Guidelines for maternal and neonatal “point of care”: Needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso

https://doi.org/10.1016/j.ijmedinf.2014.01.013Get rights and content

Highlights

  • Healthcare workers in rural Africa have a great willingness to adapt and use modern technologies.

  • Guidelines through CDSS in maternal care are perceived as a learning tool.

  • Users’ adoption behaviour to CDSS can be divided into motivators and barriers.

  • Aspects of motivators and barriers are closely connected.

  • Motivating aspects can easily be turned into barriers if not taken care of properly in the final design of the CDSS.

Abstract

Background

In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges.

Aims

To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso.

Methods

Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants’ background. Qualitative data were analyzed using manifest content analysis.

Results

Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement.

Conclusions

The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care.

Section snippets

Background

Maternal mortality varies widely between rich and poor countries. As many as 287,000 women died due to pregnancy-related causes worldwide in 2010 of which 245,000 deaths were in low-income countries. This equals a death risk of 1 in 25 women during delivery in the poorest countries [1]. Millennium Development Goal 5 (MDG 5) aiming for improving maternal health was adopted in the late 1990s but is the one that has failed to show any major improvement in recent years [2]. The priority is to

Study design and setting

To understand the perceived needs and attitudes to access WHO guidelines through the use of CDSS in maternal and neonatal rural healthcare in Burkina Faso, we used a qualitative approach with semi-structured interviews. A qualitative approach is a fruitful way to explore people's needs, experiences, attitudes, thoughts and perceptions of different phenomena [18].

This study on understanding the value and complexities of CDSS in rural maternal care is part of a comprehensive implementation

Background characteristics of informants

A total of 45 healthcare workers were interviewed: (n = 23) in Nouna and (n = 22) in Solenzo districts in Burkina Faso. There were 16 males and 29 females with an average age of 35 years (Table 2). A total of 22% of healthcare workers in Nouna district reported lack of experience with computers compared to 68% in Solenzo district (in total 44% of the interviewees). In Nouna district, 91% of healthcare workers have access to computers privately compared to 27% of healthcare workers in Solenzo

Discussion

There are four main findings in this study: (a) the fascination among healthcare workers for and a great willingness to adapt and use modern technologies like computers and learn more in the workplace, (b) a positive attitude to easy access to guidelines and implement decision-support using computers in the workplace, (c) a fear that the CDSS requires more working time and leads to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive

Methodological considerations

In qualitative interview studies, twenty informants are seen as usually enough to capture the potential variation in informants’ ways of experiencing a phenomenon [32]. The method used, involving interviews [18] and content analysis [21], is well established and the researchers are familiar with these methods and should therefore give consistent and reliable results.

We choose to interview two groups of healthcare workers from different districts in Burkina Faso. Consequently, the forty-five

Conclusions

Healthcare workers in rural maternal care in Burkina Faso are enthusiastic for easy access to guidelines through CDSS and appreciate the learning potentials of such systems. However, there are fears regarding the extra workload and the interviewees foresee a need for training in knowledge and skills of handling computers. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design of the CDSS

Authors’ contribution

All authors contributed to the conception and design of the study and to interpretation of the data. PBR guided the development of the interview guide and the coding framework together with SAZ. SAZ conducted all interviews and analyzed the data guided by PBR and with quality controls and inputs from all authors. PBR, SAZ, SL, JN, AS, LLG and GT outlined the disposition of the manuscript. The first draft was written by PBR and SAZ and completed by PBR, SAZ and LLG with major inputs by GT. The

Conflict of interest

None declared.

Summary points

What was already known on the topic:

  • Perceived usefulness and reported ease of use of computerized e-health applications will determine to what extent they are used in high-income countries.

  • User-friendly guidelines integrated in CDSS have been shown to improve the quality of care in high-income countries.

What this study added to our knowledge:

  • Healthcare workers in rural maternal care in Burkina Faso are enthusiastic for easy access to guidelines through CDSS,

Acknowledgments

The QUALMAT research project (Quality of Prenatal Care and Maternal Care: Bridging the Know-do Gap) funded by the 7th Framework Programme of the European Union (Grant agreement 22982) as a collaboration between the Centre de Recherche en Santé de Nouna (Burkina Faso), Ghent University (Belgium), Heidelberg University (Germany), Karolinska Institutet (Sweden), Muhimbili University of Health and Allied Sciences (Tanzania), and Navrongo Health Research Centre (Ghana). The general objective of this

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