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Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya:
Nhi Dinh1, Smisha Agarwal1, Lisa Avery2
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
JMIR Formative Research
|June 20, 2022
Summary
The iDeliver digital system adoption and data completeness significantly improved over time in Kenyan maternal and neonatal care. This implementation research highlights user engagement challenges during active childbirth, informing future adaptations.
Area of Science:
- Digital health interventions
- Implementation science
- Maternal and neonatal healthcare quality improvement
Background:
- The iDeliver digital clinical support system was developed to enhance maternal and neonatal care quality in Kenya.
- Implementation research was employed to evaluate the system's effectiveness and integration into routine healthcare.
Purpose of the Study:
- To evaluate the adoption rate and fidelity of the iDeliver system over time.
- To assess the feasibility of using iDeliver for routine Ministry of Health (MOH) reporting.
- To identify factors influencing the system's use in clinical workflows.
Main Methods:
- Analysis of routinely collected data from iDeliver at Transmara West Sub-County Hospital (December 2018 - September 2020).
- Evaluation of adoption through facility delivery registration rates in iDeliver.
- Assessment of fidelity via data entry completeness across the labor and delivery workflow.
- Examination of data completeness for key maternal and neonatal indicators prioritized by the Kenya MOH.
Main Results:
- iDeliver captured 45.31% of facility deliveries, with adoption significantly improving quarterly (6.7% increase).
- Overall data completeness across the workflow significantly improved quarterly (2.9% increase), reaching 49.21%.
- Completion rates for MOH indicators significantly improved quarterly (4.6% increase), reaching 83.75%.
Conclusions:
- iDeliver demonstrated significant improvements in adoption and data completeness over the study period.
- System use fidelity varied, with lower engagement during active childbirth due to provider workload.
- Adaptations to iDeliver are planned to better align with user practices and improve implementation.
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