Tulane University, New Orleans, Louisiana, USA.
BMC Health Serv Res. 2010 Jul 3;10:188. doi: 10.1186/1472-6963-10-188.
Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework.
Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework.
Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance.
The study results provide some empirical support for the reliability and validity of the PRISM instruments and the validity of the PRISM conceptual framework, suggesting that the PRISM approach can be effectively used by RHIS policy makers and practitioners to assess the RHIS and evaluate RHIS strengthening interventions. However, additional studies with larger sample sizes are needed to further investigate the value of the PRISM instruments in exploring the linkages between RHIS data quality and use, and health systems performance.
卫生部门的合理政策、资源分配和日常管理决策都需要从常规卫生信息系统（RHIS）中获取及时信息。在大多数低收入和中等收入国家，RHIS 被认为在提供质量数据和持续信息方面都存在不足，而这些数据和信息可用于帮助改善卫生系统绩效。此外，关于加强 RHIS 干预措施以提高数据质量和使用情况的有效性，相关证据也十分有限。本研究旨在评估新开发的常规信息系统管理绩效（PRISM）框架的实用性，该框架由一个概念框架和相关的数据收集与分析工具组成，旨在评估、设计、加强和评估 RHIS。本研究的具体目标是：a）评估 PRISM 工具的可靠性和有效性；b）评估 PRISM 概念框架的有效性。
2004 年至 2007 年期间，在乌干达 12 个区的 110 个卫生保健机构收集了机构层面和工作人员层面的数据，数据收集方法包括记录审查、结构化访谈和自填式问卷。分析程序包括 Cronbach's alpha 评估选定工具的内部一致性、测试-重测分析评估工具的可靠性和敏感性，以及双变量和多变量统计技术评估 PRISM 工具和概念框架的有效性。
Cronbach's alpha 分析表明，用于衡量信息文化促进、RHIS 任务自我效能和动机的指数具有较高的可靠性（0.7 或更高）。研究结果还表明，信息文化的促进会影响 RHIS 任务自我效能、RHIS 任务能力和动机，而自我效能和 RHIS 工作人员的存在会直接影响 RHIS 信息的使用，这是 RHIS 绩效的一个关键方面。
研究结果为 PRISM 工具的可靠性和有效性以及 PRISM 概念框架的有效性提供了一些经验支持，表明 PRISM 方法可被 RHIS 决策者和从业者有效用于评估 RHIS 并评估 RHIS 加强干预措施。然而，需要开展更多具有更大样本量的研究，以进一步调查 PRISM 工具在探索 RHIS 数据质量和使用与卫生系统绩效之间的联系方面的价值。
