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other·public health, epidemiology, pediatrics, research methods, family medicine·PMC10131705

Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability

JMIR Formative Research · 10 authors, 8 centres

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TL;DR

A qualitative realist evaluation assessed how health care workers in 12 Kenyan immunization clinics integrated an electronic immunization registry into their workflows through semistructured interviews and workflow observations.

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Researchers conducted semistructured interviews with 19 health care workers and observed 58 immunization clinic workflow sessions. The electronic immunization registry was generally well accepted by users; however, barriers included software bugs that incorrectly displayed key fields, poor network connectivity preventing syncing, and contextual pressures from insufficient staff and high patient load. Limitations include limited generalizability from purposive sampling and potential Hawthorne and social desirability biases.

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other

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public health

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ORIGINAL PAPER

PMC10131705

Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability

JMIR Formative Research

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ABSTRACT

Background In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. Objective In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry’s usability. Methods Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Results Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1—ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2—confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3—identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4—make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. Conclusions We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users’ workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users’ needs and again after scale-up to ensure that interventions are suitable for all user settings.

CITATION EXPORT

Samantha B Dolan, Rachel Wittenauer, Jessica C Shearer et al.. Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability. JMIR Formative Research. (2023). https://doi.org/10.2196/39775

AUTHORS

10 · 8 CENTRES

Samantha B Dolan, Rachel Wittenauer, Jessica C Shearer, Anne Njoroge, Penina Onyango, George Owiso, William B Lober, Shan Liu, Nancy Puttkammer, Peter Rabinowitz

1 International Training and Education Center for Health University of Washington Seattle, WA United States
2 Department of Global Health University of Washington Seattle, WA United States
3 Bill and Melinda Gates Foundation Seattle, WA United States
4 PATH Seattle, WA United States
5 County Department of Health Siaya Kenya
6 International Training and Education Center for Health University of Washington Nairobi Kenya
7 Biobehavioral Nursing and Health Informatics University of Washington Seattle, WA United States
8 Department of Industrial and Systems Engineering University of Washington Seattle, WA United States

EDITOR / REVIEWER

Amaryllis Mavragani, Jake Pry, Aida Jaffar, Elaine Zibrowski