Effect of ADHERE eHealth intervention on adherence to quality improvement tools in intrapartum care: Implementation research in Ethiopia
1
1 Reproductive Health and Population Studies, Bahir Dar University, Bahir Dar, Ethiopia
2
2 Department of Environmental Health, Bahir Dar University, Bahir Dar, Ethiopia
3
3 School of Medicine, Bahir Dar University, Bahir Dar, Ethiopia
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4 Department of Epidemiology, University of Washington, Seatle, United States
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5 Department of Health Systems and Population Health, University of Washington, Seatle, United States
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6 ICT4D Research Center, Bahir Dar University, Bahir Dar, Ethiopia
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7 Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
8
8 School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
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9 Department of Global Health and Population, Harvard University, Boston, United States
Popul. Med. 2026;8(Supplement Supplement 1):A1999
ABSTRACT
BACKGROUND:
The partograph and safe childbirth checklist (SCC) are quality improvement (QI) tools in intrapartum care. Poor-quality intrapartum care remains a significant barrier to improving health outcomes in countries like Ethiopia, largely due to poor adherence to these QI tools. This study examined the effect of ADHERE, an innovative eHealth system with clinical decision support, on adherence to QI tools during intrapartum care in health facilities in Ethiopia.
METHODS:
A quasi-experimental study was conducted in 9 public health facilities in Ethiopia, guided by the Implementation Research Logic Model. A total of 2,190 charts (1,076 baseline and 1,114 end-line) were included in the analysis. Difference-in-difference (DiD) analysis was used to estimate the effect of the intervention. The partograph adherence score and SCC completion rates were compared between the two arms. Statistically significant differences were determined using a p-value < 0.05 cutoff.
RESULTS:
Baseline mean partograph scores in the control and intervention arms were 4.11 and 4.23, respectively. Baseline SCC adherence rates at admission, before-birth, after-birth, and discharge were 25.8%, 24.9%, 24.9%, and 24.3% in the control arm, respectively, and 49.6%, 47.8%, 45.9%, and 45.5% in the intervention arm, respectively. The ADHERE intervention increased partograph adherence score by 4.27 units (DiD = 4.27, 95%CI [1.80, 5.09]). The ADHERE intervention increased SCC adherence by 9.3 percentage-points (DiD = 0.093, 95%CI [0.036, 0.151]) at admission, 22.3 percentage-points (DiD = 0.223, 95%CI [0.121, 0.325]) before-birth, and 15.2 percentage-points (DiD = 0.152, 95%CI [0.072, 0.231]) after-birth. Conversely, the ADHERE intervention did not significantly change SCC adherence at discharge.
CONCLUSIONS:
The ADHERE intervention significantly improved adherence to partograph and SCC at admission, before-birth, and immediately after-birth. Therefore, ADHERE-assisted implementation of QI tools can potentially prevent adverse birth outcomes related to low-quality intrapartum care and could be considered for scale-up across health facilities in Ethiopia.
The partograph and safe childbirth checklist (SCC) are quality improvement (QI) tools in intrapartum care. Poor-quality intrapartum care remains a significant barrier to improving health outcomes in countries like Ethiopia, largely due to poor adherence to these QI tools. This study examined the effect of ADHERE, an innovative eHealth system with clinical decision support, on adherence to QI tools during intrapartum care in health facilities in Ethiopia.
METHODS:
A quasi-experimental study was conducted in 9 public health facilities in Ethiopia, guided by the Implementation Research Logic Model. A total of 2,190 charts (1,076 baseline and 1,114 end-line) were included in the analysis. Difference-in-difference (DiD) analysis was used to estimate the effect of the intervention. The partograph adherence score and SCC completion rates were compared between the two arms. Statistically significant differences were determined using a p-value < 0.05 cutoff.
RESULTS:
Baseline mean partograph scores in the control and intervention arms were 4.11 and 4.23, respectively. Baseline SCC adherence rates at admission, before-birth, after-birth, and discharge were 25.8%, 24.9%, 24.9%, and 24.3% in the control arm, respectively, and 49.6%, 47.8%, 45.9%, and 45.5% in the intervention arm, respectively. The ADHERE intervention increased partograph adherence score by 4.27 units (DiD = 4.27, 95%CI [1.80, 5.09]). The ADHERE intervention increased SCC adherence by 9.3 percentage-points (DiD = 0.093, 95%CI [0.036, 0.151]) at admission, 22.3 percentage-points (DiD = 0.223, 95%CI [0.121, 0.325]) before-birth, and 15.2 percentage-points (DiD = 0.152, 95%CI [0.072, 0.231]) after-birth. Conversely, the ADHERE intervention did not significantly change SCC adherence at discharge.
CONCLUSIONS:
The ADHERE intervention significantly improved adherence to partograph and SCC at admission, before-birth, and immediately after-birth. Therefore, ADHERE-assisted implementation of QI tools can potentially prevent adverse birth outcomes related to low-quality intrapartum care and could be considered for scale-up across health facilities in Ethiopia.
| eISSN: | 2654-1459 |
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