Neneng Suryadinata, Ni Gusti Ayu Eka, Marisa Junianti Manik, Vivien Puspitasari, Mona Marlina, Grace Solely Houghty
Effectiveness of online interprofessional education-communication course during the COVID-19 pandemic
Heliyon
digital innovations shown promise improving maternal health service delivery however low middleincome countries still adoptionutilization stage evidence mobile health described black box gaps theoretical explanations account ecosystem health care effect adoption mechanisms bliss4midwives modular integrated diagnostic kit support antenatal care service delivery piloted 1 year northern ghana although users beneficiaries valued bliss4midwives results pilot showed wide variations usage behavior duration use across project sites strengthen design implementation improved prototype study objectives twofold identify causal factors underlying variation bliss4midwives usage behavior understand overcome leverage subsequent implementation cycles using multiple case study design realist evaluation bliss4midwives conducted total 3 candidate program theories developed empirically tested 6 health facilities grouped low moderate usage clusters quantitative qualitative data collected analyzed using realist thinking build configurations link intervention context actors mechanisms program outcomes employing inductive deductive reasoning nonparametric test used compare perceived usefulness perceived ease use bliss4midwives usage clusters found statistically significant differences 2 usage clusters low moderate adoption bliss4midwives better explained fear enthusiasm high expectations service delivery especially absence alternatives recognition pregnant women peers supervisors program crucial mechanism device utilization supportive mechanisms included ownership empowerment motivation adaptive responses device realignment negotiation champion users displayed high adoptionutilization behavior contexts participative authoritative supervision yet used device inconsistently interventionrelated technical challenges device rotation lack performance feedback refresher training contextrelated staff turnover competing priorities workload individual factors low technological selfefficacy baseline knowledge internal motivation suppressed utilization mechanisms study shed light optimal conditions necessary bliss4midwives thrive complex social organizational setting beyond usability viability studies advocates innovative technologies maternal care need consider implementation strategies contextual factors existing collaborations supervision styles trigger mechanisms influence program outcomes addition informing scaleup bliss4midwives prototype results highlight need interventions guided research methods account complexity