TY - JOUR
T1 - Determinants of facility-level use of electronic immunization registries in tanzania and zambia
T2 - An observational analysis
AU - Carnahan, Emily
AU - Ferriss, Ellen
AU - Beylerian, Emily
AU - DienMwansa, Francis
AU - Bulula, Ngwegwe
AU - Lyimo, Dafrossa
AU - Kalbarczyk, Anna
AU - Labrique, Alain B.
AU - Werner, Laurie
AU - Shearer, Jessica C.
N1 - Funding Information:
Acknowledgments: The authors would like to thank the Government of Tanzania and the Government of Zambia, and specifically the immunization programs, for their deep thought partnership in developing these interventions and evaluating their efficacy. This includes Dr. Dafrossa Lyimo, Dr. Mpoki Ulisubisya, Hermes Sotter, and Dr. Ngwegwe Bulula in Tanzania, and Dr. Francis Mwansa and Brivine Sikapande in Zambia. In addition, the authors would like to acknowledge the contributions of additional members of the analytics team, including Samantha B. Dolan, Jonathan Drummey, Sarah Skye Gilbert, Emma Korpi, Hil Lyons, Hassan Mtenga, Fred Njobvu, Chilunga Puta, John Richard, and Jenny Thompson. Finally, the authors would like to thank the Bill & Melinda Gates Foundation for supporting this research, and particularly thank Tove Ryman for her insights and guidance.
Publisher Copyright:
© 2020 Carnahan et al.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: As more countries transition from paper-based to electronic immunization registries (EIRs) to collect and track individual immunization data, guidance is needed for successful adoption and use of these systems. Little research is available on the determinants of EIR use soon after introduction. This observational study assesses the determinants of facility health care workers' use of new EIRs in Tanzania and Zambia, implemented during 2016 to 2018. Methods: We used EIR data entered between 2016 and 2018 from 3 regions in Tanzania and 1 province in Zambia to measure weekly EIR system use for a total of 50,639 facility-weeks. We joined secondary data on facility characteristics and applied the Performance of Routine Information System Management framework to categorize characteristics as organizational, technical, or behavioral. We used a generalized estimating equations logistic regression model to assess facility characteristics as potential determinants of system use. Results: In both countries, the estimated odds of weekly EIR use declined weekly after EIR introduction. In Tanzania, health centers and hospitals had increased odds of system use compared to dispensaries. For each additional health care worker trained in a facility during the EIR introduction, the estimated odds of weekly EIR use increased. Tanzanian facilities that had transitioned entirely to paperless reporting had higher odds of sustained use compared to those maintaining parallel electronic and paper-based reporting systems. In Zambia, distance from the district health office was significantly associated with decreasing odds of system use. There were significant differences in EIR use by district in both countries. Discussion: The results highlight the importance of organizational and behavioral factors in explaining sustained EIR use. As EIRs are introduced in new settings, we recommend indicators of engagement and use be built directly into the system so they can be routinely monitored, and course corrections can be implemented as needed.
AB - Background: As more countries transition from paper-based to electronic immunization registries (EIRs) to collect and track individual immunization data, guidance is needed for successful adoption and use of these systems. Little research is available on the determinants of EIR use soon after introduction. This observational study assesses the determinants of facility health care workers' use of new EIRs in Tanzania and Zambia, implemented during 2016 to 2018. Methods: We used EIR data entered between 2016 and 2018 from 3 regions in Tanzania and 1 province in Zambia to measure weekly EIR system use for a total of 50,639 facility-weeks. We joined secondary data on facility characteristics and applied the Performance of Routine Information System Management framework to categorize characteristics as organizational, technical, or behavioral. We used a generalized estimating equations logistic regression model to assess facility characteristics as potential determinants of system use. Results: In both countries, the estimated odds of weekly EIR use declined weekly after EIR introduction. In Tanzania, health centers and hospitals had increased odds of system use compared to dispensaries. For each additional health care worker trained in a facility during the EIR introduction, the estimated odds of weekly EIR use increased. Tanzanian facilities that had transitioned entirely to paperless reporting had higher odds of sustained use compared to those maintaining parallel electronic and paper-based reporting systems. In Zambia, distance from the district health office was significantly associated with decreasing odds of system use. There were significant differences in EIR use by district in both countries. Discussion: The results highlight the importance of organizational and behavioral factors in explaining sustained EIR use. As EIRs are introduced in new settings, we recommend indicators of engagement and use be built directly into the system so they can be routinely monitored, and course corrections can be implemented as needed.
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U2 - 10.9745/GHSP-D-20-00134
DO - 10.9745/GHSP-D-20-00134
M3 - Article
C2 - 33008860
AN - SCOPUS:85092678743
VL - 8
SP - 488
EP - 504
JO - Global health, science and practice
JF - Global health, science and practice
SN - 2169-575X
IS - 3
ER -