Effects of computerized decision support in the context of a performance-based incentive intervention on maternal and neonatal health-worker performance in Upper East Region, Ghana: A qualitative study of professional perspectives

Background: Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of combined CDSS-PBI support on performance in twelve primary care facilities in Ghana’s Upper East Region. Methods: We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 9 software. Results: Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some also reported improved and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software. Conclusions: Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.
This article is published in BMC Health Services Research, 2022;;DOI: https://doi.org/10.21203/rs.3.rs-1629630/v1
BMC Health Services Research, 2022; DOI: https://doi.org/10.21203/rs.3.rs-1629630/v1