Assessing the potential of two electronic decision support systems to improve the quality of antenatal care in primary care facilities in Nepal: study protocol

Introduction Good quality antenatal care plays an important role in reducing maternal and perinatal mortality, including in high-burden settings like Nepal. Electronic decision support systems (EDSS) aim to promote adherence to evidence-based guidelines. This protocol outlines the outcome and process evaluation of two tablet-based EDSS, the Mobile health Integrated Rural Antenatal care (mIRA) EDSS and the World Health Organization’s ANC Reference Application EDSS, on improving antenatal care quality in primary-level healthcare facilities in Nepal. The outcome evaluation aims to assess the effectiveness of the intervention on quality of antenatal care. The process evaluation aims to inform interpretation of outcome results and to improve understanding of the implementation process and intervention effects, addressing the research question: why or how does an EDSS influence quality of antenatal care and in what circumstances? Methods and analysis The pre-post outcome and theory-driven, mixed-methods process evaluation will assess implementation fidelity and improvements in the performance of selected antenatal care components, explore the implementation process and contextual factors, and examine causal mechanisms leading to change in antenatal care quality. Data for quantitative and qualitative analyses will be collected at multiple time points, and initial analyses of quantitative and qualitative data completed separately. Results will be integrated using convergent parallel-databases triangulation to develop explanations about the implementation process—over time and across settings—and the effects observed. Ethics and dissemination Ethical approval for this study was obtained from ethics committees at Kathmandu University School of Medical Sciences, Nepal Health Research Council and the London School of Hygiene & Tropical Medicine. Results will be disseminated through academic publications, stakeholder workshops, conference presentations and reports.