Knowledge, Attitude and Practice of Health workers in Using Health Information Management System in Volta and Eastern Regions, Ghana: Findings from the Pre- and Post-Surveys (Preprint)

BACKGROUND Despite the increasing attention to electronic health record (EHR) system in the field of global health, most African countries still depend on inconvenient and inaccurate paper-based system. Good Neighbors International and Evaluate 4 Health have recently supported Ghana Health Service (GHS) on rollout of EHR system called e-Tracker in two Regions in Ghana -- Volta (recently renamed to Oti and Volta Regions), and Eastern Regions. The e-Tracker is an Android-based tracker capture app that collects maternal and child health (MCH) data electronically and transmit the data into the District Health Information Management System (DHIMS)-2 managed by District Health Offices in Ghana. The GHS has implemented this new mHealth program in the Community Health Planning and Services (CHPS) in the three regions. OBJECTIVE This study aims to evaluate the improved capacity and behavioral change of health workers in using an EHR technology, the e-Tracker system to deliver MCH services. Specifically, this study assesses the changes in Knowledge, Attitude, and Practice (KAP) of the health workers towards MCH data management by comparing the pre- and post-survey results. METHODS To assess behavioral change towards the e-Tracker system, KAP of frontline health workers were measured through self-administered surveys before and after implementing the e-Tracker system. The surveys were conducted among participants of the e-Tracker system training sessions, with a purposive sampling scheme. A total of 1,124 health workers from Volta and Eastern Regions participated in both pre- and post-surveys. This study used McNemar's Chi-Square test and Wilcoxon signed-rank test for a pre-post comparison analysis. Random-effects ordered logistic regression analysis and random effects panel analysis were also conducted to identify factors associated with the level of KAP. RESULTS The results of the pre-post comparison analysis showed significant improvement in the Knowledge and Practice levels, but the positive response to the Attitude(acceptability) towards electronic data management were reduced compared to the pre-survey. The result of random-effects ordered logistic regression showed that 'days of overwork' was significantly associated with health worker’s Attitude towards this emergent e-Tacker system. CONCLUSIONS In Ghana, the e-Tracker system is planned to be scaled up nationally, increasing the need to evaluate its impact on MCH data management, and user's Attitude for sustainable utilization of the new technology. This study provides empirical evidence that the e-Tracker system has a positive impact on health workers' KAP in managing MCH data. The findings imply that using a tablet computer-based e-Tracker system could enhance Knowledge and Practice on MCH data management. However, efforts to increase acceptability of the new technology among health workers are necessary for sustainable usage of the e-Tracker system and its scale-up.