BACKGROUND: Maternal mortality remains a persistent public health concern in Sub-Saharan African countries such as Ethiopia. The Ethiopian Ministry of Health has made it a priority to improve maternal health outcomes within the country. Health information technology (HIT) solutions are a flexible and low-cost method for improving health outcomes and have been proven beneficial in low-to-middle income countries, like Ethiopia. The aims of this dissertation were: (a) to characterize the use of HIT usability evaluations in Africa; (b) to quantify facility clinical readiness for obstetric emergencies; (c) to explore the obstetric emergency supply chain dynamics and information flow; (d) to create a visualization dashboard to monitor obstetric emergency readiness; and (e) to evaluate the usability of the dashboard.
METHODS: This dissertation comprised six studies with a variety of quantitative and qualitative methods: (1) a scoping review of the literature to identify the types and timing of HIT evaluations occurring in Africa; (2) a prospective, cross-sectional, facility-level comparison of obstetric emergency clinical readiness in Amhara, Ethiopia as measured by the Signal Functions and Clinical Cascades methods; (3) qualitative semi-structured interviews to gain an understanding of the current supply chain in the region, communication flow, and the current barriers and facilitators to success; (4) a case study summarizing the process for the development of the dashboard prototype through integrating existing technology, current literature, and qualitative interview findings; (5) user-centered design sessions with individuals who interact with the obstetric emergency supply chain to create an electronic dashboard prototype to monitor facility readiness to manage obstetric emergencies; and (6) expert review of the dashboard including sessions with a domain expert and information visualization experts and a heuristic usability evaluation with human-computer interaction experts to evaluate and improve the ease of use and usefulness of the prototype.
RESULTS: The scoping review found that many usability evaluations in Africa lacked theoretical frameworks to support their work, and that most studies occurred later in the development process when the HIT was close to implementation in practice. The quantitative analysis of facility readiness found that many facilities were missing critical supplies for managing obstetric emergencies and identified a 29.6% discrepancy between the Signal Function tracer items and the Clinical Cascades readiness classifications indicating that the former, which is recommended by the World Health Organization, overestimates facility readiness. The qualitative interviews identified several locations within the current obstetric emergency supply chain where barriers such as bridging the gap of data availability between facilities and regional hubs could be addressed to improve overall facility-level readiness and pointed towards a dashboard as a potential solution. Once a prototype dashboard was developed, user-centered design sessions refined the terminology and colors that should be used throughout the dashboard screens and identified critical graphics and data elements that users believed should be included. Following domain and visualization expert review and iterative refinement of the dashboard, human-computer interaction experts rated the dashboards highly usable.
CONCLUSIONS: Dashboards are a novel method for promoting facility-level readiness to manage obstetric emergencies. By exploring the existing supply chain and including targeted end-users and experts in the design process the author was able to tailor the dashboard to meet user needs, fit into the existing integrated pharmaceutical logistics system, and ensure that it follows best practices. Consequently, these studies contribute to strategies to address maternal mortality in Ethiopia.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/3rhr-ev42 |
| Date | January 2023 |
| Creators | Dougherty, Kylie Kelleher |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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