Nigatu Dabere, Azage Muluken, Misgan Eyaya, Enquobahrie Daniel A, Kebebaw Tegegn, Abate Enyew, Alemneh Esubalew, Woldie Mirkuzie, Girma Tsinuel
Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Health Res Policy Syst. 2025 Jan 6;23(1):4. doi: 10.1186/s12961-024-01259-8.
The use of eHealth innovations is becoming increasingly important in improving health outcomes, especially for maternal and newborn health. However, planning and executing these innovations can be challenging due to their complex nature. To provide guidance and clarity on implementation approaches, researchers need to use implementation research (IR) tools. We conducted IR to recognize the challenges in implementing eHealth innovations in the context of maternal and newborn healthcare using the implementation research logic model (IRLM). Therefore, this paper aims to describe the practical application of IRLM to design, execute and evaluate eHealth innovations that improve maternal and newborn care in public facilities in Ethiopia.
We employed rapid review, formative assessment and process evaluation of an eHealth innovation in selected healthcare facilities serving maternal and newborn care. The eHealth innovation we developed and deployed was named 'ADHERE' (Antenatal Care, ChilDbirtH CarE and Postnatal CaRE), representing the continuum of maternal care. The rapid review was conducted as an initial step using the Consolidated Framework for Implementation Research (CFIR). We employed a mix of data collection methods: interview/discussion, eHealth system or document review and direct observation. Furthermore, we executed various stakeholder engagement activities: two co-creation workshops and on-site iterative discussions. We applied the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture ongoing implementation learnings.
We developed IRLM of the eHealth innovation implementation for three contexts: urban, peri-urban and remote public healthcare facilities. The model depicted the mechanism of interaction between implementation determinants and implementation strategies to produce the intended implementation outcomes. The IRLM helped to identify more than 35 implementation barriers or facilitators for eHealth interventions and to develop over 17 mitigation strategies for the study contexts. The initial IRLM was refined through ongoing implementation learnings and the mitigation strategies that were executed.
The IRLM is a comprehensive and effective guiding tool for the development, implementation and evaluation of innovations in various low- and middle-income contexts. Researchers and implementing partners should adapt and use it.
电子健康创新在改善健康结果方面正变得愈发重要，尤其是对孕产妇和新生儿健康而言。然而，由于其性质复杂，规划和实施这些创新可能具有挑战性。为了在实施方法上提供指导和清晰性，研究人员需要使用实施研究（IR）工具。我们开展了实施研究，以利用实施研究逻辑模型（IRLM）识别在孕产妇和新生儿医疗保健背景下实施电子健康创新所面临的挑战。因此，本文旨在描述IRLM在设计、执行和评估电子健康创新方面的实际应用，这些创新可改善埃塞俄比亚公共设施中的孕产妇和新生儿护理。
我们对选定的提供孕产妇和新生儿护理的医疗设施中的一项电子健康创新进行了快速审查、形成性评估和过程评估。我们开发并部署的电子健康创新名为“ADHERE”（产前护理、分娩护理和产后护理），代表了孕产妇护理的连续过程。快速审查作为第一步，使用实施研究综合框架（CFIR）进行。我们采用了多种数据收集方法：访谈/讨论、电子健康系统或文件审查以及直接观察。此外，我们开展了各种利益相关者参与活动：两次共创研讨会和现场迭代讨论。我们应用了基于证据的实施策略的报告改编和修改框架（FRAME-IS）来获取持续的实施经验教训。
我们针对城市、城郊和偏远公共医疗设施这三种情况，开发了电子健康创新实施的IRLM。该模型描绘了实施决定因素与实施策略之间的相互作用机制，以产生预期的实施结果。IRLM有助于识别超过35个电子健康干预的实施障碍或促进因素，并为研究情况制定了超过17种缓解策略。最初的IRLM通过持续的实施经验教训和执行的缓解策略得到了完善。
IRLM是在各种低收入和中等收入背景下开发、实施和评估创新的全面且有效的指导工具。研究人员和实施伙伴应加以改编和使用。
