirical data related to e-health acceptance factors were retrieved, examined, and summarized by the authors. RESULTS This systematic review identified a total of 25 predictors that have been found in the ten studies. The identified facilitators were effort expectancy, performance expectancy, facilitating conditions, social influences, attitude, computer literacy, participant age, perceived enjoyment, and educational status, duration of mobile device use, organizational culture, and habit. Moreover, technology anxiety was the most barrier to sustainable acceptance of e-health systems in Ethiopia. CONCLUSIONS The most common facilitator identified from the predictors was effort expectancy, which played a major role in the adoption of the e-health system in Ethiopia. Therefore, eHealth implementers and managers in those settings should give users of the system priority in improving the technical infrastructure by regularly providing them with basic facilitating conditions. They should also pay attention to the system they want to implement because doing so will improve the users' perception of the system's value and attitude.
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Affiliation(s)
- Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | | | - Jibril Bashir Adem
- Department of Public Health, College of Medicine and Health Sciences, Arsi University, Asella, Ethiopia
| | - Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adamu Ambachew Shibabaw
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | - Daniel Niguse Mamo
- Department of Health Informatics, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ayana Alebachew Muluneh
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Muluken Belachew Mengiste
- Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Sisay Gebeyew
- Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fikadu Wake Butta
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | - Abiy Tasew Dubale
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Science, Mattu University, Metu, Ethiopia
| | - Tigist Andargie Ferede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hailemariam T, Atnafu A, Gezie LD, Kaasbøll JJ, Klein J, Tilahun B. Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia. BMC Health Serv Res 2023; 23:644. [PMID: 37328840 DOI: 10.1186/s12913-023-09629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation. METHOD We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings. RESULTS First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders' engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis. CONCLUSION The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.
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Affiliation(s)
- Tesfahun Hailemariam
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Health Informatics, College of Health Sciences, Hawassa, Ethiopia.
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Jörn Klein
- Department of Nursing and Health Sciences Campus Porsgrunn, University of South-Eastern Norway, Porsgrunn, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Van Diepen C, Fors A, Bertilsson M, Axelsson M, Ekman I, Hensing G. How the current non-significant effects of person-centred care on nurses' outcomes could be abated by the WE-CARE roadmap enablers: A discursive paper. Nurs Open 2023; 10:2044-2052. [PMID: 36440684 PMCID: PMC10006598 DOI: 10.1002/nop2.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
AIM To describe the non-significant results in nurses' outcomes after the implementation of person-centred care (PCC) and discuss if and how enablers of the WE-CARE roadmap for implementing PCC could abate the non-significant results. DESIGN In this paper, an innovative framework of enablers in the WE-CARE Roadmap is explained in relation to increased PCC and nurses' job satisfaction. METHOD Findings from a scoping review and published material provided how PCC and nurses' outcomes connect. The WE-CARE roadmap entails five enablers: Information technology, Quality measures, Infrastructure, Incentive systems and contracting strategies. RESULTS The WE-CARE roadmap was described and each enabler in the WE-CARE roadmap is discussed concerning PCC and the nurses' job satisfaction. Thus far, the effects of PCC on nurses' outcomes have been non-significant. The WE-CARE roadmap enablers can be implemented to ensure an increased PCC implementation and higher nurses' job satisfaction.
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Affiliation(s)
- Cornelia Van Diepen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Monica Bertilsson
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Inger Ekman
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hossin A, Asante Boadi E, Bosompem J, Avornyo P, Okae-Adjei S, Atuobuah Boadi V, Say J. Personal and Organisational Resources on Electronic Health Usage Intentions in an Emerging Economy. TELEMATICS AND INFORMATICS 2022. [DOI: 10.1016/j.tele.2022.101832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ameyaw EK, Amoah RM, Njue C, Tran NT, Dawson A. Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study. BMC Health Serv Res 2022; 22:347. [PMID: 35296312 PMCID: PMC8925182 DOI: 10.1186/s12913-022-07760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana. Materials and methods This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level. Results A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50–75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected. Conclusion The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Roberta Mensima Amoah
- Department of Public Health, School of Allied Sciences, University for Development Studies, Tamale, Northern Region, Ghana
| | - Carolyne Njue
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Nguyen Toan Tran
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Kunwar B, Dhungana A, Aryal B, Gaire A, Adhikari AB, Ojha R. Cross‐sectional study on knowledge and attitude of telemedicine in medical students of Nepal. Health Sci Rep 2022; 5:e532. [PMID: 35224226 PMCID: PMC8855682 DOI: 10.1002/hsr2.532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bijay Kunwar
- Department of Medicine Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Ayushma Dhungana
- Department of Medicine National Medical College, National Medical College and Teaching Hospital Birgunj Nepal
| | - Binay Aryal
- Department of Medicine Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Arjun Gaire
- Department of Medicine Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Aramva Bikram Adhikari
- Department of Medicine Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Rajeev Ojha
- Department of Neurology Tribhuvan University Institute of Medicine Maharajgunj Nepal
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Kwan RYC, Lam SC, Wang SL, Wong AKC, Shi L, Wong FKY. Perception of E-health Technology Scale in Chinese Brief (PETS-C Brief): Translation, item reduction, and psychometric testing. Digit Health 2022; 8:20552076221126055. [PMID: 36159156 PMCID: PMC9500267 DOI: 10.1177/20552076221126055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Perception of e-health is a broad concept involving many aspects of values and thoughts related to e-health. It is an important precursor to using e-health technologies to promote health. The purpose of this study is to validate an instrument for measuring perceptions of e-health technology among healthcare professionals. Methods This methodological study was conducted in China. We based on an existing instrument to develop a new instrument (i.e. PETS-C Brief). In phase 1, we modified and translated the existing instrument into Chinese. Subsequently, we employed the modified and translated instrument to conduct a cross-sectional survey. In phase 2, we randomly selected data from 400 participants to run an exploratory factor analysis and item analysis to reduce the number of items and develop factors. In phase 3, we employed the data from the remaining participants to run a confirmatory factor analysis to confirm the instrument structure. Results In phase 1, the modified and translated instrument showed good content and face validities (S-CVI = 0.96, mean comprehensibility = 93.5%). 1338 participants completed the survey. In phase 2, the number of items was reduced from 40 to 19, which demonstrated a 4-factor model. In phase 3, the goodness-of-fit of the 4-factor PETS-C Brief was shown to be acceptable (χ2/d.f. = 6.40, CFI = 0.93, RMR = 0.40, NFI = 0.92, RMSEA = 0.076, IFI = 0.93). Discussion This study suggests using this instrument to survey perceptions of e-health technology in Chinese people. Future studies should examine its other important psychometric properties, including convergent/discriminant and predictive validity on behaviors using e-health technology.
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Affiliation(s)
| | | | - Shao Ling Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Lei Shi
- School of Nursing, Southern Medical University, Hong Kong SAR, China
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Ebenso B, Okusanya B, Okunade K, Akeju D, Ajepe A, Akaba GO, Yalma RM, Dirisu O, Tukur J, Abdullahi MK, Okuzu O, Allsop MJ. What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria. Front Glob Womens Health 2021; 2:670494. [PMID: 34816223 PMCID: PMC8594044 DOI: 10.3389/fgwh.2021.670494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks. Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery. Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use. Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking. Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings. Trial Registration: ISRCTN32105372.
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Affiliation(s)
- Bassey Ebenso
- Nuffield Center for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Babasola Okusanya
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kehinde Okunade
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Godwin O Akaba
- Department of Obstetrics and Gynecology, University of Abuja, Abuja, Nigeria
| | - Ramsey M Yalma
- Department of Community Medicine University of Abuja, Abuja, Nigeria
| | | | | | | | - Okey Okuzu
- Instrat Global Health Solutions, Abuja, Nigeria
| | - Matthew J Allsop
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
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