Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine maternal health information in Southern Tanzania: A mixed-methods study

Abstract

Health information systems are important for health planning and progress monitoring. Still, data from health facilities are often of limited quality in Low-and-Middle-Income Countries. Quality deficits are partially rooted in the fact that paper-based documentation is still the norm at facility level, leading to mistakes in summarizing and manual copying. Digitization of data at facility level would allow automatization of these procedural steps. Here we aimed to evaluate the feasibility, usability and acceptability of a scanning innovation called Smart Paper Technology for digital data processing. We used a mixed-methods design to understand users’ engagement with Smart Paper Technology and identify potential positive and negative effects of this innovation in three health facilities in Southern Tanzania. Eight focus group discussions and 11 in-depth interviews with users were conducted. We quantified time used by health care providers for documentation and patient care using time-motion methods. Thematic analysis was used to analyze qualitative data. Descriptive statistics and multivariable linear models were generated to compare the difference before and after introduction and adjust for confounders. Health care providers and health care managers appreciated the forms’ simple design features and perceived Smart Paper Technology as time-saving and easy to use. The time-motion study with 273.3 and 224.0 hours of observations before and after introduction of Smart Paper Technology, respectively, confirmed that working time spent on documentation did not increase (27.0% at baseline and 26.4% post-introduction; adjusted p = 0.763). Time spent on patient care was not negatively impacted (26.9% at baseline and 37.1% at post-intervention; adjusted p = 0.001). Health care providers described positive effects on their accountability for data and service provision relating to the fact that individually signed forms were filled. Health care providers perceived Smart Paper Technology as feasible, easy to integrate and acceptable in their setting, particularly as it did not add time to documentation.

Caught in the data quality trap: A case study from the evaluation of a new digital technology supporting routine health data collection in Southern Tanzania

“…Our findings reported here, together with results from our process evaluation (13) suggest, that institutionalization of SPT was not achieved, possibly due to low managerial buy-in although HCPs saw the technology's benefits for their work. We argue that low data quality of SPT may have contributed to this situation and at the same time, lack of buy-in and institutionalization perpetuated duplicate data entry and thus low data quality (figure 3 below).…”

“…Our research project had no mandate to enforce documentation using SPT forms, instead introduction of SPT led to duplicated documentation. We previously reported on qualitative findings from the overall SPT evaluation where HCPs and their managers described how this may have contributed to incompleteness of SPT and HMIS data (13). We noted from our current data that DHIS2 for 2018-2019 showed slightly better internal consistency than in the reference year after SPT introduction (2019-2020) (indicators 6 and 7, table 2).…”

“…This finding may suggest that the reference DHIS2 could have also been incomplete to a certain extent. Other studies on HMIS data quality support this assumption (5,6,8,13). Furthermore, HMIS research using the DQR Toolkit has confirmed upward trends of maternal coverage indicators over three years due to population increase as described in the DQR Toolkit (4,14,19).…”

“…Studies reported good SPT data quality for vaccination services in The Gambia and Uganda (11,12). Our previous findings from the process evaluation of this novel system suggest that SPT can be embedded into existing maternal health care provision, is acceptable and potentially generates time-savings for HCPs (13).…”

“…We conducted a cross-sectional study on the quality of SPT data routinely collected by 13 health facilities for maternity care services in Tandahimba district in Southern Tanzania between November 2019 and October 2020. This study was part of a process evaluation of SPT implementation in all 33 health facilities providing maternal care in the district (13). Results are reported using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (17).…”