Abstract
BackgroundThe ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. This study’s primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings.MethodsThe ePartogram was introduced at three facilities in Zanzibar, Tanzania. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Results were analyzed by shift. Short interviews, conducted with SBAs (n = 82) after each of their first five ePartogram-monitored labors, detected differences over time. After the observation period, in-depth interviews were conducted (n = 15). A thematic analysis of interview transcripts was completed.ResultsObservations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87–91%) completed each of four fundamental ePartogram tasks—registering a client, entering first and subsequent measurements, and navigating between screens—with ease or increasing ease on their first shift; this increased to 100% by the fifth shift. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed confidence in their ability to interpret and act on these reminders and alerts.ConclusionsIt is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. These findings point to the ePartogram’s potential to improve quality of care in resource-constrained labor and delivery settings.
Highlights
The ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use
Feasibility Of the 31 Skilled birth attendant (SBA) who enrolled, 30 successfully completed the three-day training (97%) with one SBA withdrawing after not passing the skills checklist. Once they were in the clinical setting, the vast majority of SBAs were able to complete four basic tasks on the ePartogram either with ease from the beginning of the first shift or with increasing ease throughout the first shift: registering a new client in the ePartogram (43% “with ease,” 48% “with increasing ease throughout shift”), entering the first set of clinical measurements in the ePartogram (38, 52%), entering subsequent data (43, 48%), and navigating between data entry screens in the ePartogram (39, 48%) (Fig. 3)
Results show that the majority of SBAs found the ePartogram to be useful and acceptable within their clinical context and further expressed their desire to integrate it fully into the care of their clients, recommending it for use in all facilities in Zanzibar
Summary
The ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. For the last four decades, the World Health Organization (WHO) has recommended that, during labor, skilled birth attendants (SBAs) use the partograph as a tool to improve documentation of intrapartum maternal and fetal measurements, identify abnormalities, and inform appropriate labor management [1]. Jhpiego developed the ePartogram for use on an Android tablet, with particular attention to improving ease and efficiency of real-time documentation, increasing visibility of labor management data to nurses and supervisors to inform decisionmaking, and providing visual and auditory cues for timely and appropriate clinical decision-making during labor. The resulting ePartogram application includes auditory reminders that prompt SBAs to take measurements, such as obtaining fetal heart rate every 30 min, and visual alerts to flag measurements indicating the need for follow-up, for example, if the dilation measurement crosses the alert or action line (see Fig. 1)
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