Unkels Regine, Manzi Fatuma, Kapologwe Ntuli A, Baker Ulrika, Ahmad Aziz, Nabiev Rustam, Berndtsson Maria, Baraka Jitihada, Hanson Claudia, Hirose Atsumi
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Health System, Policy and Economic Evaluations, Ifakara Health Institute, Dar es Salaam, Tanzania.
PLOS Glob Public Health. 2023 Jan 12;3(1):e0000972. doi: 10.1371/journal.pgph.0000972. eCollection 2023.
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.
卫生信息系统对于卫生规划和进展监测至关重要。然而,在低收入和中等收入国家,卫生设施的数据质量往往有限。质量缺陷部分源于这样一个事实,即纸质文档在设施层面仍然是常态,这导致在汇总和手工抄写时出现错误。设施层面的数据数字化将使这些程序步骤能够自动化。在此,我们旨在评估一种名为智能纸张技术的扫描创新在数字数据处理方面的可行性、可用性和可接受性。我们采用混合方法设计,以了解用户对智能纸张技术的参与情况,并确定这一创新在坦桑尼亚南部三个卫生设施中的潜在积极和消极影响。我们与用户进行了八次焦点小组讨论和十一次深入访谈。我们使用时间动作研究方法对医疗保健提供者用于文档记录和患者护理的时间进行了量化。采用主题分析来分析定性数据。生成描述性统计数据和多变量线性模型,以比较引入前后的差异并对混杂因素进行调整。医疗保健提供者和医疗保健管理人员赞赏这些表格的简单设计特点,并认为智能纸张技术节省时间且易于使用。分别在引入智能纸张技术前后进行了273.3小时和224.0小时观察的时间动作研究证实,用于文档记录的工作时间没有增加(基线时为27.0%,引入后为26.4%;调整后p = 0.763)。用于患者护理的时间没有受到负面影响(基线时为26.9%,干预后为37.1%;调整后p = 0.001)。医疗保健提供者描述了与填写个人签名表格这一事实相关的数据和服务提供问责方面产生了积极影响。医疗保健提供者认为智能纸张技术在他们的环境中是可行的、易于整合且可接受的,特别是因为它没有增加文档记录的时间。