wow-inequalities/02-data/intermediate/wos_sample/819cc73301fad6ede6e2785067f821ec-dolan-samantha-b.-a/info.yaml

abstract: 'Background: In an effort to increase vaccination coverage in

  low-resource settings, digital tools have been introduced to better

  track immunization records, improve data management practices, and

  provide improved access to vaccination coverage data for

  decision-making. Despite the potential of these electronic systems to

  improve the provision of health services, few digital health

  interventions have been institutionalized at scale in low-and

  middle-income countries. Objective: In this paper, we aimed to describe

  how health care workers in Kenya had integrated an electronic

  immunization registry into their immunization clinic workflows and to

  use these findings to inform the development of a refined program theory

  on the registry''s usability.Methods: Informed by realist methodology, we

  developed a program theory to explain usability of the electronic

  immunization registry. We designed a qualitative study based on our

  theory to describe the barriers and facilitators influencing data entry

  and use. Qualitative data were collected through semistructured

  interviews with users and workflow observations of immunization clinic

  sessions. Our findings were summarized by context-mechanism-outcome

  relationships formed after analyzing our key themes across interviews

  and workflow observations. Using these relationships, we were able to

  identify common rules for future implementers.Results: Across the 12

  facilities included in our study, 19 health care workers were

  interviewed, and 58 workflow sessions were observed. The common rules

  developed from our qualitative findings are as follows: rule 1-ensure

  that the users complete training to build familiarity with the system,

  understand the value of the system and data, and know where to find

  support; rule 2-confirm that the system captures all data needed for

  users to provide routine health care services and is easy to navigate;

  rule 3-identify work-arounds for poor network, system performance, and

  too few staff or resources; and rule 4-make users aware of expected

  changes to their workflow, and how these changes might differ over time

  and by facility size or number of patients. Upon study completion, we

  revised the program theory to reflect the importance of the goals and

  workflows of electronic immunization registries aligning with

  reality.Conclusions: We created a deeper understanding of the underlying

  mechanisms for usability of the registry. We found that the electronic

  immunization registry had high acceptability among users; however, there

  were numerous barriers to using the system, even under ideal conditions,

  causing a misalignment between the system and the reality of the users''

  workflows and their environment. Human-centered design and human-factors

  methods can assist during pilot stages to better align systems with

  users'' needs and again after scale-up to ensure that interventions are

  suitable for all user settings.(JMIR Form Res 2023;7:e39775) doi:

  10.2196/39775'
affiliation: 'Dolan, SB (Corresponding Author), Bill \& Melinda Gates Fdn, 500 5th
  Ave N, Seattle, WA 98109 USA.

  Dolan, Samantha B.; Njoroge, Anne; Puttkammer, Nancy; Rabinowitz, Peter, Univ Washington,
  Int Training \& Educ Ctr Hlth, Seattle, WA USA.

  Dolan, Samantha B.; Wittenauer, Rachel; Njoroge, Anne; Lober, William B.; Puttkammer,
  Nancy; Rabinowitz, Peter, Univ Washington, Dept Global Hlth, Seattle, WA USA.

  Dolan, Samantha B., Bill \& Melinda Gates Fdn, Seattle, WA USA.

  Shearer, Jessica C., PATH, Seattle, WA USA.

  Onyango, Penina, Cty Dept Hlth, Siaya, Kenya.

  Owiso, George, Univ Washington, Int Training \& Educ Ctr Hlth, Nairobi, Kenya.

  Lober, William B., Univ Washington, Biobehav Nursing \& Hlth Informat, Seattle,
  WA USA.

  Liu, Shan, Univ Washington, Dept Ind \& Syst Engn, Seattle, WA USA.

  Dolan, Samantha B., Bill \& Melinda Gates Fdn, 500 5th Ave N, Seattle, WA 98109
  USA.'
author: Dolan, Samantha B. and Wittenauer, Rachel and Shearer, Jessica C. and Njoroge,
  Anne and Onyango, Penina and Owiso, George and Lober, William B. and Liu, Shan and
  Puttkammer, Nancy and Rabinowitz, Peter
author-email: sdolan11@gmail.com
author_list:
- family: Dolan
  given: Samantha B.
- family: Wittenauer
  given: Rachel
- family: Shearer
  given: Jessica C.
- family: Njoroge
  given: Anne
- family: Onyango
  given: Penina
- family: Owiso
  given: George
- family: Lober
  given: William B.
- family: Liu
  given: Shan
- family: Puttkammer
  given: Nancy
- family: Rabinowitz
  given: Peter
da: '2023-09-28'
doi: 10.2196/39775
eissn: 2561-326X
files: []
journal: JMIR FORMATIVE RESEARCH
keywords: 'immunizations; electronic immunization registry; workflow; usability;

  realist research'
keywords-plus: HUMAN-CENTERED DESIGN; PUBLIC-HEALTH
language: English
number-of-cited-references: '48'
orcid-numbers: 'Wittenauer, Rachel/0000-0002-6606-8708

  Puttkammer, Nancy/0000-0002-6693-9278

  Lober, William/0000-0002-1053-7501

  Rabinowitz, Peter/0000-0002-6873-0208

  Dolan, Samantha/0000-0001-8088-6611'
papis_id: c0b0f82f9de49fe14d74ce374c0e94ae
ref: Dolan2023integrationdigital
times-cited: '1'
title: 'Integration of a Digital Health Intervention Into Immunization Clinic Workflows
  in Kenya: Qualitative, Realist Evaluation of Technology Usability'
type: article
unique-id: WOS:000998490100041
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '7'
web-of-science-categories: Health Care Sciences \& Services; Medical Informatics
year: '2023'