168 lines
5.5 KiB
YAML
168 lines
5.5 KiB
YAML
abstract: 'Background: In an effort to increase vaccination coverage in
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low-resource settings, digital tools have been introduced to better
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track immunization records, improve data management practices, and
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provide improved access to vaccination coverage data for
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decision-making. Despite the potential of these electronic systems to
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improve the provision of health services, few digital health
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interventions have been institutionalized at scale in low-and
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middle-income countries. Objective: In this paper, we aimed to describe
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how health care workers in Kenya had integrated an electronic
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immunization registry into their immunization clinic workflows and to
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use these findings to inform the development of a refined program theory
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on the registry''s usability.Methods: Informed by realist methodology, we
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developed a program theory to explain usability of the electronic
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immunization registry. We designed a qualitative study based on our
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theory to describe the barriers and facilitators influencing data entry
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and use. Qualitative data were collected through semistructured
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interviews with users and workflow observations of immunization clinic
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sessions. Our findings were summarized by context-mechanism-outcome
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relationships formed after analyzing our key themes across interviews
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and workflow observations. Using these relationships, we were able to
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identify common rules for future implementers.Results: Across the 12
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facilities included in our study, 19 health care workers were
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interviewed, and 58 workflow sessions were observed. The common rules
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developed from our qualitative findings are as follows: rule 1-ensure
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that the users complete training to build familiarity with the system,
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understand the value of the system and data, and know where to find
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support; rule 2-confirm that the system captures all data needed for
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users to provide routine health care services and is easy to navigate;
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rule 3-identify work-arounds for poor network, system performance, and
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too few staff or resources; and rule 4-make users aware of expected
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changes to their workflow, and how these changes might differ over time
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and by facility size or number of patients. Upon study completion, we
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revised the program theory to reflect the importance of the goals and
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workflows of electronic immunization registries aligning with
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reality.Conclusions: We created a deeper understanding of the underlying
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mechanisms for usability of the registry. We found that the electronic
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immunization registry had high acceptability among users; however, there
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were numerous barriers to using the system, even under ideal conditions,
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causing a misalignment between the system and the reality of the users''
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workflows and their environment. Human-centered design and human-factors
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methods can assist during pilot stages to better align systems with
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users'' needs and again after scale-up to ensure that interventions are
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suitable for all user settings.(JMIR Form Res 2023;7:e39775) doi:
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10.2196/39775'
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affiliation: 'Dolan, SB (Corresponding Author), Bill \& Melinda Gates Fdn, 500 5th
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Ave N, Seattle, WA 98109 USA.
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Dolan, Samantha B.; Njoroge, Anne; Puttkammer, Nancy; Rabinowitz, Peter, Univ Washington,
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Int Training \& Educ Ctr Hlth, Seattle, WA USA.
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Dolan, Samantha B.; Wittenauer, Rachel; Njoroge, Anne; Lober, William B.; Puttkammer,
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Nancy; Rabinowitz, Peter, Univ Washington, Dept Global Hlth, Seattle, WA USA.
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Dolan, Samantha B., Bill \& Melinda Gates Fdn, Seattle, WA USA.
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Shearer, Jessica C., PATH, Seattle, WA USA.
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Onyango, Penina, Cty Dept Hlth, Siaya, Kenya.
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Owiso, George, Univ Washington, Int Training \& Educ Ctr Hlth, Nairobi, Kenya.
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Lober, William B., Univ Washington, Biobehav Nursing \& Hlth Informat, Seattle,
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WA USA.
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Liu, Shan, Univ Washington, Dept Ind \& Syst Engn, Seattle, WA USA.
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Dolan, Samantha B., Bill \& Melinda Gates Fdn, 500 5th Ave N, Seattle, WA 98109
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USA.'
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author: Dolan, Samantha B. and Wittenauer, Rachel and Shearer, Jessica C. and Njoroge,
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Anne and Onyango, Penina and Owiso, George and Lober, William B. and Liu, Shan and
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Puttkammer, Nancy and Rabinowitz, Peter
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author-email: sdolan11@gmail.com
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author_list:
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- family: Dolan
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given: Samantha B.
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- family: Wittenauer
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given: Rachel
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- family: Shearer
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given: Jessica C.
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- family: Njoroge
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given: Anne
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- family: Onyango
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given: Penina
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- family: Owiso
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given: George
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- family: Lober
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given: William B.
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- family: Liu
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given: Shan
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- family: Puttkammer
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given: Nancy
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- family: Rabinowitz
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given: Peter
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da: '2023-09-28'
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doi: 10.2196/39775
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eissn: 2561-326X
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files: []
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journal: JMIR FORMATIVE RESEARCH
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keywords: 'immunizations; electronic immunization registry; workflow; usability;
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realist research'
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keywords-plus: HUMAN-CENTERED DESIGN; PUBLIC-HEALTH
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language: English
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number-of-cited-references: '48'
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orcid-numbers: 'Wittenauer, Rachel/0000-0002-6606-8708
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Puttkammer, Nancy/0000-0002-6693-9278
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Lober, William/0000-0002-1053-7501
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Rabinowitz, Peter/0000-0002-6873-0208
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Dolan, Samantha/0000-0001-8088-6611'
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papis_id: c0b0f82f9de49fe14d74ce374c0e94ae
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ref: Dolan2023integrationdigital
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times-cited: '1'
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title: 'Integration of a Digital Health Intervention Into Immunization Clinic Workflows
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in Kenya: Qualitative, Realist Evaluation of Technology Usability'
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type: article
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unique-id: WOS:000998490100041
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usage-count-last-180-days: '0'
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usage-count-since-2013: '0'
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volume: '7'
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web-of-science-categories: Health Care Sciences \& Services; Medical Informatics
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year: '2023'
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