Chanyalew Moges Asressie, Yitayal Mezgebu, Atnafu Asmamaw, Mengiste Shegaw Anagaw, Tilahun Binyam
Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
JMIR Med Inform. 2022 Apr 22;10(4):e30518. doi: 10.2196/30518.
Weak health information systems (HISs) hobble countries' abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager.
This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia.
The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the β coefficients, 95% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05.
Data were collected using the endpoint survey from 155 out of 172 (90.1%) participants in the intervention group and 166 out of 172 (96.5%) participants in the comparison group. The average level of information use for the comparison group was 37.3% (95% CI 31.1%-43.6%) at baseline and 43.7% (95% CI 37.9%-49.5%) at study endpoint. The average level of information use for the intervention group was 52.2% (95% CI 46.2%-58.3%) at baseline and 75.8% (95% CI 71.6%-80.0%) at study endpoint. The study indicated that the net program change over time was 17% (95% CI 5%-28%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95% CI -0.089 to 0.182), -0.002 (95% CI -0.015 to 0.009), -0.055 (95% CI -0.190 to 0.079), -1.63 (95% CI -5.22 to 1.95), and -0.006 (95% CI -0.017 to 0.005), respectively.
The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits.
Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5.
薄弱的卫生信息系统阻碍了各国有效管理和分配资源以应对疾病负担的能力。在埃塞俄比亚阿姆哈拉地区的部分地区实施了能力建设与指导计划（CBMP），以提高卫生信息系统的绩效；然而，关于该干预措施有效性的证据却很少。
本研究旨在确定埃塞俄比亚西北部阿姆哈拉地区卫生设施和部门负责人将常规卫生信息用于循证决策的有效性。
该研究在阿姆哈拉地区的10个区开展：5个区为干预组，5个区为对照组。我们采用类实验研究设计，形式为前测-后测对照组。2020年6月至7月，从36个干预设施和43个对照设施的部门和设施负责人处收集数据。使用双总体公式计算样本量，每组招募172名参与者。我们采用差分分析方法来确定干预措施的有效性。使用三重差分法（即差分-差分-差分[DIDID]法）评估亚组间项目效果的异质性。因此，计算每个参数的β系数、95%置信区间和P值，若交互项在P<0.05时具有显著性，我们则判定该项目有效。
使用终点调查从干预组172名参与者中的155名（90.1%）和对照组172名参与者中的166名（96.5%）收集了数据。对照组信息使用的平均水平在基线时为37.3%（95%置信区间31.1%-43.6%），在研究终点时为43.7%（95%置信区间37.9%-49.5%）。干预组信息使用的平均水平在基线时为52.2%（95%置信区间46.2%-58.3%），在研究终点时为75.8%（95%置信区间71.6%-80.0%）。该研究表明，随着时间推移项目的净变化为17%（95%置信区间5%-28%；P=0.003）。亚组分析还表明，地理位置显示出显著的项目效果异质性，DIDID估计值等于0.16（95%置信区间0.026-0.29；P=0.02）。然而，性别、年龄、教育水平、薪资和经验在项目效果方面未显示出显著异质性，DIDID估计值分别为0.046（95%置信区间-0.089至0.182）、-0.002（95%置信区间-0.015至0.009）、-0.055（95%置信区间-0.190至0.079）、-1.63（95%置信区间-5.22至1.95）和-0.006（95%置信区间-0.017至0.005）。
CBMP在提高研究参与者使用常规卫生信息系统进行决策的能力方面是有效的。我们注意到城市设施比农村设施受益更多。该干预措施已显示出产生了积极成果，应扩大规模以在其他地区使用。此外，应重新设计针对农村设施的指导模式，以实现效益最大化。
泛非临床试验注册中心PACTR202001559723931；https://tinyurl.com/3j7e5ka5 。
