Usability of implementing a tablet-based decision support and integrated record- keeping (DESIRE) tool in the nurse management of hypertension in rural Kenya.
In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes significantly to the CVD burden in SSA. In order to address the human resource challenge of managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension care from physicians to nurses has been proposed. To support this task-shifting strategy, the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist with clinical decision-making. We investigated the usability of the DESIRE tool in the setting of nurse management of hypertension in rural western Kenya through the use of "mock patient" encounters and "think aloud" exercises. Fiftyseven critical incidents were identified and twenty-three design changes were suggested. Optimization of the tool has the potential to broadly impact treatment of non-communicable diseases in LMICs by providing a model of electronic decision-support in task shifting.
Mount Sinai School of Medicine, New York, USA.
Evan
E
Blank
Nelly
N
Tuikong
Lawrence
L
Misoi
Jemima
J
Kamano
Claire
C
Hutchinson
Sylvester
S
Kimaiyo
Valentin
V
Fustera
Martin
M
Were
Rajesh
R
Vedanthan
D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055991:Health Records, Personal; D006801:Humans; D006973:Hypertension / Q000451:nursing*; D016247:Information Storage and Retrieval / Q000706:statistics & numerical data; D007630:Kenya; D062527:Meaningful Use / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data*; D008498:Medical Record Linkage / Q000379:methods*; D048108:Nursing Informatics / Q000379:methods; D012424:Rural Population / Q000706:statistics & numerical data; D012984:Software; D018511:Systems Integration; D014584:User-Computer Interface; D014600:Utilization Review