Barriers and facilitators to the use of the mental health information system in Ghana: A qualitative study amongst users at the Accra Psychiatric Hospital

Kpobi, Lily Naa Ayorkor (2015-12)

Thesis (MA)--Stellenbosch University, 2015

Thesis

ENGLISH ABSTRACT : One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a mental health information system (MHIS) has been found most successful. A properly established and operational MHIS is crucial in developing equitable and appropriate mental health care systems. Despite the obvious benefits of having a well-structured MHIS, its existence does not guarantee efficient use. There are a number of potential problems which may arise in the implementation of the MHIS, especially in poorly-resourced contexts. All of these problems may result in poor quality data being generated through the system, thereby compromising the use and efficiency of the MHIS. Staff motivation to provide accurate data for entry will also be affected. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital was old and outdated. In light of this and other factors, the Mental Health and Poverty Project (MHaPP) undertook a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana in 2010. Although much was written on the implementation of the information systems, little is known about the current state of the system in Ghana four years after it was implemented. In view of this the present study sought to explore the experiences of users at the Accra Psychiatric Hospital in using the new MHIS, and to ascertain what their perceptions are of areas for improvement in the current system. A mixed methods approach was adopted. First, an audit was undertaken of usage of the MHIS. Second, participants‘ knowledge of the system and its use, as well as the influence of institutional processes on work were explored through the use of observations and semi-structured in-depth interviews. Data was analyzed using an interpretative phenomenological approach. Participants in the study were in three categories: prescriber, administrator, and records clerk. The final sample consisted of seven prescribers, one administrator and one records clerk. Participants reported increased workload, inadequate logistic support and staff shortages as the barriers to the effective use of the MHIS. Recommendations for improving the system included revising the form and migrating to a fully computerized system. These are discussed with reference to both micro and macro level institutional structures.

AFRIKAANSE OPSOMMING : Een van die mees suksesvolste metodes van rekordhouding en data-insameling is die gebruik van gesondheidbestuur inligtingstelsels, waar pasiënt inligting en bestuursplanne eenvormig ingevoer word in 'n databasis om die inligting te vereenvoudig en vir die gemak van verdere pasiënt bestuur. Vir geestelike gesondheidsorg, word 'n geestesgesondheid inligtingstelsel (GGIS) as meer suksesvol beskou. 'n Goed gevestigde en operasionele GGIS is van kardinale belang in die ontwikkeling van billike en gepaste geestesgesondheidsorg stelsels. Ten spyte van die ooglopende voordele van 'n goed-gestruktureerde GGIS, sal bloot sy bestaan nie noodwendig doeltreffende gebruik waarborg nie. Daar is 'n aantal potensiële probleme wat mag ontstaan in die implementering van die GGIS, veral in swak toegeruste kontekste. Al hierdie probleme kan lei daartoe dat swak gehalte data gegenereer word deur die stelsel en daardeur die gebruik en doeltreffendheid van die GGIS affekteer. Personeel motivering om toepaslike data in te voer, sal ook geraak word. Tot en met 2010 was die sisteem vir die behoud van pasiënt rekords en inligting in die Accra Psigiatriese Hospitaal verouderd. In die lig van hierdie en ander faktore, het die Mental Health and Povert Project (MHaPP) onderneem om 'n volledige hervorming van die geestesgesondheid inligtingstelsels in drie psigiatriese hospitale in Ghana in 2010 te voltooi. Hoewel baie geskryf is oor die implementering van die inligtingstelsels, is min bekend oor die huidige toestand van die stelsel in Ghana vier jaar nadat dit geïmplementeer is. In die lig hiervan het die huidige studie gepoog om die ervarings van gebruikers van die nuwe GGIS by die Accra Psigiatriese Hospitaal te ondersoek, en om te bepaal wat hul persepsies is van areas vir verbetering in die huidige stelsel. 'n Gemengdemetodebenadering word gevolg. Eerstens, was 'n oudit onderneem oor die gebruik van die GGIS. Tweedens, is deelnemers se kennis van die stelsel en die gebruik daarvan, asook die invloed van institusionele prosesse op werk ondersoek deur gebruik te maak van waarnemings en semi-gestruktureerde in-diepte onderhoude. Data is geanaliseer deur gebruik te maak van 'n interpreterende fenomenologiese benadering. Deelnemers aan die studie was in drie kategorieë: voorskrywer, administrateur, en rekords klerk. Die finale steekproef het bestaan uit sewe voorskrywers, een administrateur en een rekords klerk. Deelnemers het verhoogde werklas, onvoldoende logistieke ondersteuning en personeeltekorte as hindernisse tot die effektiewe gebruik van die GGIS rapporteer. Aanbevelings vir die verbetering van die stelsel het ingesluit die hersiening van die vorm en migrasie na 'n volle gerekenariseerde stelsel. Hierdie aanbevelings word bespreek met verwysing na beide mikro- en makrovlak institusionele strukture.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/97878
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