Download - ICT4H 2015 B Wolf Piggott
A Clinic-Level View ofthe MomConnect Implementation
ICT4Health ConferenceBrendon Wolff-Piggott
25 November 2015
Research Setting
<<graphic of connected mothers >>
Use Cases from Training MaterialOption Use CaseOption 1 Health Education Class and MomConnect Information => Consultation
with Nurse (record of decision and EDD) => File to Data Capturer
Option 2 Health Education Class and MomConnect Information => Consultation with Nurse (record of decision and EDD) => Nurse signs mother up (recorded in clinic file)
Option 3 If no Health Education Class => Clinic staff member tasked to hand out informational fliers to mothers while waiting => Consultation with Nurse => Nurse signs mother up (recorded in clinic file)
Research Question
What are the key influences on how a mobile health application is routinely used in a public clinic setting?
Research DesignMultiple case study
Exploratory investigationOpen codingHermeneutic analysis
Framed using Activity Theory
Data Collection Open-ended Interviews with Key Staff
Facility ManagersANC SistersSupporting staff using MomConnect
Observation of MomConnect Registration
Observation of General Clinic Routines
Data Analysis Interviews
Recorded and transcribedLoaded and coded in Atlas-TIGroup codes
ObservationsReviewed and highlightedCorrelations and contradictions with
transcripts notedHigher-level Analysis drawing on Activity
Theory
ResultsGeneral perceptions and work practices
MomConnect use issues
Other issues
Perceptions of MomConnect useCode Quotes Type of SourceInappropriate for professional health workers
“ Professionals don't do this, really. There are volunteers who can do this”
Facility manager / nursing sister interview
Shortage of time and professional nursing staff
"The work is being added (to) every day. … Work is added ... (by) this Mom Connect, it's on top of other things"
Facility manager / nursing sister interview
Delaying professional tasks
"If the phones are not going through it means I don't start working. Because I connect to Mom Connect before I take bloods, I do everything"
Nursing sister interview
MomConnect RegistrationCode Quotes Type of SourceRegistration errors
“there are times when like, when was it? Monday or Nursing sister interviewTuesday, the phones were not going through. And that lady, I've forgot her name from Mom Connect office, she was here. I told her that I'm frustrated”
Nursing sister interview
English literacy “we thought she was slow, but she can’t read English”
Observation
Registration errors
Touch-screen phones are difficult Observation
Handset UseCode Quotes Type of SourceHandset presence
"… some of them they don't even have the telephone numbers, the telephones, they say they can't have these telephones because they come very early. Most of them here they give the history that they have lost their phones and it's difficult because you need to use your own phone”
Facility manager / nursing sister interview
Handset use “... if a patient doesn't have a phone then I use my phone and I enter that patients phone number. But when ... they have a cell phone but they don't know how to use them, and that bothers me the most. "
Facility manager / nursing sister interview
Client concerns "Some antenatal patients are sceptical when it comes to registration process. Because some of them are HIV positive”
Facility manager / nursing sister interview
Discussion
How is the application used in practice?
Can this be thought of as an Activity System?
What influences may be identified?
Actual work practicesWork practices
User Groups
Reasons given
Relevant dynamics
Who Primarily support staff
“Not professional work”Time constraints
Professional / non-professional divideResource constraints
How (Why)
Multiple modes
Nurses said so / excluded from ANC space
Power relations Contradictions between nurse and auxiliary aims
When In-between routine ANC tasks. Registration after
Keeps nurses from doing their work
EfficiencyContradictions between nurse and mother’s interests
Actual Work Practices
MomConnect
Presentation Consultation
JointRegistratio
n
Presentation Details on paper
Consultation
Registration
Registration by CHW
Registration by ClientsTechnical System
Work Environment
Subject Object Outcome
Tools
Rules Community Division of Labour
The ActivitySystem Model
National Department
of Health
MomConnect Registrations
Improved Health for Women and Children
MomConnect SystemClinics
National MomConnect Activity
Levels of FocusUnit of Analysis Subject Focus
Clinic Facility Manager Activity: Curative & preventive
care delivery
Antenatal Care
Section
ANC Sister Activity: Physical examination,
calculation of EDD, & referral
for further test as required
ANC Health
Promotion
Health Promoter /
Volunteer
Activity: Health Management
Presentation and MomConnect
Registration
National Department
of Health
Registration ofPregnant Women
All clinics
National MomConnect Activity
Clinic Care Activity
Antenatal Care Activity
MomConnect and Clinic ANC Care
ImplicationsLocal clinic characteristics, existing work practices and
staff dynamics – Task shifting
MomConnect characteristics also shape staff perceptions and ease of use
Activity Theory can help understand why observed dynamics occur, and suggest useful interventions
Practice: Short term – improve feedback to facility managers and staffLong term – expand the role of CHW / Health Promotion
staff, and locate “ownership” there
LimitationsFieldwork only undertaken in clinics where
MAMA was implemented previously
Limited access to staff because of workload and language barriers
No formal access to technical service providers
Way forwardExtend investigation to include rural clinics
Repeat interviews and observation to obtain longitudinal perspective
Examine digital traces from registration database
Thank You!