Date of Award

Spring 1-1-2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

First Advisor

John K. Bennett

Second Advisor

S. Revi Sterling

Third Advisor

Clayton Lewis

Fourth Advisor

Penelope Bennett

Fifth Advisor

Gaetano Borriello

Abstract

This dissertation presents the PartoPen, a new approach to addressing maternal labor monitoring challenges in developing countries. The PartoPen is a hardware and software system that uses digital pen technology to enhance, rather than replace, the paper-based labor monitoring tool known as the partograph. In the developing world, correct use of the partograph form to monitor the progress of maternal labor has been shown to reduce the number of obstructed labors, and consequently, the number of maternal deaths and stillbirths. However, previous work over the last decade has shown that there are several barriers to both partograph completion, and to correct use of the partograph form. Inadequate training and lack of ongoing education regarding partograph use are among the most significant of these barriers.

The PartoPen seeks to address these barriers by adding interactivity to the partograph in the form of audio instructions, decision-support, and patient-specific reminders. The design of the PartoPen system is based on the hypotheses that (1) audio instructions accessible via tapping the digital pen to the paper partograph will reinforce nurse training and promote partograph completion; (2) real-time decision support will reduce data interpretation errors and promote timely decision-making regarding patient care; and (3) time-based patient-specific reminders will promote ongoing and timely delivery of patient care.

This dissertation describes the design, implementation and evaluation of the PartoPen system in teaching and clinical settings in Nairobi, Kenya. The results of four PartoPen studies, conducted both in nursing classrooms and in labor wards, were used to evaluate the system and refine its design. At the University of Nairobi, nursing students using the PartoPen as a training tool were able to correctly perform controlled partograph completion tasks with minimal or no training on PartoPen use. PartoPens deployed in the labor ward at Kenyatta National Hospital were successfully used and sustained for nine-months of continuous hospital use. Finally, results from the PartoPen system evaluation also provide significant guidance for future work using digital pen systems for healthcare applications in developing countries.

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