AN EVALUATION OF THE RELEVANCE OF MOBILE CLINICAL DECISION SUPPORT FOR PREGNANT WOMEN IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Maternal healthcare in Nigeria is a critical issue, marked by significant challenges that affect the health and well-being of pregnant women. The World Health Organisation (2021) indicates that Nigeria has one of the highest maternal mortality rates globally, worsened by limited healthcare access, socioeconomic challenges, and inadequate information for pregnant women (Adepoju et al., 2020; Abubakar et al., 2022; Bello et al., 2021). In this context, mobile Clinical Decision Support (CDS) systems provide a practical solution by supplying prompt, evidence-based information and recommendations to pregnant women via mobile platforms (Osadolor & Eze, 2023).

The increasing accessibility of mobile phones in Nigeria has generated new prospects for improving healthcare, particularly in remote and rural areas where conventional healthcare resources are few (Idowu & Adewale, 2022; Mohammed et al., 2021; Nwachukwu et al., 2023; Yusuf & Musa, 2022). Despite the promise of mobile Clinical Decision Support technologies, there is less understanding of their importance, impact, and applicability to the specific challenges faced by pregnant women in Nigeria. Evaluating the relevance of these technologies in Nigerian maternal healthcare might reveal their potential to rectify information gaps, encourage timely health-seeking behaviours, and ultimately improve maternal health outcomes.

Mobile Clinical Decision Support systems for pregnant women may empower them by providing crucial health information and reminders for routine check-ups, diet, and symptom management (Oladipo et al., 2020; Oyeyemi et al., 2021). Studies demonstrate that mobile health (mHealth) interventions have beneficially influenced maternal knowledge and engagement in several low- and middle-income nations, indicating that similar tools might be helpful for women in Nigeria (Ibrahim & Sani, 2023; Ugwuanyi et al., 2023). These instruments typically utilise algorithms that aid users in performing fundamental health assessments, alert them to potential health concerns, and advise when to seek medical attention, thereby fostering a proactive approach to maternal health (Amadi & Emenike, 2021; Esomonu & Adefarati, 2022; Oyeniyi et al., 2021; Adeyemi & Adeniran, 2022).

The use of mobile Clinical Decision Support systems in maternal healthcare might significantly enhance healthcare practitioners' ability to provide timely and accurate treatment. Research demonstrates that decision support systems reduce diagnostic errors and improve treatment quality, especially in resource-constrained settings (Blumenthal et al., 2019). In rural Nigerian regions with little healthcare infrastructure, mobile CDS technologies enable frontline healthcare practitioners to get medical support and directives for addressing pregnancy-related issues. These tools may enhance the early detection of high-risk pregnancies by prompting clinicians to evaluate prevalent risk factors such as preeclampsia, anaemia, and gestational diabetes, which are common but often overlooked in low-resource settings (Okonofua et al., 2020). Mobile CDS may enable pregnant women to make informed health choices by providing information about suitable prenatal care, nutrition, and potential warning signs of complications.

Despite the promise of mobile Clinical Decision Support systems to enhance maternity care, many obstacles and limitations impede their adoption and implementation in Nigeria. A major issue is the digital divide, since not all pregnant women, especially those in rural or economically disadvantaged areas, have access to cellphones or reliable internet connectivity (Olufemi et al., 2019). Furthermore, healthcare professionals often lack the necessary proficiency to use mobile Clinical Decision Support systems efficiently, hence reducing their effectiveness in clinical settings. In addition to technological and infrastructural challenges, a cultural factor must be addressed; some women may be reluctant to use mobile health technology due to unfamiliarity or a lack of confidence in digital healthcare solutions. Research demonstrates that the effectiveness of mobile Clinical Decision Support systems depends not only on technological capabilities but also on community engagement, awareness campaigns, and alignment with local cultural norms and beliefs around pregnancy (Ekong et al., 2018). Therefore, an evaluation of mobile CDS tools must include these contextual factors to understand their true importance and potential impact on maternal health outcomes in Nigeria.

The rapid progress of mobile technology presents Nigeria with a unique opportunity to address persistent maternal health issues and improve outcomes for pregnant moms. Recent studies reveal that Nigeria has one of the largest mobile phone markets in Africa, possibly facilitating the widespread implementation of mobile CDS technology (GSMA, 2021). The Nigerian government has committed to improving maternal health and reducing maternal mortality in accordance with the Sustainable Development Goals (SDGs), thereby creating a favourable environment for the adoption of innovative solutions such as mobile Community Delivery Services in maternal health programs (Federal Ministry of Health, 2021). To guarantee that mobile CDS technologies are a successful component of the healthcare system, it is essential to evaluate their relevance, effectiveness, and acceptability within the Nigerian context. This study seeks to evaluate the importance of mobile clinical decision support for pregnant women in Nigeria.

1.2 Statement of the problem

Nigeria's maternal death rate is very high, with restricted access to prompt information and healthcare resources substantially exacerbating this issue (Adepoju et al., 2020; Eze et al., 2021; Bello et al., 2022). Numerous pregnant women in Nigeria encounter obstacles, including restricted access to healthcare facilities, particularly in rural regions, which hinders or obstructs essential medical treatment (Onah et al., 2023; Yusuf & Nwachukwu, 2021; Abubakar & Osadolor, 2023). The deficiencies in healthcare access are exacerbated by a lack of information about prenatal health, leaving pregnant women susceptible to issues that might be controlled or averted. Mobile Clinical Decision Support (CDS) solutions may effectively address information and access deficiencies by delivering critical health information and advice directly to pregnant women (Idowu & Amadi, 2022; Bello & Musa, 2023; Adebayo et al., 2021). Nonetheless, despite the potential of these tools, their significance and efficacy within the Nigerian healthcare system remain insufficiently examined, prompting enquiries over their capacity to tackle the distinct issues encountered by pregnant women in Nigeria.

Despite the increasing use of mobile technology in Nigeria, pregnant women, especially in rural and resource-limited areas, often encounter obstacles in obtaining mobile health solutions. Factors such as digital literacy, language obstacles, and unreliable internet connection impede the widespread use of mobile CDS tools, hence limiting access for those who might benefit the most (Nwachukwu et al., 2022; Afolabi et al., 2021; Ibrahim & Adefarati, 2023). Furthermore, several existing Clinical Decision Support systems are not customised to the cultural and linguistic variety of Nigeria, hence limiting their accessibility and relevance to the particular health issues faced by pregnant women in Nigeria (Ajayi & Falade, 2021; Udo & Onigbogi, 2023; Sanni et al., 2022). Therefore, it is essential to assess both the accessibility and cultural adaption of mobile CDS tools for Nigerian women, determining how these tools might be adjusted to successfully surmount technical and societal obstacles. This evaluation is essential for ensuring that mobile health treatments correspond with the requirements and circumstances of Nigerian healthcare consumers, hence enhancing maternal health outcomes.

Moreover, the Nigerian healthcare system encounters structural obstacles, such as resource limitations and elevated patient-to-provider ratios, which impair the quality and frequency of maternal healthcare (Ukwuoma & Oladipo, 2021; Eze & Olatunde, 2022; Adetokunbo & Onuoha, 2023). In this context, mobile CDS applications might provide a supporting function by augmenting clinician guidance and delivering ongoing, evidence-based health information that enables pregnant women to make educated health choices. The lack of empirical evidence about the efficacy and influence of mobile Clinical Decision Support (CDS) tools on maternal health in Nigeria restricts policymakers and healthcare providers' understanding of the possible advantages and obstacles associated with incorporating these tools into standard maternity care. To address this gap, a comprehensive assessment of mobile Clinical Decision Support technologies is necessary, emphasising their relevance, accessibility, and influence on maternal health outcomes in Nigeria. This research seeks to provide an assessment, bringing essential insights to the discourse on using technology to enhance maternal health in Nigeria.

1.3 Objectives of the study

The primary objective of this study is to critically evaluate the relevance of mobile clinical decision support (CDS) for pregnant women in Nigeria. Specific objectives of this study are to:

1. To assess the impact of mobile clinical decision support tools in improving maternal health outcomes for pregnant women in Nigeria

2. To explore the impact of mobile CDS on the knowledge and awareness of pregnant women regarding their health during pregnancy

3. To determine the impact of mobile CDS tools on health-seeking behavior and timely medical intervention among pregnant women

4. To evaluate the impact of mobile CDS tools on empowering pregnant women with self-care guidance

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the impact of mobile clinical decision support tools in improving maternal health outcomes for pregnant women in Nigeria?

      2. What is the impact of mobile CDS on the knowledge and awareness of pregnant women regarding their health during pregnancy?

      3. What is the impact of mobile CDS tools on health-seeking behavior and timely medical intervention among pregnant women?

      4. What is the impact of mobile CDS tools on empowering pregnant women with self-care guidance?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Mobile clinical decision support tools have no significant impact in improving maternal health outcomes for pregnant women in Nigeria

Ha: Mobile clinical decision support tools have a significant impact in improving maternal health outcomes for pregnant women in Nigeria

1.6 Significance of the study

This study's relevance encompasses several stakeholders, including healthcare practitioners, expectant mothers, legislators, and technology developers.

This study's results will augment healthcare practitioners' comprehension of integrating mobile Clinical Decision Support technologies into clinical practice to boost the quality of treatment for pregnant women. This study emphasises the distinct functions and attributes of mobile Clinical Decision Support (CDS) that aid healthcare workers in making prompt and informed choices, hence enhancing maternal and neonatal health outcomes. Acquired insights will enable providers to use these technologies efficiently, optimising operations, enhancing patient communication, and assuring compliance with evidence-based practices.

This research primarily benefits pregnant women by assessing technologies aimed at enhancing their healthcare experience. The project will provide significant insights into how mobile Clinical Decision Support technologies might improve knowledge and comprehension of prenatal care, associated hazards, and the need of regular check-ups. Enhanced access to information may enable women to take a more proactive role in their healthcare choices, cultivating a feeling of autonomy and confidence in managing their pregnancies. Comprehending the significance of these instruments helps enhance patient satisfaction and involvement in treatment, which are essential for improving health outcomes for both mothers and their newborns.

The research is crucial for policymakers and healthcare managers as it highlights the systemic and infrastructural improvements necessary for the effective integration of mobile Clinical Decision Support technologies into maternal healthcare systems in Nigeria. Results will guide policy choices that emphasise investments in digital health technology, ensuring appropriate resource allocation to promote these breakthroughs. Furthermore, understanding the obstacles to acceptance and implementation may inform the creation of focused strategies to address issues and improve the sustainability of mobile Clinical Decision Support in various healthcare environments. This research may act as a fundamental reference for policymakers aiming to enhance maternal healthcare services via technology innovations.

This research provides evidence-based insights on the introduction and impacts of decision support technology in maternity care contexts, making it very beneficial for policymakers and healthcare managers. The study's findings provide policymakers guidance for formulating regulations, policies, and initiatives that promote the integration of digital technology to improve patient empowerment within the healthcare system. Understanding the factors that facilitate or hinder the use of these tools allows policymakers to identify key areas for investment, such as infrastructure, training, or patient education initiatives. Healthcare administrators may use this study to evaluate their facilities' readiness for the implementation of decision support technologies and ascertain the necessary resources for effective deployment, particularly in low-resource areas with limited healthcare access.

Students and researchers in health informatics, public health, and maternity healthcare will benefit from the findings of this study. The study will provide an exhaustive examination of mobile CDS tools, enhancing the current understanding of digital health interventions in Nigeria and analogous settings. Students will get practical insights into the uses and consequences of technology in healthcare, enhancing their comprehension of how these technologies might tackle significant health concerns. The study presents opportunities for researchers to further investigate the efficacy, acceptability, and scalability of mobile Clinical Decision Support systems in maternity care, promoting continuous inquiry and innovation in this critical domain of health technology. This project aims to significantly enhance maternal health outcomes and deepen the comprehension of mobile health solutions within Nigeria's healthcare framework.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the relevance of mobile clinical decision support (CDS) for pregnant women in Nigeria. Empirically, the study will discuss the impact of mobile clinical decision support tools in improving maternal health outcomes for pregnant women in Nigeria, the impact of mobile CDS on the knowledge and awareness of pregnant women regarding their health during pregnancy, the impact of mobile CDS tools on health-seeking behavior and timely medical intervention among pregnant women and the impact of mobile CDS tools on empowering pregnant women with self-care guidance

Geographically, the study will be carried out at Maitama District Hospital, Abuja.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an evaluation of the relevance of mobile clinical decision support for pregnant women in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around Maitama District Hospital, Abuja. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Maternity care: Maternity care is a broad term that refers to the healthcare provided to women, their partners, family, and children during pregnancy, childbirth, and the postnatal period. It also includes the health professionals who work in this field, such as doctors, midwives, and nurses.

Clinical decision support: Clinical decision support (CDS) is a set of tools that provide information to help clinicians and patients make decisions about patient care. CDS can help improve patient outcomes and healthcare delivery by providing relevant information, alerts, and reminders

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