Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique
Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique
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DOI：
10.2196/13963
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发表时间：
2019-05-13
影响因子：
5
通讯作者：
Gimbel, Sarah
中科院分区：
文献类型：
--
作者：
Kawakyu, Nami;Nduati, Ruth;Gimbel, Sarah
背景：在撒哈拉以南非洲，预防母婴传播艾滋病毒（PMTCT）护理级联失败导致儿童艾滋病毒感染。随着护士在预防母婴传播中的临床和管理作用的扩大，需要为护士提供决策支持工具，以促进识别级联效率低下和解决方案。基于移动的电话的预防母婴传播级联分析工具（mPCAT）为卫生机构工作人员提供了一个快速汇总，其中包括预防母婴传播级联护理每一步的患者数量和脱落百分比，以及如果优化一个步骤，将保留多少对妇女-婴儿。目的：本研究的目的是了解和改进mPCAT的核心可用性因素，并评估卫生工作者使用mPCAT.Methods:总体而言，在肯尼亚和莫桑比克，来自4家诊所的卫生工作者和妇幼保健方面的主要专家使用录像带有声思维评估技术进行了两轮可用性测试。半结构化的小组访谈衡量的mPCAT的核心可用性因素的理解，尼尔森可用性框架的基础上，其次是认知需求表描述所需的mPCAT更新的发展。适应后，在3个高容量诊所中评估了12周的可行性。参与者完成了一份5点Likert问卷，旨在衡量易用性、融入工作的便利性以及未来使用mPCAT的意愿。焦点小组讨论与护士参与者在每个设施和护士经理的深入访谈也进行了评估的可接受性，使用，并建议适应mPCAT.Results：软件工程师的可用性测试，使实时反馈，建立一个工具，共情的设计原则。修订后的《中期计划》改进了导航，简化了数据输入界面，每页只有一个数据输入字段。结果页面的改进包括数据可视化功能和通过WhatsApp分享结果的能力。简化了编码，以使非技术人员能够在未来进行修订，这对于针对具体情况进行调整以扩大规模至关重要。医护人员和设施管理人员发现该工具易于使用（平均值=4.3），经常使用该工具（平均值=4.1），并明确打算继续使用该工具（平均值=4.8）。易用性是最常见的主题确定，重点是如何随时告知系统改进decisionmaking.Conclusions的工具：前线卫生工作者和设施管理人员广泛接受的mPCAT。软件开发人员和用户之间的协作过程导致开发了一种更加用户友好的、特定于上下文的工具，该工具可以轻松集成到常规临床实践和工作流程中。mPCAT为一线卫生工作者和设施管理人员提供了一种即时、直接和切实的方式，可以使用他们的临床文件和定期报告的数据，为他们自己的临床实践和设施级别的改进做出决策。
Background: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone-based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized.Objective: The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT.Methods: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT.Results: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff-critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making.Conclusions: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements.