Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands.
Department of Mental Health and Prevention, Netherlands Institute for Mental Health and Addiction, Utrecht, Netherlands.
Front Public Health. 2021 May 20;9:645521. doi: 10.3389/fpubh.2021.645521. eCollection 2021.
It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.
人们普遍认识到，高质量的产前护理是产妇保健的关键要素。坦桑尼亚的孕产妇死亡率非常高，每 10 万例活产中有 524 例孕产妇死亡。大多数孕产妇死亡是由怀孕期间可以检测到的可预防原因造成的，因此产前护理在降低产妇发病率和死亡率方面发挥着重要作用。不幸的是，坦桑尼亚的产前护理质量很低：研究表明，医护人员对产前护理指南的遵循情况不佳，大多数孕妇错过了基本服务。数字健康工具可以提高医护人员的工作表现，并有助于提高产前护理质量。为此，2016 年在坦桑尼亚开发并实施了电子临床决策和支持系统（护士助手应用程序），为医护人员提供产前护理咨询期间的数字辅助。本研究系统评估了该护士助手应用程序在坦桑尼亚马古区的开发和实施过程，旨在为未来的规划人员提供数字健康干预措施开发过程中的相关步骤。桌面研究与半结构化访谈相结合，评估数字健康工具的开发过程。我们采用了 Godin 等人规定的标准，这些标准基于干预映射 [IM； Bartholomew Eldredge 等人] 的六个步骤。研究结果表明，在开发和实施护士助手应用程序的过程中，IM 的六个步骤中有五个步骤已经完成。与社区参与、调整当地环境、与当地合作伙伴合作在实际环境中实施以及严格评估相关的任务已经完成。但是，与确定基于理论的行为改变方法相关的任务尚未完成。基于在开发和实施护士助手应用程序过程中吸取的经验教训，我们得出结论，建议项目开发者（1）让社区参与并听取他们的意见，（2）关注明确的项目目标和期望的变革，（3）咨询或涉及行为改变专家，以及（4）预料到意外情况下可能出现的问题。
