Abstract
BackgroundThe use of routine immunization data by health care professionals in low- and middle-income countries remains an underutilized resource in decision-making. Despite the significant resources invested in developing national health information systems, systematic reviews of the effectiveness of data use interventions are lacking. Applying a realist review methodology, this study synthesized evidence of effective interventions for improving data use in decision-making.MethodsWe searched PubMed, POPLINE, Centre for Agriculture and Biosciences International Global Health, and African Journals Online for published literature. Grey literature was obtained from conference, implementer, and technical agency websites and requested from implementing organizations. Articles were included if they reported on an intervention designed to improve routine data use or reported outcomes related to data use, and targeted health care professionals as the principal data users. We developed a theory of change a priori for how we expect data use interventions to influence data use. Evidence was then synthesized according to data use intervention type and level of the health system targeted by the intervention.ResultsThe searches yielded 549 articles, of which 102 met our inclusion criteria, including 49 from peer-reviewed journals and 53 from grey literature. A total of 66 articles reported on immunization data use interventions and 36 articles reported on data use interventions for other health sectors. We categorized 68 articles as research evidence and 34 articles as promising strategies. We identified ten primary intervention categories, including electronic immunization registries, which were the most reported intervention type (n = 14). Among the research evidence from the immunization sector, 32 articles reported intermediate outcomes related to data quality and availability, data analysis, synthesis, interpretation, and review. Seventeen articles reported data-informed decision-making as an intervention outcome, which could be explained by the lack of consensus around how to define and measure data use.ConclusionsFew immunization data use interventions have been rigorously studied or evaluated. The review highlights gaps in the evidence base, which future research and better measures for assessing data use should attempt to address.
Highlights
The use of routine immunization data by health care professionals in low- and middle-income countries remains an underutilized resource in decision-making
We developed a review protocol (Appendix A) with input from a technical steering committee composed of ten global and regional senior leaders in the areas of immunization, data quality, and data use from the Pan American Health Organization (PAHO), World Health Organization (WHO) headquarters, the Bill & Melinda Gates Foundation, PATH, the US Centers for Disease Control and Prevention, the United Nations Children’s Fund, and Gavi, as well as country representatives from both the Better Immunization Data Initiative (BID Initiative) Learning Network and Improving Data Quality for Immunizations core project countries
The hypotheses and assumptions reflected in the theory of change (TOC) were informed by existing health information and data use frameworks, as well as systematic reviews on topics related to health information system strengthening and evidence-informed decision-making [11,12,13,14,15,16]
Summary
The use of routine immunization data by health care professionals in low- and middle-income countries remains an underutilized resource in decision-making. The barriers to using health data have been relatively well studied and point to insufficient skills in data use core competencies among health workers, lack of trust in data due to poor quality, and inadequate availability because of fragmented data across multiple sources, among others [1, 4,5,6,7,8], to date there is no formal review of evidence from existing efforts to strengthen immunization data use To address this gap, we conducted a realist systematic review of existing research evidence on immunization data use interventions in low- and middle-income countries (LMICs). Our review was designed to answer two specific research questions: 1. What are the most effective interventions to improve the use of data for immunization program and policy decision-making?
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