The acceptability of a TB patient management information system among e-TB manager supervisors in Oyo State, Nigeria

Abstract

Background: The introduction of an electronic TB patient management information system (e-TB manager) in TB control is new in Nigeria. This innovation is important at a time Nigeria is ranked third among the TB high-burden countries in the world. Electronic patient information systems provide numerous advantages over the use of paper-based systems and the benefits of using these systems are well documented. This system assists in promoting informed decision by stakeholders on areas of improvement. However, it is crucial that this innovation is acceptable to the users of e-TB manager. This study aims to measure the acceptability of a TB patient management information system (e-TB manager) and determine the relationship between acceptability and its theoretical determinants (demographic, organisational-, structural-, provider-, innovation-, and patient- level determinants) among e-TB users in Oyo state, Nigeria.Methods: A cross-sectional mixed-methods study involving all thirty-three users of the e-TB manager in Oyo state, Nigeria, followed by semi-structured interviews in a purposive sample (n=10). The study was conducted between May 2018 and October 2019. Quantitatively, data was collected using questionnaires and analysed with STATA 14. Composite scores for acceptability and determinants of acceptability were constructed and translated to 1 – 100 scale. Percentages, frequencies, means, and standard deviation were used to summarise data. Our outcome variable, acceptability, has three ordered categories and a robust ordered logistic regression was used to identify predictors of acceptability. All statistical tests with p-value < 0.05 were considered as statistically significant. Qualitative data were analysed using thematic analysis to explore potential factors for acceptability. The integration of qualitative and quantitative data occurred at the level of interpretation using triangulation. Results: In the quantitative study, the mean acceptability score was 83% (SD = 10.94). The tertile distributions of mean acceptability scores were 71.60%, 82.75% and 96.46% respectively. In the unadjusted model, practice location (Rural/Urban), organisational-, structural-, provider-, innovation-, and patient- determinants positively influenced acceptability of e-TB manager. In the adjusted model, provider determinant was associated with high acceptability of e-TB manager. In the qualitative study, based on the experiences of the E-TB users, factors identified to be associated with acceptability of e-TB manager were categorized into five key themes (structural-, organisational-, provider-, innovation-, andpatient-factors) based on the conceptual framework of this study and practice location. Structural factors included challenges with the mobile network connectivity, mobile Internet subscription and access to offline module feature. Organisational factors encompassed management support, supportive supervision, workload strain, technical support and Incentive/Stipend. Provider factors included self-efficacy and training. Innovation factors included compatibility, ease of retrieval of patient information, access to patient information, security of patient record, ease of data collation and management of Stock-outs. Finally, patient factors included patient-provider relationship.Conclusion: This study identified a useful framework that aided deeper insights into e-TB users related factors responsible for acceptability of e-TB manager in Oyo, State, Nigeria. The e-TB manager was highly acceptable by e-TB users and its acceptance was influenced by practice location, Structural-, Organisational-, Provider-, Innovation-, and Patient- level determinants. Acceptability of e-TB manager is lower among e-TB users in rural areas compared to their counterparts in the urban areas, thus special consideration should be given to this population of e-TB users. These determinants could be the target of future implementation strategies.