Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa
Abstract Background Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical al...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-09001-2 |
| _version_ | 1797952659904266240 |
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| author | Christiane Horwood Silondile Luthuli Sphindile Mapumulo Lyn Haskins Cecilie Jensen Deidre Pansegrouw Neil McKerrow |
| author_facet | Christiane Horwood Silondile Luthuli Sphindile Mapumulo Lyn Haskins Cecilie Jensen Deidre Pansegrouw Neil McKerrow |
| author_sort | Christiane Horwood |
| collection | DOAJ |
| description | Abstract Background Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa. Methods We undertook a mixed methods study to prospectively explore experiences of implementation from the perspective of newly-trained eIMCI practitioners. eIMCI uptake was monitored throughout implementation. In-depth interviews (IDIs) were conducted with selected participants before and after training, after mentoring, and after 6 months implementation. Participants were then invited to participate in focus group discussions (FGDs) to provide further insights into barriers to eIMCI implementation. Results We conducted 36 IDIs with 9 participants between October 2020 and May 2021, and three FGDs with 11 participants in October 2021. Most participants spoke positively about eIMCI reporting that it was well received in the clinics, was simple to use, and improved the quality of clinical assessments. However, uptake of eIMCI across participating clinics was poor. Challenges reported included lack of computer skills which made simple tasks, like logging in or entering patient details, time consuming. Technical support was provided, but was time consuming to access so that eIMCI was sometimes unavailable. Other challenges included heavy workloads, and the perception that eIMCI took longer and disrupted participant’s work. Poor alignment between recording requirements of eIMCI and other clinic programmes increased participant’s administrative workload. All these factors were a disincentive to eIMCI uptake, frequently leading participants to revert to paper IMCI which was quicker and where they felt more confident. Conclusion Despite the potential of CDSSs to increase adherence to guidelines and improve clinical management and prescribing practices in resource constrained settings where clinical support is scarce, they have not been widely implemented. Careful attention should be paid to the work environment, work flow and skills of health workers prior to implementation, and ongoing health system support is required if health workers are to adopt these approaches (350). |
| first_indexed | 2024-04-10T22:49:56Z |
| format | Article |
| id | doaj.art-ee940fe516f94c028e606f7b515a3060 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-10T22:49:56Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-ee940fe516f94c028e606f7b515a30602023-01-15T12:07:39ZengBMCBMC Health Services Research1472-69632023-01-0123111110.1186/s12913-022-09001-2Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South AfricaChristiane Horwood0Silondile Luthuli1Sphindile Mapumulo2Lyn Haskins3Cecilie Jensen4Deidre Pansegrouw5Neil McKerrow6Centre for Rural Health, University of KwaZulu-NatalCentre for Rural Health, University of KwaZulu-NatalCentre for Rural Health, University of KwaZulu-NatalCentre for Rural Health, University of KwaZulu-NatalHealth Systems Strengthening Unit, Health Systems TrustKwaZulu-Natal Department of Health, Ilembe DistrictKwaZulu-Natal Department of Health, Paediatrics and Child HealthAbstract Background Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa. Methods We undertook a mixed methods study to prospectively explore experiences of implementation from the perspective of newly-trained eIMCI practitioners. eIMCI uptake was monitored throughout implementation. In-depth interviews (IDIs) were conducted with selected participants before and after training, after mentoring, and after 6 months implementation. Participants were then invited to participate in focus group discussions (FGDs) to provide further insights into barriers to eIMCI implementation. Results We conducted 36 IDIs with 9 participants between October 2020 and May 2021, and three FGDs with 11 participants in October 2021. Most participants spoke positively about eIMCI reporting that it was well received in the clinics, was simple to use, and improved the quality of clinical assessments. However, uptake of eIMCI across participating clinics was poor. Challenges reported included lack of computer skills which made simple tasks, like logging in or entering patient details, time consuming. Technical support was provided, but was time consuming to access so that eIMCI was sometimes unavailable. Other challenges included heavy workloads, and the perception that eIMCI took longer and disrupted participant’s work. Poor alignment between recording requirements of eIMCI and other clinic programmes increased participant’s administrative workload. All these factors were a disincentive to eIMCI uptake, frequently leading participants to revert to paper IMCI which was quicker and where they felt more confident. Conclusion Despite the potential of CDSSs to increase adherence to guidelines and improve clinical management and prescribing practices in resource constrained settings where clinical support is scarce, they have not been widely implemented. Careful attention should be paid to the work environment, work flow and skills of health workers prior to implementation, and ongoing health system support is required if health workers are to adopt these approaches (350).https://doi.org/10.1186/s12913-022-09001-2Electronic decision-making support systemIntegrated management of childhood illnessMhealthChild healthIMCISouth Africa |
| spellingShingle | Christiane Horwood Silondile Luthuli Sphindile Mapumulo Lyn Haskins Cecilie Jensen Deidre Pansegrouw Neil McKerrow Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa BMC Health Services Research Electronic decision-making support system Integrated management of childhood illness Mhealth Child health IMCI South Africa |
| title | Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa |
| title_full | Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa |
| title_fullStr | Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa |
| title_full_unstemmed | Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa |
| title_short | Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses’ experiences of using an electronic clinical decision support system (CDSS) in South Africa |
| title_sort | challenges of using e health technologies to support clinical care in rural africa a longitudinal mixed methods study exploring primary health care nurses experiences of using an electronic clinical decision support system cdss in south africa |
| topic | Electronic decision-making support system Integrated management of childhood illness Mhealth Child health IMCI South Africa |
| url | https://doi.org/10.1186/s12913-022-09001-2 |
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