Clinical decision support in Tanzanian healthcare facilities: an activity theory approach to analysing tools and procedures for enhanced patient care
研究通过访谈坦桑尼亚26名医疗人员，发现他们主要依赖非计算机化的临床指南，面临指南更新慢、基础设施差和培训不足等挑战，并采用非标准工具和职业判断来适应。
Purpose The study aims to explore the utilisation of Clinical Decision Support (CDS) tools in Tanzanian healthcare facilities by identifying the tools used, the challenges encountered and the adaptive strategies employed by healthcare practitioners. It utilises an Activity Theory (AT) approach to understand the dynamic interactions between healthcare providers, CDS tools and the broader healthcare system. Design/methodology/approach The research adopts a qualitative approach in two prominent regions of Tanzania, Dar es Salaam and Dodoma. It involves semi-structured interviews with 26 healthcare professionals and key stakeholders across ten healthcare facilities, supplemented by document reviews. The study employs AT to analyse the interactions between healthcare professionals, CDS tools and the broader healthcare system, identifying best practices and providing recommendations for optimising the use of CDS tools. Findings The study reveals that Tanzanian healthcare practitioners predominantly rely on non-computerised CDS tools, such as clinical guidelines prepared by the Ministry of Health. Despite the availability of Health Information Systems (HIS), these systems often lack comprehensive decision-support functionalities, leading practitioners to depend on traditional methods and their professional judgement. Significant challenges include limited accessibility to updated clinical guidelines, unreliable infrastructure and inadequate training. Adaptive strategies identified include using non-standardised tools like Medscape, professional judgement and reliance on past experiences and colleagues’ opinions. Research limitations/implications The investigation was constrained by access limitations because it was challenging to get some respondents to share information. However, a sufficient number of individuals participated in the interviews, and their knowledge was very beneficial in understanding the procedures and tools for clinical decision support. Originality/value This study contributes to AT by extending its application to a low-resource healthcare setting, uncovering new dimensions of the theory related to socio-cultural and technological constraints in healthcare facilities in Tanzania. It provides valuable insights into the practical barriers and facilitators of HIS and CDS tool implementation in developing countries, emphasising the need for context-specific adaptations, robust training programs and user-centred designs. The findings highlight the resilience and imagination of healthcare practitioners in adapting to systemic limitations, offering recommendations to enhance clinical decision-making and improve patient care outcomes in Tanzania.