Karmacharya Biraj Man, Das Seema, Shrestha Abha, Shrestha Abha, Karki Sulata, Shakya Rajani, Radovich Emma, Penn-Kekana Loveday, Calvert Clara, Campell Oona M R, McCarthy Ona L
Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal.
Glob Health Sci Pract. 2025 Aug 14;13(1). doi: 10.9745/GHSP-D-23-00370.
Electronic decision-support systems (EDSSs) aim to improve the quality of antenatal care (ANC) through adherence to evidence-based guidelines. We assessed the potential of the mHealth integrated model of hypertension, diabetes, and ANC EDSS and the World Health Organization EDSS to improve the quality of ANC in primary-level health care facilities in Nepal.
From December 2021 to January 2023, we conducted a mixed-methods evaluation in 19 primary-level ANC facilities in Bagmati Province, Nepal. Implementation was from March 2022 to August 2022. We conducted a health facility survey, ANC clinical observations, longitudinal case studies and validation workshop, in-depth interviews, monitoring visits, research team debriefing meetings, health care provider attitude survey, and stakeholder engagement and feedback meetings. Results were integrated using concurrent triangulation to develop explanations about the EDSS implementation process and the effects observed.
We identified 9 themes on implementation challenges that hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS were mixed. It was not always used or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women's needs or ensure that tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short.
Different understandings of and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple substudies offers uniquely valuable insights into the many factors needed for the successful implementation of an EDSS to improve the quality of ANC in Nepal.
电子决策支持系统（EDSS）旨在通过遵循循证指南来提高产前保健（ANC）的质量。我们评估了高血压、糖尿病和ANC电子决策支持系统的移动健康集成模型以及世界卫生组织电子决策支持系统在尼泊尔初级卫生保健机构中提高ANC质量的潜力。
2021年12月至2023年1月，我们在尼泊尔加德满都谷地省的19个初级ANC机构进行了混合方法评估。实施时间为2022年3月至2022年8月。我们开展了卫生机构调查、ANC临床观察、纵向案例研究和验证研讨会、深入访谈、监测访问、研究团队汇报会议、医疗保健提供者态度调查以及利益相关者参与和反馈会议。通过并行三角测量法整合结果，以对EDSS的实施过程和观察到的效果进行解释。
我们确定了9个关于实施挑战的主题，这些挑战阻碍了EDSS对ANC质量产生预期的改善。机构准备情况以及提供者使用EDSS的信心参差不齐。它并非总是被使用或按预期使用并且提供ANC的方式没有改变。EDSS缺乏灵活性，没有反映出工作人员如何就孕妇的需求做出决策，也没有确保在正确的时间进行检查。有混合证据表明ANC工作人员认为EDSS对他们的工作有益。EDSS没有完全融入现有的卫生系统。关键利益相关者的参与不足。
对EDSS的不同理解和不一致的使用凸显了增加培训和支持时间、加强利益相关者参与以及进一步融入现有卫生系统的必要性。我们整合多个子研究结果的新颖方法为成功实施EDSS以提高尼泊尔ANC质量所需的诸多因素提供了独特而有价值的见解。
