An assessment of the quality of vaccination data produced through smart paper technology in The Gambia

Sowe, Alieu; Gariboldi, Maria Isabella

doi:10.1016/j.vaccine.2020.07.074

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…Our findings that SPT was well accepted by users for format and layout leading to time-savings was also raised by two studies evaluating SPT for child vaccination services in Uganda and The Gambia [31, 38]. However, other studies reporting on various other digital technologies such as electronic patient records also indicate high satisfaction with electronic tools, a finding that may suggest that HCPs generally accept digital technology well [29, 39].…”

Section: Discussionsupporting

confidence: 73%

“…A study evaluating SPT for vaccination services in Uganda found a neglectable 24 seconds increase in documentation time per immunization service [31]. Another SPT evaluation of vaccination services in The Gambia found a reduction by 16 minutes per child [38]. In contrast, evaluations using other options than SPT pointed to an increased time spent on documentation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine health information in Southern Tanzania: A mixed-methods study

Unkels

Manzi

Kapologwe

et al. 2022

Preprint

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Background: Health information systems are important for health planning and monitoring of progress. Still, data from health facilities are often of limited quality in Low-and-Middle-Income Countries. Quality deficits are partially rooted in the fact that paper-based documentation is still the norm at facility level, leading to mistakes in summarizing and manual copying. Digitalization of data at facility level would allow automatization of these procedural steps. Here we aimed to evaluate the feasibility, usability and acceptability of a scanning innovation called Smart Paper Technology for digital data processing. Methods: We used a mixed-methods design to understand users' engagement with Smart Paper Technology and to identify potential positive and negative effects of this innovation in three health facilities in Southern Tanzania. Eight focus group discussions and 11 in-depth interviews with users were conducted. We quantified time used by health care providers for documentation and patient care using time-motion methods. Thematic analysis was used to analyze qualitative data. Descriptive statistics and multivariable linear models were generated to compare the difference before and after introduction and adjust for confounders. Results: Health care providers and health care managers appreciated the forms' simple design features and perceived Smart Paper Technology as time-saving and easy to use. The time-motion study with 273.3 and 224.0 hours of observations before and after introduction of Smart Paper Technology, respectively, confirmed that working time spent on documentation did not increase (27.0% at baseline and 26.4% post-introduction; adjusted p=0.763). Time spent on patient care was not negatively impacted (26.9% at baseline and 37.1% at post-intervention; adjusted p=0.001). Health care providers described positive effects on their accountability for data and service provision relating to the fact that individually signed forms were filled. Discussion: Health care providers perceived Smart Paper Technology as feasible, easy to integrate and acceptable in their setting, particularly as it did not add time to documentation.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine health information in Southern Tanzania: A mixed-methods study

Unkels

Manzi

Kapologwe

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…SPT can potentially improve HMIS data quality through simplified primary data entry and automated digitization. Studies reported good SPT data quality for vaccination services in The Gambia and Uganda (11,12). Our previous findings from the process evaluation of this novel system suggest that SPT can be embedded into existing maternal health care provision, is acceptable and potentially generates time-savings for HCPs (13).…”

Section: Introductionmentioning

confidence: 79%

Caught in the data quality trap: A case study from the evaluation of a new digital technology supporting routine health data collection in Southern Tanzania

Unkels

Ahmad

Manzi

et al. 2023

Preprint

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Background Health service data from Health Management Information Systems is important for decision–making at all health system levels. Data quality issues in low-and-middle-income countries hamper data use however. Smart Paper Technology, a novel digital–hybrid technology, was designed to overcome quality challenges through automated digitization. Here we assessed the impact of the novel system on data quality dimensions, metrics and indicators as proposed by the World Health Organization′s Data Quality Review Toolkit. Methods This cross–sectional study was conducted between November 2019 and October 2020 in 13 health facilities sampled from 33 facilities of one district in rural Tanzania, where we implemented Smart Paper Technology. We assessed the technology′s data quality for maternal health care against the standard District Health Information System-2 applied in Tanzania. Results Smart Paper Technology performed slightly better than the District Health Information System–2 regarding consistency between related indicators and outliers. We found <10% difference between related indicators for 62% of the facilities for the new system versus 38% for the standard system in the reference year. Smart Paper Technology was inferior to District Health Information System–2 data in terms of completeness. We observed that data on 1st antenatal care visits were complete >90% in only 76% of facilities for the new system against 92% for the standard system. For the indicator internal consistency over time 73%, 59% and 45% of client numbers for antenatal, labour and postnatal care recorded in the standard system were documented in the new system. Smart Paper Technology forms were submitted in 83% of the months for all service areas. Conclusion Our results suggest that not all client encounters were documented in Smart Paper Technology, affecting data completeness and partly consistency. The novel system was unable to leverage opportunities from automated processes because primary documentation was poor. Low buy–in of policymakers and lack of internal quality assurance may have affected data quality of the new system. We emphasize the importance of including policymakers in evaluation planning to co-design a data quality monitoring system and to agree on a realistic way to ensure reporting of routine health data to national level.

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“…The sample size calculation was performed using a significance level of P=.05 and 80% power. We estimated the mean values for each outcome within each group based on the EIR time-use estimates reported in the literature (Multimedia Appendix 1) [27][28][29]. On the basis of our specifications, our sample size was computed to be 9 HCWs, 3 per facility size.…”

Section: Samplingmentioning

confidence: 99%

“…Projecting time savings and subsequent cost savings would be important for demonstrating the value of the system. There are no other published studies that have specifically assessed time utilization between a dual-data entry workflow and a paperless workflow; however, there are evaluation reports in the gray literature of time utilization following the introduction of an EIR implemented in Afghanistan, the Gambia, and Uganda comparing paper-based with paperless data management activities [27][28][29]. In each country, reductions in time utilization for a child's first immunization visit were observed, ranging from 1.45 to 6.21 minutes.…”

Section: Time Savingsmentioning

confidence: 99%

Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows

Dolan¹,

Wittenauer²,

Njoroge³

et al. 2023

JMIR Form Res

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Background Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. Objective We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual–data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). Methods We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient’s total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Results Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR’s performance and ability to connect to the internet were particularly insightful about potential causes of delays. Conclusions We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.

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An assessment of the quality of vaccination data produced through smart paper technology in The Gambia

Cited by 7 publications

References 14 publications

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine health information in Southern Tanzania: A mixed-methods study

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine health information in Southern Tanzania: A mixed-methods study

Caught in the data quality trap: A case study from the evaluation of a new digital technology supporting routine health data collection in Southern Tanzania

Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows

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