Technology integration in newborn care: examining communication and decision-making among health professionals in Kenyan hospitals

Thesis

Neonatal deaths remain a significant challenge in many Low-and Middle-Income Countries, including Kenya. Affordable technologies such as Comprehensive Positive Airway Pumps (CPAP) and phototherapy can effectively reduce neonatal mortality and are being utilised across Africa. However, their introduction and implementation in resource-constrained health systems are poorly understood. This study explores the communication and decision-making processes among health professionals regarding CPAP and phototherapy use in Kenyan newborn units and their impact on the technology implementation.

Using a focused ethnographic approach, I conducted unstructured non-participatory observations, in-depth interviews, and document reviews in two newborn units in level-five Kenyan hospitals. Data collection occurred in two phases, six months apart. My conceptual framework, developed from a scoping review and the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework, guided data collection, analysis, and presentation. Combining inductive and deductive coding, the thematic data analysis identified key themes and built explanations.

Findings reveal that physical context elements, such as adequate staffing, patient rooms in close proximity and health professionals’ communal congregation area promote more frequent and in-depth communication among health professionals using CPAP and phototherapy. A positive socio-organisational context, characterised by teamwork, supportive networks, a common language, and practical rewards, fosters more friendly communication and inclusive decision-making among health professionals. Moreover, when health professionals perceive technology features and functions as complicated, as with CPAP, communication increases significantly, prompting detailed discussions and thorough documentation during its use. Wider system factors, such as inadequate financial support hindered evidence-informed decisions and communication by impacting the availability of clinical tests and documentation materials. These interconnected factors shape health professionals’ communication and decision-making processes, ultimately influencing technology implementation from initiation to maintenance, discontinuation, and repair.

Stakeholders, including funders, policymakers, local governments, and health professionals, must recognise how physical, organisational, and technological contexts shape communication among health professionals during decision-making in newborn care. These factors directly affect the use of life-saving technologies. A tailored approach that considers these variables, rather than a one-size-fits-all approach, will ensure better integration and sustainability of these technologies, leading to improved outcomes in newborn care.

Authors: Ngaiza, GK

• DOI: 10.5287/ora-rjkq25rg7
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: health facilities; newborn; communication; technology; decision-making; health professionals
• Subjects: implementation science; health service delivery; ethnography; global health