title: Guidelines for maternal and neonatal "point of care": needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso.
abstract: BACKGROUND
  In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges.
  
  
  OBJECTIVE
  To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso.
  
  
  METHODS
  Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants' background. Qualitative data were analyzed using manifest content analysis.
  
  
  RESULTS
  Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement.
  
  
  CONCLUSIONS
  The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care.
authors.affiliation: Centre de Recherche en Santé de Nouna, BP 02 Nouna, Burkina Faso; Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
authors.forename: S Alphonse
authors.initials: SA
authors.lastname: Zakane
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324-69120 Heidelberg, Germany.
authors.forename: Svetla
authors.initials: S
authors.lastname: Loukanova
authors.affiliation: Centre de Recherche en Santé de Nouna, BP 02 Nouna, Burkina Faso.
authors.forename: Ali
authors.initials: A
authors.lastname: Sié
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
authors.forename: Josefine
authors.initials: J
authors.lastname: Nasiell
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, SE-171 77 Stockholm, Sweden; Public Healthcare Services Committee Administration, Stockholm County Council, SE-118 91 Stockholm, Sweden. Electronic address: pia.bastholm-rahmner@sll.se.
authors.forename: Pia
authors.initials: P
authors.lastname: Bastholm-Rahmner
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002050:Burkina Faso; D020000:Decision Support Systems, Clinical / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006282:Health Personnel / Q000193:education / Q000523:psychology* / Q000592:standards; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D009042:Motivation; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D012423:Rural Health
keywords: Burkina Faso; Computerized clinical decision support systems; Maternal and neonatal care; Perceived needs and attitudes; Rural healthcare