Abstract
It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.
Highlights
Current best estimates from the United Nations show that one of the countries with a “very high” maternal mortality ratio is Tanzania, with 524 maternal deaths per 100,000 live births [1]
Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to [1] engage the community and listen to their insights, [2], focus on clear programme goals and the desired change, Frontiers in Public Health | www.frontiersin.org van Pelt et al Implementing Digital Health Tools
A description of the completed planning tool combined with the analysis of the practical execution of the six steps of Intervention Mapping is presented below to evaluate the development and implementation of the Nurse Assistant App (NAA)
Summary
Current best estimates from the United Nations show that one of the countries with a “very high” maternal mortality ratio is Tanzania, with 524 maternal deaths per 100,000 live births [1]. The consequences of maternal death are far-reaching, as it impacts women as well as their children, families, and communities [2]. Antenatal care (ANC) is a crucial intervention to promote maternal and child health [6,7,8,9] and identify issues early during pregnancy. ANC improves the survival and health of mothers through the prevention and management of pregnancy-related complications and by providing an entry point for health contact with pregnant women [8, 10]. ANC offers an opportunity to promote facilitybased deliveries, which is considered as the key intervention for reducing maternal mortality in low- and middle-income countries [6, 11,12,13,14,15]
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