297140
Feasibility of Implementing a Decision Support and Integrated Record-Keeping Tool in the Nurse Management of Hypertension in Rural Western Kenya
To address the human resource challenge of managing hypertension in low- and middle- income countries (LMICs), the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-ba¬¬sed electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist frontline health workers with clinical decision-making. However, the feasibility of this type of tool for hypertension care has not previously been assessed in a LMIC setting.
Objective/Purpose
Understanding the feasibility of implementing the DESIRE tool has the potential to broadly impact treatment of non-communicable diseases in LMICs by providing a model for optimization of electronic decision-support in task redistribution among frontline health workers.
Methods
To evaluate the feasibility of the DESIRE tool, we conducted semi-structured interviews with five nurses, semi-structured interviews with two members of the implementation team, and one focus group discussion with five nurses. Content analysis was used to analyze the qualitative data, focusing on two components of feasibility: acceptability and infrastructure.
Results
Five themes were found to emerge: barriers to implementation, facilitators to implementation, provider issues, patient issues, and feature requests. Technical barriers included network issues, server problems, loading incorrect patient cohort, and inability to create new patient records. Human resource barriers included transportation difficulty, prolonged procurement process, and insufficient clinical mentorship. Facilitators included electricity availability, privacy of digital health information, and improved health record organization. Ten feature requests were proposed including ability to create new records, encounter review screen, free text field and confirmation of data sync.
Conclusion
The use of a participatory feasibility study uncovered many previously unknown feasibility issues in implementing a tablet-based decision support tool for use in hypertension care by nurses in a resource-limited setting. The feasibility issues identified resulted in system change suggestions, highlighting the importance of feasibility testing as part of implementing mHealth systems in LMICs.
Learning Areas:
Chronic disease management and preventionCommunication and informatics
Implementation of health education strategies, interventions and programs
Learning Objectives:
Explain feasibility issues of implementing a mobile health application that aims to optimize nurse management of hypertension in low-resource settings.
Keyword(s): International Health, Information Technology
Qualified on the content I am responsible for because: I am a medical student with an interest in human factors research and using mobile health technology to address chronic disease in low income countries. I am a co-investigator on a grant to address the use of a smart phone tool to assist in the nurse management of hypertension in rural western Kenya.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.