Jens Johan Kaasbøll

• Øgland, Petter & Kaasbøll, Jens Johan (2026). Isomorphism in General System Theory | Journal of the International Society for the Systems Sciences. Proceedings of the annual meeting of the ISSS. 70(1), p. 1–15. Full text in Research Archive Show summary

  This paper revisits the role of General System Theory (GST) within Critical Systems Thinking (CST) and Critical Systems Practice (CSP), arguing that GST has been too narrowly interpreted as a functionalist and regulation-oriented approach associated primarily with hard systems thinking. Drawing on Ludwig von Bertalanffy’s original concern with isomorphism, the paper proposes an alternative reading in which GST is understood as a general framework for relating structurally comparable models across different domains and paradigms. Inspired by van Fraassen’s pragmatic philosophy of science and the use of isomorphism in abstract algebra, the paper argues that isomorphism should be understood primarily as a relation between epistemological models rather than between real-world systems themselves. On this basis, the paper develops Critical Systems Intervention (CSI) as a model-centric approach to multimethodological intervention. CSI maintains coherence across paradigmatic shifts by introducing an explicit intervention ontology in the form of a game model representing the evolving socio-technical situation under study. Different systems methodologies associated with the Burrell–Morgan paradigms are then treated as generating structurally related representations of the same underlying intervention situation. The paper illustrates this argument through a reinterpretation of the Health Information Systems Programme (HISP) and concludes that GST can be repositioned as the broader ontological and epistemological framework within which critical and plural systems interventions become theoretically integrated.

• Jemere, Adamu Takele; Yilma, Tesfahun Melese; Gezie, Lemma Derseh; Mengiste, Shegaw Anagaw; Gullslett, Monika Knudsen & Kaasbøll, Jens Johan [Show all 7 contributors for this article] (2026). Healthcare providers’ awareness of a mobile-based app for disease classification in northwest Ethiopia: A multilevel logistic regression analysis. PLOS ONE. 21(5 May). doi: 10.1371/journal.pone.0348362. Full text in Research Archive
• Wu, Tsung-Shu Joseph; Mvula, Matthew Vundu; Chado, Edward Kada Koma; Kamanga, Blessings Nthezemu; Mapemba, Daniel Denis & Billy, Rajab Enoch [Show all 13 contributors for this article] (2026). Establishing One Health Surveillance Platform for Electronic Integrated Disease Surveillance and Response in Malawi: Action Design Research Study. JMIR Public Health and Surveillance. 12. doi: 10.2196/72029. Full text in Research Archive Show summary

  Background Facing the threats of emerging and reemerging health issues requires One Health surveillance systems to provide information for integrated responses. Malawi started enhancing the electronic integrated disease surveillance and response (eIDSR) system in 2015, progressing with the aim of developing a One Health Surveillance Platform (OHSP) using District Health Information Software 2 (DHIS2) as its technical backbone, thereby supporting the COVID-19 pandemic response more resiliently and impacting the integrated disease surveillance and response (IDSR) performance. Digital solutions are critical components of One Health surveillance; however, evidence of the successful establishment and implementation of adaptive digital One Health surveillance systems is scarce. Objective This study aims to report on the establishment of the OHSP in Malawi and how an adaptive digital health solution contributed to strengthening and impacting the country’s eIDSR during the COVID-19 pandemic and beyond the pandemic. Methods The establishment of Malawi’s OHSP was based on the action design research methodology with a transdisciplinary approach. The core team reflected the multiple iterative processes of building the OHSP and formalized its impact on IDSR reporting quality. Results The OHSP core team conducted multiple iterative cycles to build the platform, leveraging lessons from previous eIDSR pilots, reusing digital health infrastructure, and developing DHIS2 digital solutions in 2019, right before the COVID-19 pandemic. The initial establishment was to cover 48.3% (14/29) of the country’s health districts. Pivoting from the initial plan as the COVID-19 pandemic emerged, the core team swiftly adapted the OHSP to scale up nationwide and assisted the health system in responding to the pandemic. The pandemic shock resulted in a national scale-up of the OHSP and impacted the national weekly IDSR reporting quality from nonexistence in 2015 to 97.8% and 74.5% for completeness and timeliness, respectively, in 2024. Conclusions The establishment of the OHSP significantly bolstered the surveillance function for weekly IDSR reporting. Government leadership and good coordination were key to success. Continuous capacity building, enhancement of community-level surveillance with digital innovations, adaptable technical infrastructure, and a reuse strategy can provide long-term sustainability for One Health surveillance. Malawi’s experience may apply to other countries with demonstrated value of resilient, government-led digital health interventions. Future efforts should focus on improving interoperability with other One Health domains and investing in infrastructure upgrades with local leadership and domestic funding to prepare for future emergencies.

• Msendema, Martin Bright; Kaasbøll, Jens Johan; Chigona, Wallace & Kumwenda, Benjamin (2025). Legitimacy Maintenance for Data Quality Management Practices: A Case of Health Management Information Systems. Electronic Journal of Information Systems in Developing Countries. 91(3). doi: 10.1002/isd2.70010. Full text in Research Archive
• Taye, Biniam Kefiyalew; Gezie, Lemma Derseh; Atnafu, Asmamaw; Mengiste, Shegaw Anagaw; Kaasbøll, Jens Johan & Gullslett, Monika Knudsen [Show all 7 contributors for this article] (2025). Enhancing the antenatal care quality through incentivized routine health information system in Northwestern Ethiopia: a quasi-experimental study (2020–2021). BMC Public Health. 25(1). doi: 10.1186/s12889-025-25632-6. Full text in Research Archive Show summary

  Background Antenatal care (ANC) is essential for maternal and newborn health, yet its utilization and quality remain suboptimal in many low-income settings. Evidence on the effectiveness of non-financial incentives to improve ANC is limited. This study examined the effect of a performance-based non-financial incentive (PBNI) intervention on the quality and optimal utilization of ANC in northwestern Ethiopia. Methods A quasi-experimental pre-post study with a comparator group was conducted in 2020–2021 involving 1,927 women. The intervention provided non-financial incentives such as smartphones, power banks, scholarships, and certificates, which were distributed at the facility, departmental, and individual levels. Incentives were tied to the performance of the Routine Health Information System(RHIS), focusing on data quality and utilization, including maternal care indicators among the evaluation criteria. Quality ANC was defined as receiving at least 8 of 9 essential components, while optimal ANC was defined as having four or more visits, in accordance with 2020–2021 national guidelines. The analysis used difference-in-differences robust Poisson regression, reporting incidence rate ratios (IRRs) with 95% confidence intervals. Results The study revealed a significant 1.44-fold improvement in ANC quality through a PBNI (IRR=1.44, 95% CI [1.07–1.96]). However, no statistically significant association was found for optimal ANC (IRR=0.85, 95% CI [0.68, 1.05]). The adjusted analysis identified rural residence (IRR=1.43, 95% CI [1.12, 1.83]), husbands with primary education (IRR=1.30, 95% CI [1.09, 1.55]), and birth intervals of 24 to 33 months (IRR=1.59, 95% CI [1.16, 2.19]) as factors associated with quality ANC. Besides, women with higher education (IRR=1.98, 95% CI [1.55, 2.52]), engagement in housework (IRR=0.63, 95% CI [0.52, 0.77]), and awareness of at least two danger signs (IRR=1.15, 95% CI [1.02, 1.29]) were linked to optimal ANC. Conclusion PBNI significantly enhances ANC quality but lacks statistical significance for optimal utilization. PBNI can motivate providers and enhance service quality when integrated with RHIS-strengthening efforts; however, longer implementation and complementary demand-side strategies may be necessary for sustained optimal ANC improvements

• Taye, Biniam Kefiyalew; Gezie, Lemma Derseh; Atnafu, Asmamaw; Mengiste, Shegaw Anagaw; Kaasbøll, Jens Johan & Gullslett, Monika Knudsen [Show all 7 contributors for this article] (2025). Negligence in data recording during institutional birth: exploring health workers’ perspectives on the barriers and enablers of data documentation practices. Archives of Public Health. ISSN 0778-7367. 83(1). doi: 10.1186/s13690-025-01735-9. Full text in Research Archive Show summary

  Abstract Background The availability of well-documented records during labor and delivery is essential for monitoring childbirth and ensuring positive outcomes for mothers and newborns. However, recent research in northwestern Ethiopia shows that data recording during these critical periods is inadequately performed. This study explored the barriers and enablers of data recording practices during institutional childbirth in this region. Methods A descriptive qualitative study was conducted in six health centers in the Wegera district, focusing on three source documents: one facility-level log (the Delivery Register) and two personal records (the Integrated Card and the Women’s Folder). An interview guide was used to collect spoken accounts from 14 health workers. The spoken data was transcribed and analyzed using thematic framework analysis, assisted by ATLAS.ti (version 9.1.3). Results This study identified three primary barriers to recording institutional birth data: organizational, behavioral, and technical. Four key subthemes emerged from the analysis within the organizational barriers category: the workload during childbirth, the lack of supervision of data within personal records, a lack of accountability for recording, and the turnover of trained staff responsible for data management. Behavioral barriers included health workers neglecting data recording and negative attitudes toward documentation. Regarding technical obstacles, the complexity of data recording formats presents challenges, resulting in missing data and errors when transferring data from one source to another. Despite these barriers, the study highlighted enablers, all of which were organizational, including the presence of routine data quality reviews, training, and supervision from the higher officials. Conclusions This study examines health workers’ perspectives in northwestern Ethiopia on the barriers and enablers to recording birth data, focusing on women’s personal records. It shows that weak organizational emphasis on client-level documentation and limited accountability for personal records diminishes motivation and contributes to neglect of crucial data. Busy settings, marked by heavy workloads, staff shortages, and competing priorities, further undermine confidence in maintaining accurate records. Interventions should aim to enhance motivation, build staff self-esteem in documenting under pressure, and foster a sense of professional responsibility. Promoting a positive attitude toward detailed record-keeping is also essential.

• Kaunda, Auxilia Nyaukaya; Manda, Tiwonge & Kaasbøll, Jens Johan (2025). Influence of Institutional Factors on Community Level Technology Implementation for Enhanced Data Utilization in Malawi's Health Management Information System. Electronic Journal of Information Systems in Developing Countries. 91(2). doi: 10.1002/isd2.70007. Full text in Research Archive
• Hailemariam, Tesfahun; Atnafu, Asmamaw; Gezie, Lemma Derseh; Kaasbøll, Jens Johan; Klein, Joern & Tilahun, Binyam (2025). Digitalizing the community health information system improved women's retention on the maternal continuum of care pathway in northwest Ethiopia: A quasi-experimental study. PLOS ONE. 20(3). doi: 10.1371/journal.pone.0312965. Full text in Research Archive Show summary

  Background Retaining women on the maternal continuum of care pathway remains a significant challenge for the healthcare system. Digitalizing primary healthcare system using community health workers is a key strategy to enhance maternal healthcare utilization in Ethiopia. However, the effectiveness of digitalizing community health system using frontline health system workers is uncertain. Objective To determine the effect of electronic community health information system intervention on maternal continuum of care in northwest Ethiopia. Methods A pre-post experimental study was conducted in Wogera district, northwest Ethiopia. Data were collected at household level from April to May 2022 including a total of 830 women with children with age less than one-year. A log-binomial logistic regression model was used to estimate the effect of electronic community health information system on the maternal continuum of care and its predictors. Relative risk with a 95% confidence interval was reported, with a p-value of <0.05 considered statistically significant. Results The study revealed that 10.6% women were fully retained on the maternal continuum of care before the intervention while 32.5% after the intervention(p < 0.001). Women in the intervention cluster had 3.12 times higher coverage of maternal continuum of care(ARR: 3.12,95%CI: 2.20–4.41). In addition, primary education(ARR: 1.54, 95%CI:1.14, 2.08), secondary and above education(ARR: 1.61, 95%CI:1.08,2.39); pregnancy intention (ARR: 1.67, 95%CI: 1.11,2.51), and women’s autonomy in healthcare decision making (ARR: 2.02, 95%CI: 1.03, 3.97) were significantly associated with maternal continuum of care. Conclusions Electronic community health information system improved maternal continuum of care. Maternal health service programs in rural should consider the implementation of electronic community health information system. Provision of women’s education, prevention of unintended pregnancy, and enhancement of autonomy of women in healthcare decision making should be emphasized to improve maternal continuum of care.

• Matewere, Florence & Kaasbøll, Jens Johan (2025). Using Digital Integrated Community Case Management to Strengthen Protocol Adherence Over the Sick Child Recording Form for Under-Five Children Referrals From Community to Higher Level Facilities in Malawi: Affordance Perspective. Electronic Journal of Information Systems in Developing Countries. 91(2). doi: 10.1002/isd2.70000. Full text in Research Archive
• Sayem, Abu Sadat Mohammad; Kaasbøll, Jens Johan; Halim, Abul & Abdullah, Abu Sayeed (2024). Maternal and perinatal death surveillance and response in Bangladesh: A case study on measuring impact through health information systems. F1000 Research. 13, p. 1–28. doi: 10.12688/f1000research.142710.2. Full text in Research Archive Show summary

  The health sector in Bangladesh is thriving, and the Maternal and Perinatal Death Surveillance and Response (MPDSR) program has been in place to investigate the causes of maternal and perinatal death. This study aimed to investigate the availability of information systems for measuring the status of an MPDSR program and the planning process and actions developed based on real-time information. This study delved into innovative information systems that can be used to monitor and measure the impact of health programs. The study included both the primary and secondary data. A total of six key informant interviews were conducted to explore the enablers and strengths of information systems. Secondary data were collected from government websites and MPDSR action plans. This study highlights the potential and challenges of governmental health information systems in notifying maternal and neonatal deaths. While the current notification rates are not up to national standards, it is encouraging to see health managers d

• Taye, Biniam Kefiyalew; Gezie, Lemma Derseh; Atnafu, Asmamaw; Mengiste, Shegaw Anagaw; Kaasbøll, Jens Johan & Gullslett, Monika Knudsen [Show all 7 contributors for this article] (2024). Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study. JMIR Medical Informatics. 12. doi: 10.2196/54278. Full text in Research Archive Show summary

  Background: Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers’ commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia. Objective: This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia. Methods: We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women’s medical records. The study was conducted in the “Wegera” and “Tach-armacheho” districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women’s birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women’s birth records. The average treatment effect on the treated (ATET), with 95% CIs, was computed using a difference-in-differences model. Results: In the intervention district, data completeness in women’s personal records was nearly 4 times higher (ATET 3.8, 95% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95% CI 4.18-19; P=.03) than in the comparator district. Conclusions: This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up.

• Hailemariam, Tesfahun; Atnafu, Asmamaw; Gezie, Lemma Derseh; Kaasbøll, Jens Johan; Klein, Joern & Tilahun, Binyam (2024). Postnatal care utilization within 48 h after birth and its determinants in northwest Ethiopia: a multilevel logistic regression analysis. Scientific Reports. 14(1), p. 1–11. doi: 10.1038/s41598-024-64244-9. Full text in Research Archive Show summary

  Postnatal care immediately after birth is a crucial component to save lives of mothers and the newborns. A paucity of evidence indicated that women’s unwillingness to receive care after birth is a remained challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the utilization of postnatal care within 48 h after birth and its determinants in northwest Ethiopia. A community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had birth within the last one year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and p value of 0.05. The study revealed that 13.3% (95% CI 10.9–15.7%) of women attended postnatal care visits within 48 h after birth. Attending secondary and above education (AOR = 2.39; 95% CI 1.18, 4.84); health extension workers home visiting during pregnancy (AOR = 1.74; 95% CI 1.08, 2.82); birth order (AOR = 2.07; 95% CI 1.03, 4.14); place of delivery (AOR = 7.49; 95% CI 3.73, 15.06); and short distance to health facility (AOR = 4.19; 95% CI 1.64, 10.70) were significantly associated with postnatal care utilization within 48 h after birth. Postnatal care utilization within 48 h is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider multilevel intervention strategies focusing on maternal health education, engaging community health workers in health promotion, and ensuring physical accessibility of healthcare facilities to be more effective in improving postnatal care utilization within 48 h.

• Hailemariam, Tesfahun; Atnafu, Asmamaw; Gezie, Lemma Derseh; Kaasbøll, Jens Johan; Klein, Joern & Tilahun, Biniyam Chakilu (2024). Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model. JMIR Human Factors. 11(1), p. 1–14. doi: 10.2196/47081. Full text in Research Archive Show summary

  Background: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective: This study aimed to assess HEWs’ intentions to use the eCHIS for health data management and service provision. Methods: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs’ intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. Results: A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs’ intention to use the eCHIS. Conclusions: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

• Asah, Flora Nah & Kaasbøll, Jens Johan (2023). Challenges and Strategies for Enhancing eHealth Capacity Building Programs in African Nations. Journal of Personalized Medicine. 13(10). doi: 10.3390/jpm13101463. Full text in Research Archive Show summary

  eHealth applications play a crucial role in achieving Universal Health Coverage. (1) Background: To ensure successful integration and use, particularly in developing and low/middle-income countries (LMIC), it is vital to have skilled healthcare personnel. The purpose of this study was to describe challenges that hinder capacity-building initiatives among healthcare personnel in developing and LMIC and suggest interventions to mitigate them. (2) Methods: Adopted a descriptive research design and gathered empirical data through an online survey from 37 organizations. (3) Results: The study found that in developing and LMIC, policymakers and eHealth specialists face numerous obstacles integrating and using eHealth including limited training opportunities. These obstacles include insufficient funds, inadequate infrastructure, poor leadership, and governance, which are specific to each context. The study suggests implementing continuous in-service training, computer-based systems, and academic modules to address these challenges. Additionally, the importance of having solid and appropriate eHealth policies and committed leaders were emphasized. (4) Conclusions: These findings are consistent with previous research and highlight the need for practical interventions to enhance eHealth capacity-building in LMICs. However, it should be noted that the data was collected only from BETTEReHEALTH partners. Therefore, the results only represent their respective organizations and cannot be generalized to the larger population.

• Kaunda, Auxilia; Manda, Tiwonge Davis & Kaasbøll, Jens Johan (2023). Institutional Dynamics Shaping Data Use in Health Management at the District Level in Malawi: Case of Selected District Health Offices. Journal of Health Informatics in Developing Countries. 17(2), p. 1–21. Full text in Research Archive Show summary

  Background: While there has been overwhelming evidence of the importance of data use in health management, data use in Malawi’s Health Management Information System remains low. This paper investigates how institutional dynamics are shaping data use in health management at the district level in Malawi Health Management Information System, focusing on four selected District Health Offices (DHOs). Methods: This qualitative study applied semi-structured interviews, active participant observations and document reviews to collect data at selected District Health Offices in Malawi. Results: The study findings have demonstrated that institutional dynamics’ mechanisms shaping data use in health management at the district level are 1) District Health Office regulations and policy 2) organisational structures and partnership patterns 3) data management and data use, and 4) District Health Office collaboration with healthcare partner organisations in shared activities. These mechanisms provide an organisational context in which health managers’ efforts deal rationally with constraints and uncertainty, resulting in a change process of established data use. While the Ministry of Health has stipulated regulatory policies to guide healthcare services delivery at District Health Offices, strong and supportive organisational leadership is crucial. The Ministry of Health’s commitment to quarterly supervision visits motivates Directors of Health and Social Services at the District Health Offices. In turn, the District Health Officers provide supportive leadership in strengthening community-level organisation structures where data is collected for effective data use. The paper details how the definition of Programme Managers’ norms, roles, behaviours, and inter-organisational interactive patterns, initiated a change process that led to improved data use at one District Health Office out of the four selected District Health Offices. The findings imply that, despite inadequate resources, these Programme Managers acted as a bridge between the District Health Office and the community level. Not only did the Programme Managers ensure that data was collected from the organisation structures at the community level but the Programme Managers also became a critical resource enabling timely District Health Management Team performance assessment data reviews at the District Health Office. District Health Management Team’s performance assessment data reviews facilitated informed data use decision-making in planning and management of healthcare services delivery to the district health population. However, inadequate resources, weak community organisation structures, and lack of coordination and collaborations in shared activities and data use for sustainable healthcare organisation partnerships compromise effective data use in health management in most District Health Offices. Conclusion: The study argues for a well-articulated definition of the District Health Offices’ policy guidance from the Ministry of Health in mapping healthcare partner organisations’ activities to ensure effective data reporting across the districts. Not only will the effective data reporting result in collaboration and coordination of shared healthcare activities but also strengthen informed data use in healthcare services delivery to the district health population.

• Matewere, Florence & Kaasbøll, Jens Johan (2023). Use of Mobile Application to Support Community Health Workers in Patients’ Assessment and Referrals. The Case of Malawi Rural Healthcare. In Jones, Matthew (Eds.), After Latour: Globalisation, Inequity and Climate Change. Springer Nature. ISSN 9783031501531. p. 280–295. doi: 10.1007/978-3-031-50154-8_21. Full text in Research Archive
• Msendema, Martin Bright; Chigona, Wallace; Kumwenda, Benjamin; Kaasbøll, Jens Johan & Kanjo, Chipo (2023). Legitimization of data quality management practices in health management information systems: A soft systems methodology perspective. Electronic Journal of Information Systems in Developing Countries. 90(1). doi: 10.1002/isd2.12289. Full text in Research Archive
• Hailemariam, Tesfahun; Atnafu, Asmamaw; Gezie, Lemma Derseh; Kaasbøll, Jens Johan; Klein, Joern & Tilahun, Binyam (2023). Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09629-8. Full text in Research Archive Show summary

  Background The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation. Method We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings. Results First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders’ engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis. Conclusion The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.

• Mengiste, Shegaw Anagaw; Antypas, Konstantinos; Johannessen, Marius Rohde; Klein, Joern; Kazemi, Gholamhossein & Kaasbøll, Jens Johan (2022). Research Landscape and Research Priorities in eHealth in four African Countries - A survey. CEUR Workshop Proceedings. p. 130–140. Full text in Research Archive Show summary

  There is a huge interest by stakeholders in the potentials of eHealth. Accordingly, there is a strong demand from donors, and other stakeholders for eHealth research outputs to address infrastructural, policy, and human challenges. The BETTEReHEALTH project explores infrastructure, policy, and human factors impacting eHealth in Ethiopia, Ghana, Malawi, and Tunisia. This study applies the National eHealth Strategy Toolkit introduced by WHO and ITU to assess the conformity of the research landscape and research priorities of these countries with the building blocks defined in the toolkit. The status of ICT, policy, and human factors of partner countries indicates that there is a serious lack of policies and skilled workers along with infrastructural challenges. Collected data revealed that Infrastructure-Policy-Human is a fundamental triangle for successful eHealth implementation while Ethiopia, Ghana, Malawi, and Tunisia, as a sample representing Africa, suffer from lack of policies the most both at the governmental and research communal level.

• Chrysantina, Aprisa; Sæbø, Johan Ivar & Kaasbøll, Jens Johan (2022). Introducing online training for health staff: An institutional perspective. Electronic Journal of Information Systems in Developing Countries. doi: 10.1002/isd2.12233. Full text in Research Archive Show summary

  Online training has been gaining popularity for its flexibility and cost-efficiency. Its introduction challenges existing practices of in-service training which are mostly in the form of onsite training. Based on a participative, interpretive case study, we conceptualized in-service training as an institution, examining how the introduction of online training affected changes to the in-service training practices. Our research investigates three modes of in-service training; onsite training, self-paced online course, and synchronized online training. Two conflicting institutional logics that are associated with the first two modes of training emerge; onsite training logic and online training logic. The in-service training institution in Indonesia remained stable despite changes in technology used and the covid pandemic. The logic of onsite training continued to be dominant throughout the period, and most training practices in onsite training were carried over to the online training without reflections.

• Asah, Flora Nah; Kaasbøll, Jens Johan & Anthun, Kirsti Sarheim (2022). Obstacles of eHealth Capacity Building and Innovation Promotion Initiative in African Countries. Studies in Health Technology and Informatics. ISSN 0926-9630. 299, p. 33–43. doi: 10.3233/SHTI220961. Full text in Research Archive Show summary

  eHealth applications and tools have the potential to improve coordination, knowledge, and information sharing between health professionals as well as continuity of care. One of the main obstacles hindering its full integration and use, particularly in the healthcare sector in developing and low and middle-income countries is the lack of qualified staff and healthcare personnel. To explore obstacles that hinder capacity and innovation promotion initiatives, a survey was conducted among BETTEReHEALTH partners. A questionnaire was used to collect quantitative data from 37 organizations. Although there are different buckets of capacity-building and innovation promotion activities going on, the findings showed very few targeting policymakers and eHealth specialists. The findings found that obstacles to capacity building and innovation promotion include lack of finance, poor infrastructure, poor leadership, and governance, and these obstacles are context or region specific. Findings from our study concur with those from previous research on the need to identify practical solutions and simple interventions to address eHealth obstacles to capacity building in developing countries. As measures to mitigate these obstacles, our study proposed the need for adequate policies, strong political commitment, the development of academic modules to be integrated into existing educational programs, and the creation of more in-country and on-site capacity-building activities. While this study contributes to the discourse on eHealth capacity-building and innovation promotion initiatives among healthcare and public health professionals, the study has a limitation as data was collected only from BETTEReHEALTH partners.

• Msendema, Martin; Chigona, Wallace; Kumwenda, Benjamin; Kaasbøll, Jens Johan & Kanjo, Chipo (2021). Legitimization of Data Quality Practices in Health Management Information Systems Using DHIS2. Case of Malawi. In Masiero, Silvia & Nielsen, Petter (Ed.), IFIP 9.4 2021 – 1st Virtual Conference Conference Theme: Resilient ICT4D. Proceedings. Universitetet i Oslo. ISSN 9788273684622. p. 924–935. Full text in Research Archive
• Thodesen, Thea Hvalen; Tran, Uy; Kaasbøll, Jens Johan; Kanjo, Chipo & Manda, Tiwonge Davis (2021). MEDICAL GRAPHS IN PATIENT INFORMATION SYSTEMS IN PRIMARY CARE. In Masiero, Silvia & Nielsen, Petter (Ed.), IFIP 9.4 2021 – 1st Virtual Conference Conference Theme: Resilient ICT4D. Proceedings. Universitetet i Oslo. ISSN 9788273684622. p. 363–377. Full text in Research Archive
• Kaur, Gagandeep; Kaasbøll, Jens Johan; Manda, Tiwonge Davis & Kanjo, Chipo (2021). Gluing Papers to Computers: How QR- and Bar-codes Enable Hybrid Information Systems. In Cunningham, Miriam & Cunningham, Paul (Ed.), IST-Africa 2021 Conference Proceedings. IEEE (Institute of Electrical and Electronics Engineers). ISSN 9781905824670. p. 1–8. Full text in Research Archive
• Asah, Flora Nah & Kaasbøll, Jens Johan (2021). Deconstructing the Dichotomous Relationship Between "IT analysts and End-users": A Case of Implementing Standard Indicators in Cameroon. In Masiero, Silvia & Nielsen, Petter (Ed.), IFIP 9.4 2021 – 1st Virtual Conference Conference Theme: Resilient ICT4D. Proceedings. Universitetet i Oslo. ISSN 9788273684622. p. 957–968. Full text in Research Archive
• Asah, Flora Nah; Kaasbøll, Jens Johan; Nielsen, Petter & Seukap, Roger (2021). Organizations failing to learn: Roadblocks to the Implementation of Standardized Information Systems. Journal of Health Informatics in Developing Countries. 15(1), p. 1–31. Full text in Research Archive Show summary

  Purpose: Implementing standard health indicators aims at harmonizing fragmented information systems. However, they have not always met this expectation. This article argues that standard information systems fail because organizations fail to learn effective ways of solving problems. Design: Using an interpretive phenomenological approach, we draw examples from the implementation of standard health indicators in Cameroon to explore why organizations fail to learn. We collected data from April and September 2017 from 25 staff in healthcare facilities and district offices. Findings: Staff at the peripheral level encountered multiple levels of organizational challenges. We argue that these challenges are deeply rooted in the organizational structure. Using organizational learning as a lens, we theorize the factors (i.e., a disincentive for learning, educational barriers, and organizational culture) that hinder learning. Then identify three beliefs (i.e., technological fix, silver bullet, and emperors of the same empire) embedded in organizational structure that hinder organizational learning. Finally, we propose practical measures to mitigate the challenges that impede the implementation of standard health indicators in Cameroon and beyond. Conclusion: Organizations often misplace their attention on what and how they should learn. While they are fast to learn from external sources and are often eager to accommodate information systems, they fail to provide a conducive atmosphere where local experiences thrive, do not value learning from experiences, and adopt few processes to promote learning. Originality: Linking the challenges encountered by staff at the peripheral level after implementing standard health indicators to poor organizational learning opportunities offers a novel perspective to conceptualize the challenges of implementing information systems in low and middle-income countries.

• Kanjo, Edith Chipo Hilda; Hara, Joshua & Kaasbøll, Jens Johan (2020). Digital Empowerment for Health Workers and Implications on EMRs Utilisation. Journal of Health Informatics in Africa. ISSN 2197-6902. 6(2), p. 74–83. doi: 10.12856/JHIA-2019-v6-i2-262. Full text in Research Archive Show summary

  Background and Purpose: Utilization of Electronic Medical Records (EMRs) bring many benefits to patient record handling. Previous research has shown that medical doctors in hospitals in Africa had poor IT skills, partly disabling their use of EMRs. Working in health centres, we wanted to know how to improve the digital skills of their personnel. Methods: Qualitative methods including interviews, informal discussions and observation were used for data collection. The study was conducted in three health facilities in Malawi, selected purposively as these were the ones implementing the EMR under study. The study targeted all staff that were capturing data at point of care using the app between January and June 2019. Results: Personnel in the health centres were computer illiterate, even if they used phones, and some smart phones. After computer training, they were still not comfortable using EMRs because their typing speed was delaying the process. Improving the typing speed allowed the users to comfortably use the EMRs. Three levels of EMR empowerment were identified; being able to 1) use EMR where typing speed is less relevant, 2) use EMR at point of care, 3) guide colleagues on their EMR use and find new ways of exploiting the technology. For reaching level 2, 50-100 hours of typing practice would be necessary. Conclusions: Health workers who lack computer skills tend to shy away from using EMRs. Even if falling prices of equipment will enable more EMRs in rural areas, the digital empowerment process will still require significant resources.

• Ayebazibwe, Immaculate; Kimaro, Honest Christopher & Kaasbøll, Jens Johan (2019). System use and user satisfaction in the adoption of electronic medical records systems: A case of DHIS2 tracker implementation in Tanzania. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 551, p. 63–75. doi: 10.1007/978-3-030-18400-1_6. Full text in Research Archive
• Chhetri, Amrit; Iversen, Mari; Kaasbøll, Jens Johan & Kanjo, Chipo (2019). Evaluating mHealth Apps Using Affordances: Case of CommCare Versus DHIS2 Tracker. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 551, p. 619–632. doi: 10.1007/978-3-030-18400-1_51. Full text in Research Archive
• Msiska, Brown Chawanangwa; Nielsen, Petter & Kaasbøll, Jens Johan (2019). Leveraging Digital Health Platforms in Developing Countries: The Role of Boundary Resources. In Nielsen, Petter & Kimaro, Honest C. (Ed.), Information and Communication Technologies for Development: Strengthening Southern-Driven Cooperation as a Catalyst for ICT4D. 15th IFIP WG 9.4 International Conference on Social Implications of Computers in Developing Countries, ICT4D 2019, Dar es Salaam, Tanzania, May 1–3, 2019, Proceedings, Part I. Springer Nature. ISSN 9783030183998. p. 116–126. doi: 10.1007/978-3-030-18400-1_10. Full text in Research Archive
• Kaasbøll, Jens Johan; Kanjo, Chipo & Kimaro, Honest C. (2019). Building Sustainable Collaborations and Academic Networks in Low Income Countries: Case of Master Programmes. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 552, p. 398–408. doi: 10.1007/978-3-030-19115-3_33. Full text in Research Archive
• Asah, Flora Nah; Chikumba, Patrick Albert; Kaasbøll, Jens Johan; Manya, Ayub Shisia; Moyo, Christon M. & Msiska, Brown Chawanangwa [Show all 7 contributors for this article] (2018). From Sustainable to Continuously Adaptive Information Systems. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2018 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824601. p. 1–10. Full text in Research Archive Show summary

  Many previous studies have pointed to unsustainable information systems in developing countries, meaning that software is not used after some time. When a system fails in one of seven identified dimensions, people will not use it, hence these are unsustainability criteria. This paper reports from three health information systems having been adapted to a changing environment over more than a decade. Data is collected from documents and from three of the authors’ experience and systematized and analyzed by the other authors. Sustainability was redefined to mean the ability of an information system to adapt to new requirements, where software replacement may be one of the adaptations made. Factors which contributed to sustainability were found in the seven dimensions for unsustainable systems. Taking advantage of findings from other literature, including more stakeholders in the system was identified as an additional strategy for sustaining the systems.

• Wu, Tsung-Shu Joseph; Kagoli, Matthew; Kaasbøll, Jens Johan & Bjune, Gunnar Aksel (2018). Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert. PLOS ONE. 13(11), p. 1–19. doi: 10.1371/journal.pone.0200858. Full text in Research Archive Show summary

  Objective: The emerging and recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon efforts from globe to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening. Methods: This was a mixed-method observational study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2). Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and key informants of the IDSR system implementation and administration at district and national levels. Findings: The current IDSR system showed relatively good completeness (76.4%) but poor timeliness (41.5%) of total expected monthly reports nationwide and zero weekly reports. The challenges of IDSR implementation revealed through qualitative data included lack of supervision, inadequate resources for training and difficulty to implement weekly report due to overwhelming paperwork at frontline health services. Conclusions: The differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

• Ismanov, Zufarzhan; Iversen, Mari; Kaasbøll, Jens Johan; Manda, Tiwonge Davis & Ni, Ilia (2018). Patient information systems for hospitals versus primary health care – implications for data structures and user interaction. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2018 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824601. Full text in Research Archive Show summary

  Research has shown that implementing information systems in hospital wards is notoriously difficult, regardless of the amount of resources used. This paper reports findings from ongoing efforts to adapt a software solution designed for primary care, to support practices and protocols around inpatient neonatal care in a hospital ward. Practices and protocols to be supported include: patient admission and discharge, calculation of medicine doses, and hourly monitoring of patients’ vitals and medication. Experimental results show that, using the system for patient admission and discharge was rather straight forward, except a work-around had to be done in the data model. Calculation of medicine doses was also implemented. On the other hand, using the software solution for the hourly monitoring and medication of patients was deemed considerably difficult, as this required a tablet at each bedside, with custom developed user interaction. Similar issues have been found in other studies of electronic medical records.

• Isaksen, Helene; Iversen, Mari; Kaasbøll, Jens Johan & Kanjo, Chipo (2017). Methods for Evaluation of Tooltips. In Kurosu, Masaaki (Eds.), Human-Computer Interaction. User Interface Design, Development and Multimodality. Springer. ISSN 9783319580715. p. 297–312. doi: 10.1007/978-3-319-58071-5_23. Full text in Research Archive Show summary

  Tooltips are context-sensitive help aimed at improving learnability of a system. Evaluation of tooltips would therefore be a part of evaluation of documentation, which is a subcategory of evaluation of software learnability. Previous research only includes two evaluations of tooltips, both gauging learning outcome after initial training, while the purpose of tooltips is helping users whenever in doubt when using systems after training. The previous evaluations are therefore of a low content validity. This paper concerns data field tooltips aimed at improving correctness of data entry. It present studies a scale of content validities. On the low level is a questionnaire on users’ opinion, which is a cheap evaluation. The medium type of evaluation was an adapted question-suggestion test measuring learning outcome. The high content validity evaluation method was a field experiment over two weeks, which demonstrated improved performance caused by tooltips. If the cheap questionnaire came out with the same preferences as the costly experiment, doing the questionnaire could have replaced experiments. However, the experiment did not confirm the results from the questionnaire.

• Isaksen, Helene; Iversen, Mari; Kaasbøll, Jens Johan & Kanjo, Chipo (2017). Design of Tooltips for Health Data. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2017 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824564. p. 1–8. doi: 10.23919/ISTAFRICA.2017.8102409. Full text in Research Archive Show summary

  Tooltips are regarded as beneficial methods for users to understand either a user interface element or tasks related to the system. However, little research has compared text, tables and illustrations or addressed the content of tooltips, thus this research aims to address this aspect. Through a question-suggestion approach, accompanied by interviews and questionnaires, we have looked at what actual users would prefer as expression format and content type for tooltips. We found that text is the preferred type of expression, while normal values are the preferred content type.

• Isaksen, Helene; Iversen, Mari; Kaasbøll, Jens Johan & Kanjo, Chipo (2017). Design of Tooltips for Data Fields: A Field Experiment of Logging Use of Tooltips and Data Correctness. In Marcus, Aaron & Wang, Wentao (Ed.), Design, User Experience, and Usability: Understanding Users and Contexts. Springer. ISSN 9783319586403. p. 63–78. doi: 10.1007/978-3-319-58640-3_6. Full text in Research Archive Show summary

  Many health professionals in developing countries carry out tasks which require a higher level of education than they have. To help such undereducated health workers filling correct data in patient information systems, data fields were furnished with tooltips for guiding users. In a previous study with questionnaires and interviews, health workers preferred tooltip contents being normal values of the data with medical explanation as the second best. The experiment reported in this paper set out to test these content alternatives and also aimed at finding health workers’ use of tooltips and possible effects on data correctness. In order to resemble the work setting, each of the 15 undereducated health workers participating was given a tablet PC with the patient information system and booklet of 22 cases to be entered over a period of two weeks. They were given a one hour introduction to the system. Their use of the tablet was recorded, and after completing, the participants were interviewed. The health workers opened tooltips frequently for the first cases, and thereafter the use dropped. Reasons given were that they learnt the data field during the first cases, and thereafter they did not need the tooltips so often. The number of correct data entries increased over time. The group with medical explanation tooltips performed better than the group with normal value tooltips, thus the preferred tooltip in the questionnaire gave a lower performance than the second alternative. While the experiment demonstrated that tooltips improved performance, it did not quantify the effect.

• Namatovu, Esther; Sæbø, Johan Ivar & Kaasbøll, Jens Johan (2017). Mobilities of the Community Health Work Practice: Mobile Health System Mediated Work. Journal of Community Informatics. 13(3), p. 54–74. Full text in Research Archive Show summary

  New technologies have been implicated in various forms of mobilities creating new realities and questioning normative categories and the order in contexts where they are applied. Our study argues that through understanding technology mobilities, we uniquely bring to light new forms of social phenomena that materialize with interactions between mHealth systems and the work of Community Health workers in Malawi. Through the analysis, we also elaborate the role of both human and non-human actants in work transformations. This is important in managing technological innovations and theorizing electronically supported work practices.

• Moyo, Christon M.; Kaasbøll, Jens Johan; Nielsen, Petter & Sæbø, Johan Ivar (2016). The information transparency effects of introducing league tables in the health system in Malawi. Electronic Journal of Information Systems in Developing Countries. 75:2, p. 1–16. doi: 10.1002/j.1681-4835.2016.tb00544.x. Full text in Research Archive
• Bjørge, Ellen Marie; Jønsson, Anniken; Kaasbøll, Jens & Pinard, Matthieu (2015). Training Mentors of Health Information Systems through eLearning. In Nielsen, Petter (Eds.), Proceedings of the 13th International Conference on Social Implications of Computers in Developing Countries. Universitetet i Oslo. ISSN 9788273684653. p. 312–319. Full text in Research Archive Show summary

  The district health information system (DHIS) is currently used in more than 40 developing countries. The project aims in finding effective training methods to improve user’s learning outcomes and in grooming mentors that can attract new users. Based on literature recommendations and a user survey, an eLearning course through an in-app in the software is under development to be used in low connectivity areas. The eLearning course will emphasize interactivity, motivation, practice exercises and feedback. In addition to the normal user level, this course also has a mentor level to be taken by some users in each site where the system is used, such that the mentors can guide new users locally.

• Bjørge, Ellen Marie; Jønsson, Anniken; Kaasbøll, Jens & Pinard, Matthieu (2015). From user training courses and central support To creating local user competence for mentoring colleagues: a preliminary study in Malawi. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2015 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824502. doi: 10.1109/ISTAFRICA.2015.7190570. Full text in Research Archive Show summary

  Learning to use distributed business systems requires expensive and sustained training efforts. An approach to nurture local users to become mentors for colleagues has been developed as an alternative to training courses. A user level plus a mentor level distance learning course were evaluated amongst users of a health information system in Malawi. The user level course was adequate for users with some computer fluency, while IT novices required a mentor present. The mentor level course required the mentors to have higher system competence than most of the relevant users had. An advanced level course between the user and the mentor levels is therefore suggested, in addition to including more practicals and cooperative, reflective components in the mentor course. With such amendments, distance learning courses can replace most face-to-face training courses and training of trainers approaches for implementation of information systems.

• Moyo, Christon M.; Frøyen, Marte Hesvik; Sæbø, Johan Ivar & Kaasbøll, Jens (2015). Using Performance League Tables to Promote Acccounability and Feedback in Health management in Malawi. In Nielsen, Petter (Eds.), Proceedings of the 13th International Conference on Social Implications of Computers in Developing Countries. Universitetet i Oslo. ISSN 9788273684653. p. 265–276. Full text in Research Archive Show summary

  One of the challenges of health management in developing countries is the existence of weak accountability and feedback practices. This paper assesses the conditions for introducing performance league tables for promoting accountability and feedback in health management. A qualitative approach with an interpretive perspective has been adopted in this study. Data was collected using interviews, prototyping, observations and document analysis. The assessment revealed the importance of having a participatory process in the design and implementation of league tables used within the existing management practices. This ensures flexibility in the use of performance league tables. In addition, appropriate technology should facilitate availability and accessibility of data to stakeholders so that they manipulate it to suit their needs. Collaboration among stakeholders is a critical condition for ensuring access to additional resources for the implementation of performance league tables. A decentralized approach to league table definition allows districts to choose and weight indicators according to their own goals. Relevance, local choices through a participatory bottom up design process leads to broader acceptance and use of the performance league tables.

• Moyo, Christon M.; Nkhonjera, Tasokwa & Kaasbøll, Jens (2015). Assessing the Use of Mobile Technology to improve Timeliness of HMIS Reports in Malawi. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2015 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824502. p. 1–9. doi: 10.1109/ISTAFRICA.2015.7190573. Full text in Research Archive Show summary

  Low timeliness of routine HMIS reports has been a major concern in many developing countries. The deployment and use of mobile technology in these countries offers an opportunity to use it to improve timeliness of report sent to the next level. The aim of this study is to assess the use of mobile technology for improving timeliness of reports in one district in Malawi. Data was collected using semi-structured interviews, observations, field notes and document review. DHIS2 mobile implementation has shown some positive results concerning knowledge and skills development; improved timeliness of reports; reduction in the cost of sending reports and delegation of responsibility in data entry from the district to the health facility. The deployment of mobile technology for reporting requires appropriate technical, behavioural and organizational factors to effectively contribute to improved timeliness of reports.

• Dittrich, Yvonne; Harpe, Retha de la; Korpela, Mikko; Gertrudes, Macueve; Bekele, Rahel & Kaasbøll, Jens (2014). Participation for Development. In Clement, Andrew; Winschiers, Heike; D'Andrea, Vincenzo & Bødker, Keld (Ed.), Proceedings of the 13th Participatory Design Conference: Short Papers, Industry Cases, Workshop Descriptions, Doctoral Consortium papers, and Keynote abstracts - Volume 2. ACM Digital Library. ISSN 9781450332149. p. 213–214. doi: 10.1145/2662155.2662207. Full text in Research Archive Show summary

  Information and Communication Technology (ICT) is more and more promoted as a driver and facilitator of economic growth and development in low and middle income countries. ICT for Development (ICT4D) though has mixed successes. Sustainability of solutions and usability respectively usefulness for the intended beneficiaries have been reported as causes. Participatory approaches to development have been proposed to address these causes. Participatory Design (PD) seems like a perfect fit. However, at the Participatory Design Conferences, research that addresses PD in low and middle income countries is rare. The workshop aims at bringing together the PD researchers working with under-privileged communities and attracting researchers from the ICT4D communities to the PD conference. The goal is to share experiences and start a discussion on how participation, ICT and development might relate.

• Kaasbøll, Jens (2014). Suitability of diagrams for IT user learning. In Costa, Carlos J. & Manuela, Aparicio (Ed.), ISDOC '14 Proceedings of the International Conference on Information Systems and Design of Communication. ACM Publications. ISSN 9781450327138. p. 56–62. doi: 10.1145/2618168.2618177. Full text in Research Archive Show summary

  Training and user documentation aim at people being able to use IT when returning from training. Such transfer is in general difficult to achieve. Based on a model of IT use learning, two types of diagrams in documentation were compared in a field study; instructions showing the sequence of how to carry out an operation by means of screen shots and structural models showing data structures without user interface elements. Instructions were in general favoured. Even if the instructions only to a small extent were presented with projector during training, the trainees stated that they learnt a lot from these presentations. The learning outcome might have been the existence of an operation and where in the software to locate it. While primarily intended as help for understanding data structures, the trainees also used structural models as guides for carrying out operations. Instructions in particular, but also structural models were utilised by the trainees after the training sessions, hence helping transfer. Trainers should include both types of models in courses.

• Chawani, Marlen Stacey; Kaasbøll, Jens; Finken, Sisse; Herstad, Jo & Malata, Address (2014). Balancing work practices and protocols in the design of EMR systems: The case of developing an EMR system for antenatal care services in Malawi. Electronic Journal of Information Systems in Developing Countries. 63(1), p. 1–26. doi: 10.1002/j.1681-4835.2014.tb00446.x. Full text in Research Archive Show summary

  Implementing ICTs in healthcare settings has proved to be very challenging such that progress towards widespread adoption and use of Electronic Medical Record (EMR) systems has been slow. The challenges of implementing these technologies have been described as complex, diverse, and locally situated. One of the challenging aspects of designing EMR systems is the need for inscribing standardised protocols whilst taking into account local work practices. Previous research has called for the need to balance work practices and protocols in the design of EMR systems. We present an attempt to balance the work practices and protocols in the development of an EMR system for antenatal care in a developing country, Malawi. This was done through implementing weak inscriptions of the protocols in some cases and strong inscriptions in other cases. The study highlights the important role that clients play in healthcare work and thus, influence the design of EMR systems.

• Chawani, Marlen Stacey; Kaasbøll, Jens & Finken, Sisse (2014). Stakeholder Participation in the development of an Electronic Medical Record system in Malawi. Proceedings of the Participatory Design Conference (PDC). ISSN 2150-5896. 1, p. 71–80. doi: 10.1145/2661435.2661444. Full text in Research Archive Show summary

  In this paper we are concerned with stakeholders’ participation in the development of an Electronic Medical Record (EMR) system for health facilities in Malawi, Africa. We draw on insights gained during the process of an Action Research project, which involved different stakeholders. We examine the different roles and forms of participation of these stakeholders. Through this, we illustrate how participation changes over time and coevolves with the progress of the project. Our analysis also reveals that, in rural low-resource settings, expected endusers of EMR systems do not always have the health domain knowledge or expertise to effectively participate in such design projects. Therefore, participation of managers and other health domain experts is essential in order to supplement users’ limited specialized knowledge of the domain.

• Kaasbøll, Jens Johan (2013). A Three-level Content Model of Learning IT Use. In Fallmyr, Terje; Bygstad, Bendik; Fog, Jørgen; Habib, Laurence; Munkvold, Bjørn Erik; Opdahl, Andreas Lothe & Sindre, Guttorm (Ed.), NOKOBIT 2013 : Universitetet i Stavanger 18. - 20. november 2013 : Norsk konferanse for organisasjoners bruk av informasjonsteknologi. Akademika forlag. ISSN 9788232103737. p. 173–188. Full text in Research Archive Show summary

  Super-users often get the responsibility of training and helping other users with learning revamped business systems. This requires the super-users to have competence for solving IT related problems. Studies have shown that good problem solvers work systematically, but little else is known about what super-user competence is or how it can be attained. Taxonomies for IT user learning have been suggested, but they do not seem to be built on theory and they miss competence areas. Also, the taxonomies do not indicate how to climb the competence ladder. Based on research from IS, library and information science, HCI, and school research, three subject matter areas of IT use competence are suggested; information, IT and the fit of IT in business. For each of these three contents areas, three competence levels are identified; skill, understanding and problem solving. The understanding level is often overlooked in documentation, training as well as research. An implication of the three level contents model is that conceptual models aimed at guiding understanding should be divided into functional models for understanding input-process-output and structural models for understanding data structures, technology principles, and business fit. The three level contents model also points to the need for research on training for problem solving.

• Pascoe, Luba; Lungo, Juma Hemed; Kaasbøll, Jens Johan & Koleleni, Ismael (2012). Collecting Integrated Disease Surveillance and Response Data through Mobile Phones. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2012 Conference Proceedings. International Information Management Corporation Limited. ISSN 9781905824342. p. 1–6. Full text in Research Archive Show summary

  This study focuses on improving the routine reporting of health data by identifying the challenges associated with timely reporting of routine data from the primary health facilities to the district and determines how mobile phones can be used to overcome the problem and thus enhance information use for action at all levels of the health system. Findings have indicated that, timely reporting of routine health data face challenges such as poor infrastructure, remoteness of the health facilities from the district where they have to submit their reports as well as transport costs that health workers have to incur in order to submit their report. Facing these challenges, this research revealed that the use of mobile phone application built in the District Health Information System database can provide an easy, cost effective and reliable means for reporting of health data. Over a period of 5 months, the data completeness and timeliness improved from 50% to 89%. This implies that the routine reporting of around ten data elements through mobile phones is feasible. The study recommends rigorous supervision, which among other things checks for data quality and correctness. Key words: Integrated Disease Surveillance and Response, Routine reporting of health data,

• Ngoma, Caroline Abdul; Kimaro, Honest Christopher; Igira, Faraja Teddy; Mukulu, John; Kaasbøll, Jens Johan & Yona, Alice [Show all 15 contributors for this article] (2012). Challenges in Implementing a Computerized Name-based Information Tracking System: Practical Experiences from Maternal Health Care. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2012 Conference Proceedings. International Information Management Corporation Limited. ISSN 9781905824342. p. 1–9. Full text in Research Archive Show summary

  This paper presents challenges encountered in implementing a computerized name-based system for tracking information of pregnant women and children in rural clinics. Results indicate that the implementation of a computerized name-based system faces potential challenges that include; understanding the complexity of local healthcare practices within the community as well as correlating standardised and improvised data collection tools used in health facilities. Other challenges are; application of localised and standardised procedures in healthcare provision, replacing the paper-based system and lastly gradual learning curve during the implementation. These are initial findings drawn from a qualitative research study conducted in the Coastal region of Tanzania. This study intends to improve data reporting and utilisation of health facility services for pregnant women, children and other key community members.

• Damtew, Zufan Abera; Moges, Amsalu Shiferaw & Kaasbøll, Jens Johan (2012). Revisiting the Quality of Health Extension Workers’ Training: Case study from Amhara Region, Ethiopia. Ethiopian Journal of Health Development. ISSN 1021-6790. 25(3), p. 201–205. Full text in Research Archive
• Klungland, Ingeborg M F & Kaasbøll, Jens Johan (2011). Non Governmental Organisations as Change Agents in Implementation of new Software in the Health Information System in Tanzanian Regions - Ways of Handling Conflicts. In Fallmyr, Terje (Eds.), Proceeding from Norsk konferanse for organisasjoners bruk av informasjonsteknologi, 2011. Tapir Akademisk Forlag. ISSN 9788251928458. p. 53–66. Full text in Research Archive Show summary

  There is currently an ongoing process in Tanzania to strengthen the health management information system of the country. A consortium of several partners, including the Clinton Health Access Initiative (CHAI) are engaged in implementing the District Health Information System (DHIS) software. The likely way forward for the DHIS to be implemented in all regions of the country is based on the support of external organizations like CHAI. A study of the project in two regions, Mtwara and Lindi, was carried out mainly by qualitative interviews. Main findings of this study indicate that although many efforts have been made, and positive outcomes have been reached, some challenges are still left for the project to face. Findings are analyzed through Heeks´s (2002) ITPOSMO-model for assessing gaps between the design of an information system and the reality where it is to be implemented. There are many actors involved in the implementation of the DHIS in Mtwara and Lindi, all with their own goals. All though many goals are legitimate, they are not all compatible, constituting conflicts. Galtung´s (2000) conflict theory is used as an extension of ITPOSMO model, and for analyzing findings related to the many actors involved in the process. A specific way of handling conflicts in such projects, based on Galtung (2000) is recommended.

• Mahundi, Masoud; Kaasbøll, Jens Johan & Twaakyondo, H.M (2011). Health Information Systems Integration in Tanzania: Tapping the Contextual Advantages. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2011 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824243. p. 1–11. Full text in Research Archive
• Damtew, Zufan Abera & Kaasbøll, Jens Johan (2011). Target Setting Procedures for Immunisation Services in Ethiopia: Discrepancies between Plans and Reality. Journal of Health Management. ISSN 0972-0634. 13(1), p. 39–58. doi: 10.1177/097206341001300103. Full text in Research Archive Show summary

  This study identifies the problems related with target setting for immunisation service in Ethiopia. We adopted qualitative case study and drew concepts from institutional theory to collect data and analyse our findings. The findings showed that the plan of district health offices depends on the population data projected from census. Peripheral level health workers, on the other hand, enumerate the number of population in their respective localities. Subsequently, the ambiguity occurs from mismatch between the target from census and number of eligible children counted by health workers. Health facilities are expected to follow the target given from district health offices, which is higher than the local count in most cases. Thus, we found most peripheral level health workers considered that the inflated target given from the projected census lowers their achievements, since their performance should be calculated against the given target. This in turn affects the incentive given, thus, has implication on job satisfaction and performance. The need of considering the reality at the ground, rather than following only the formal institutional rules is emphasised in order to address the identified impediments.

• Damtew, Zufan Abera; Kanjo, Chipo; Kaasbøll, Jens Johan & Williamson, Louisa Joan (2010). Using and sharing locally generated information for action: the case from three developing countries, IADIS International Conference Information Systems 2010. IADIS Press. ISSN 9789728939090. p. 85–93. Full text in Research Archive Show summary

  This paper argues that locally generated information is crucial in the work practices of health managers at all levels in the developing country context. Using case studies conducted independently in Ethiopia, Malawi and South Africa, the use and significance of local knowledge is analysed. We draw on concepts from knowledge literature and an interpretive approach to illustrate the importance of locally generated information and knowledge in the three contexts. We compare and contrast how low level health managers operate, their actions, practices, how they handle and utilise the locally generated information and knowledge for the benefit of the system. Our study shows that low level health managers tend to know their population. This implies knowing the different villages, communities, households or even patients in their clinics and their practices. This local knowledge is what they base their managerial work on. We suggest that this knowledge be formalized and used as input for district and higher levels to make planning and resource allocation. We emphasize the importance of deriving information for action in health using a bottom-up approach.

• Kaasbøll, Jens Johan; Galimoto, Marlen Stacey; Hamre, Gro Alice & Sandvand, Jon (2010). Competencies and Learning for Management Information Systems. Journal of Information, Information Technology, and Organizations. ISSN 1557-1319. 5, p. 85–100. Full text in Research Archive Show summary

  Previous research has established that users need competence in both computing and the context of the software. Information systems often fail due to low competence amongst users, and no study is known to provide a systematic account of the user competence needed. This research concerns competence needs amongst prospective users of a computerised management information system where there is no operational computer based IS from which to obtain data. The study shows that three subject matter areas of user competence are needed for people who will use computerised IS -- knowledge on how the domain is represented, work competence, and computer literacy. Work competence is mainly practice based, while the domain related knowledge and computer literacy are based on explicit concepts, grounded in science or technology. User training should therefore start with practice in the case of work competence, while presentation of principles, concepts, and structures would constitute a better starting point when teaching computer literacy and how the domain is represented

• Williamson, Louisa Joan & Kaasbøll, Jens Johan (2009). Health Information and Managerial Work: Exploring the Link. In Byrne, Elaine; Nicholson, Brian & Salem, Fadi (Ed.), Assessing the Contribution of ICT to Development Goals. Dubai School of Government and International Federation for Information Processing. ISSN 9780903808057. p. 291–304. Full text in Research Archive Show summary

  Health information systems are tools to support management. Responsible for service implementation; yet tasked with monitoring performance of service delivery; PHC facility manager cadres lack the authority to take decisions about change in practices. It is thus relevant to explore the nature of management work at this functional level and how this work links to the information system created to support management processes. Three key questions were asked: what is the role of these managers; what is the context within which information is used; and, what information is relevant to support management practices. Within common core management tasks, a range of management roles were identified. These were largely utilised in processing information about operational issues that impact on service delivery. As in related empirical studies on management work, the findings revealed a high dependency on soft data obtained from informal information systems rather than that of the formal system; an information mismatch. Future challenges involve discussion on how to align this information mismatch.

• Damtew, Zufan Abera; Kaasbøll, Jens Johan & Williamson, Louisa Joan (2009). From information for decision making to information for keeping core knowledge updated – health managers who know their population. In Byrne, Elaine; Nicholson, Brian & Salem, Fadi (Ed.), Assessing the Contribution of ICT to Development Goals. Dubai School of Government and International Federation for Information Processing. ISSN 9780903808057. p. 381–388. Full text in Research Archive Show summary

  This study pointed out how health information is gained and applied for action. Computer support for health management consists of reports of health indicators, which are supposed to be used for deciding upon changes in the health services. Qualitative case studies of low level health managers of two developing countries, on the other hand, showed that instead of checking such information when decisions are made, health managers rather tend to “know their population and other health related issues” which means knowing the different villages, communities, households or even patients in small clinics. This tacit knowledge is what they base their managerial work on. Having such a conceptualisation of their prime tacit knowledge corresponds to findings from other practices. This embedded knowledge is developed through accumulation of learning from their routine practices and their close interaction with the community. Besides, geographical information stricture was implemented. This local knowledge can also be used by district and other higher health managers for different purposes.

• Kanjo, Chipo & Kaasbøll, Jens Johan (2009). Rules, Reality and Results: Inter-Institutional Coordination and Impact on Health Information Systems in Developing Countries. In Molka-Danielsen, Judith (Eds.), Proceedings of the 32nd Information Systems Research Seminar in Scandinavia, IRIS 32, Inclusive Design. Høgskolen i Molde - Vitenskapelig høgskole i logistikk. ISSN 9788279621201. Full text in Research Archive Show summary

  In the health organisation field, weak or lack of coordination between different players leads to inefficiency in the whole health information system. The Malawi health sector is no exception. It has a plurality of health service providers, as is the case in most low income countries, and these providers are separated into the traditional and modern sectors (ADF, 2005). The traditional health providers are considered as the informal health providers. This paper aims to identify the extent which the informal and formal health providers coordinate and how much information from the informal health providers, with specific focus on the traditional birth attendants, is integrated into the health management information system (HMIS). This will take into consideration the existing rules in the health care system and the reality on the ground in the rural areas. While the existing rules ban the operations of traditional birth attendants (TBAs), the masses see the TBAs as being responsive to their needs. This results in weak links in the HMIS as some information which could have been captured from the TBAs end up being missed as they fear to report data due to the set rules.

• Lagebo, Birkinesh Woldeyohannes & Kaasbøll, Jens Johan (2009). Lessons learned from Local Videoconferencing Tool for Training Health Staff. In Molka-Danielsen, Judith (Eds.), Proceedings of the 32nd Information Systems Research Seminar in Scandinavia, IRIS 32, Inclusive Design. Høgskolen i Molde - Vitenskapelig høgskole i logistikk. ISSN 9788279621201. p. 1–18. Full text in Research Archive Show summary

  Videoconferencing technology was used to train around 5000 health extension workers who reside at different places of the Oromia region, in Ethiopia. Case study is employed to identify challenges and opportunities of using the local videoconferencing tool for training health extension workers and take lessons to apply the tool for health management information system (HMIS) training. The vastness of the country with poor transportation facility made the video conferencing tool suitable for health workers‟ training in Ethiopia. The tool reduced some of the traditional class room based training problems such as time and fund constraint, and shortage of trainers. The absence of IT professional to handle the videoconferencing tool in some woredas(district) made the videoconferencing tool idle. The negative attitude of the woreda people towards the tool in relation to the per diem issue made them reluctant to provide support for the infrastructure. As a result the videoconferencing tool became non functional due to lack of minor accessories.

• Williamson, Louisa Joan; Kaasbøll, Jens Johan; Braa, Jørn & Sun, Violeta (2008). South-South collaboration: adapting information systems integration strategies in Namibia. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2008 Conference Proceedings. International Information Management Corporation Limited. ISSN 9781905824076. Full text in Research Archive Show summary

  The research tests the feasibility of an information systems integration strategy within the Namibian health care system. Early findings suggest that the transfer of ‘best practices’ may be inappropriate in different country contexts, or that previously considered ‘best practices’ are less than optimal. The adaptation process builds on a South-Africa - Namibia collaboration of sharing practices, experiences and expertise. The role of South-South collaboration in supporting adaptation interventions in offering opportunities to explore both feasibility and appropriateness of potential interventions is addressed. The finding emphasizes the usefulness of extending joint knowledge on how to develop information systems in the health sectors of African and Asian countries.

• Damtew, Zufan Abera & Kaasbøll, Jens Johan (2008). Working towards precise and ambiguous targets: - the challenge for Health Extension Workers of Ethiopia. In Asproth, Viveca (Eds.), Proceedings of IRIS 31. The IRIS association. ISSN 9789186073121. Full text in Research Archive Show summary

  Immunization is one of the strategies designed to reduce mortality and morbidity of children. The health care system of Ethiopia concentrates its effort in order to ensure full immunization of all eligible children with national goal of 90% coverage. However, the planning system for immunization has drawbacks because of the ambiguity arising from the targets. Drawing from the institutional theory, we studied the problem associated with target setting. The plan of district health offices depend on the population data projected from census. Health extension workers, on the other hand, enumerate the number of population in their respective localities. Subsequently, the ambiguity occurs from mismatch between the target from census and the number of eligible children counted by health workers. In practice, they are expected to follow the target given from district health offices, which is high in most cases. Thus, we found that most peripheral health workers considered as the inflated target given from their higher level lowers their achievements. This in turn affects the incentive given, thus, has implication on job satisfaction and performance. The need of considering the reality at the ground, rather than following only the formal institutional rules is emphasised in order to address the identified impediments.

• Hamre, Gro Alice & Kaasbøll, Jens Johan (2008). Motivation and Demotivation: a Case Study of the Malawian Health Management Information System. Electronic Journal of Health Informatics. 3(2), p. 1–11. Full text in Research Archive Show summary

  This paper addresses the problems of utilisation of health management information systems (HMIS) in developing countries due to the critical shortage of qualified and motivated human resources. The study employed qualitative research methods in an interpretive in-depth case study, and the study was carried out in two districts in Malawi. Analyses are based on motivational theory and the six categories of good and bad critical motivational incidents defined by Machungwa and Schmitt [1]. Gasser’s [20] theory of integration of computing and routine work was applied to address the secondary, and supportive, nature of HMIS computing work. This research suggests that motivational items identified by Machungwa and Schmitt [1] are chiefly relevant to the Malawian context, but since the HMIS work is of a secondary type compared to core health activities, the work motivation that comes from work itself has little motivating effects. Supervision visits and a recognition scheme were social arenas which motivated the health workers.

• Ngoma, Caroline; Kaasbøll, Jens Johan & Aanestad, Margunn (2008). From User Training to In-Service Support. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2008 Conference Proceedings. International Information Management Corporation Limited. ISSN 9781905824076. p. 1–11. Full text in Research Archive
• Samuelsen, Terje & Kaasbøll, Jens Johan (2007). Hvordan veiledning kan bidra til problemløsning og begrepsbygging innenfor objekt-orientert programmering. In Sandnes, Frode Eika (Eds.), Norsk informatikkonferanse NIK 2007. Tapir Akademisk Forlag. ISSN 9788251922722. Full text in Research Archive
• Stamatova, Elena Ivanova & Kaasbøll, Jens Johan (2007). Users’ Learning of Principles of Computer Operations. Issues in Informing Science and Information Technology (IISIT). ISSN 1547-5840. 4, p. 291–306. Full text in Research Archive
• Samuelsen, Terje & Kaasbøll, Jens (2007). Hvordan veiledning kan bidra til problemløsing og begrepsbygging innenfor objektorientert programmering, NIK 2007 : Norsk informatikkonferanse. Tapir Akademisk Forlag. p. 87–96. Full text in Research Archive Show summary

  Selv om det har vokst fram en oppfatning om at studenter lærer programmering på laben og ikke i auditoriet, så vet vi lite om hvordan labveiledning bør foregå. I denne studien prøves det ut en alternativ måte å veilede på. Metoden er hentet fra Schoenfeld [13] for bruk i matematikken, der veilederen stiller 3 spørsmål som skal få studentene til å reflektere over sin framgangsmåte. Hos oss førte dette til at studentene raskt lærte å løse programmeringsproblemer og klarte å anvende objektorienterte begreper. Til forskjell fra tidligere forskning ble studentene raskt fortrolige med veiledningsformen.

• Kaasbøll, Jens Johan (2006). The learners’ environment in OO first: implications for sequence of teaching and tools. In Rong, Chunming & Løkketangen, Arne (Ed.), NIK'2006 : Norsk informatikkonferanse. Tapir Akademisk Forlag. ISSN 9788251921862. p. 167–176. Full text in Research Archive

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• Duc, Anh Nguyen; Eikebrokk, Tom Roar; Johannessen, Trond Vegard; Karlsen, Anniken Th; Kaasbøll, Jens Johan & Toussaint, Pieter Jelle (2019). Vol. 27 No. 1 (2019): Proceedings from the annual NOKOBIT conference held in Narvik 26-27 November 2019. NOKOBIT/OJS Norge. Full text in Research Archive Show summary

  Siden 1993 har NOKOBIT vært en nasjonal konferanse innen informasjonsvitenskap/informasjonssystemer. Den tar opp aktuelle temaer knyttet til utvikling, implementering og bruk av IKT i organisasjoner, samt samfunnsmessige problemstillinger ved IKT. Alle artikkelbidrag går gjennom blind-review. Aksepterte bidrag blir publisert og er meritterende på nivå 1.

• Rolland, Knut-H.; Kaasbøll, Jens Johan; Karlsen, Anniken Th; Eikebrokk, Tom Roar & Netteland, Grete (2018). Vol. 26 No. 1 (2018): Proceedings from the annual NOKOBIT conference held at Svalbard the 18th-20th of September 2018. NOKOBIT/OJS Norge. Full text in Research Archive Show summary

  Siden 1993 har NOKOBIT vært en nasjonal konferanse innen informasjonsvitenskap/informasjonssystemer. Den tar opp aktuelle temaer knyttet til utvikling, implementering og bruk av IKT i organisasjoner, samt samfunnsmessige problemstillinger ved IKT. Alle artikkelbidrag går gjennom blind-review. Aksepterte bidrag blir publisert og er meritterende på nivå 1.

• Rolland, Knut-Helge Ronæs; Netteland, Grete; Kaasbøll, Jens Johan; Karlsen, Anniken Th & Eikebrokk, Tom Roar (2017). Proceedings from the annual NOKOBIT (&UDIT) conference held in Oslo the 27th-29th of November 2017. NOKOBIT/OJS Norge. Full text in Research Archive Show summary

  NOKOBIT (Norsk Konferanse om Organisasjoners Bruk av IT) er en etablert nasjonal konferanse for formidling av forskningsresultater rundt informasjonsteknologi i en organisatorisk sammenheng. Proceedings inneholder 18 fagfellevurderte artikler som ble presentert på NOKOBIT i Oslo 27.-29. november 2017. Vi mottok i utgangspunktet 24 innsendte bidrag, og etter fagfellevurdering ble 18 artikler valg ut til publisering i dette tidsskriftet. Nummeret inneholder også 6 av artiklene som ble presentert på UDIT, en samlokalisert konferanse om Utdanning og Didaktikk i IT-fag. Samlet mottok UDIT 17 bidrag og publiserer 11. Disse bidragene ble fagfellevurdert av en egen programkomite for UDIT. UDIT har også denne gangen 3 korte praksisbidrag som ikke har vært gjennom fagfellevurdering, men som har blitt godkjent av redaksjonskomité. Øvrige bidrag på UDIT ble publisert i tidsskriftet til NIK. NOKOBIT’s redaksjonskomité ønsker å gi en spesiell takk til den lokale arrangementskomiteen ved Westerdals Oslo ACT: Siri Fagernes, Tor-Morten Grønli, Knut H. Rolland og Wanda Presthus. Samt Andreas Biørn-Hansen, som har bidratt sterkt med tilrettelegging av websider og annet praktisk håndverk. Redaksjonskomité for tidsskriftet i 2017, har bestått av • Knut Helge Rolland, Universitetet i Oslo • Grete Netteland, Høgskolen i Sogn og Fjordane • Jens Kaasbøll, Universitetet i Oslo • Anniken Karlsen, NTNU • Tom Roar Eikebrokk, Universitetet i Agder

• Sindre, Guttorm; Eikebrokk, Tom Roar; Karlsen, Anniken Th; Kaasbøll, Jens Johan; Netteland, Grete & Opdahl, Andreas Lothe [Show all 7 contributors for this article] (2016). NOKOBIT - Norsk konferanse for organisasjoners bruk av informasjonsteknologi, Proceedings fra NOKOBIT 2016, Bergen, 29.-30. november 2016. NOKOBIT/OJS Norge. Full text in Research Archive
• Sindre, Guttorm; Fog, Jørgen; Kaasbøll, Jens Johan; Netteland, Grete; Opdahl, Andreas Lothe & Munkvold, Bjørn Erik [Show all 7 contributors for this article] (2015). NOKOBIT - Norsk konferanse for organisasjoners bruk av informasjonsteknologi, Proceedings fra NOKOBIT 2015, Ålesund, 24.-25. november 2015. NOKOBIT/OJS Norge. Full text in Research Archive
• Fallmyr, Terje; Fog, Jørgen; Kaasbøll, Jens; Netteland, Grete; Opdahl, Andreas Lothe & Munkvold, Bjørn Erik [Show all 7 contributors for this article] (2014). NOKOBIT 2014, Norsk konferanse for organisasjoners bruk av informasjonsteknologi, Høgskolen i Østfold 17 - 19. november 2014. Norsk konferanse for organisasjoners bruk av informasjonsteknologi. ISBN 9788251928458. 255 p. Full text in Research Archive

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• Øgland, Petter & Kaasbøll, Jens Johan (2026). Using the Viable System Model to Make Organisational Action Research More Sustainable. Full text in Research Archive Show summary

  Organisational action research frequently struggles to achieve sustainability beyond specific projects, individuals, or institutional conditions. Such failures are commonly attributed to contextual factors including organisational politics, leadership change, or lack of management commitment. This paper argues that these explanations are incomplete, as recurring breakdowns also reflect limitations in how action research methodologies themselves conceptualise organisational viability. Focusing on the Networks of Action (NOA) approach and its foundation in the bootstrap algorithm (BA), the paper examines why NOA-based initiatives have achieved long-term sustainability within the Health Information Systems Programme (HISP) while similar attempts elsewhere have repeatedly failed. Drawing on Stafford Beer’s Viable System Model (VSM), the paper re-articulates NOA as a viable organisational system in its own right, making explicit the functions of coordination, control, development, and identity that remain implicit in the original bootstrap formulation. Through a retrospective re-analysis of a failed action research initiative in public administration, the study demonstrates how sustainability problems can be understood as deficiencies in systemic design rather than contextual misfortune. The contribution is a VSM-based BA for NOA development: the paper reframes action research sustainability as a problem of organisational viability and shows how organisational cybernetics can complement existing socio-technical approaches by providing design principles for more sustainable Networks of Action.

• Kaasbøll, Jens Johan (2021). Hva kan Norge lære om eHelse fra lavinntektsland? Full text in Research Archive Show summary

  https://www.youtube.com/watch?v=D1XskFsP6i0&list=PLnJR1cwhRTrMYAu7JOKD9q9vBJ-b2Rxqr&index=46

• Kanjo, Chipo; Hara, Joshua & Kaasbøll, Jens Johan (2019). Digital Empowerment for Health Workers and Implications on EMRs Utilisation. Full text in Research Archive
• Ayebazibwe, Immaculate; Kimaro, Honest Christopher & Kaasbøll, Jens Johan (2019). System Use And User Satisfaction In The Adoption Of Electronic Medical Records Systems: A Case Of Dhis2 Tracker Implementation In Tanzania. Full text in Research Archive
• Kaasbøll, Jens Johan; Kanjo, Chipo & Kimaro, Honest Christopher (2019). Building Sustainable Collaborations and Academic Networks in Low Income Countries: Case of Master Programmes. Full text in Research Archive
• Amrit, Chhetri; Iversen, Mari; Kaasbøll, Jens Johan & Kanjo, Chipo (2019). Evaluating mHealth Apps: From Front-End Usability to Three Front-Ends and one Back-End Affordance. Full text in Research Archive
• Kanjo, Chipo; Msiska, Brown Chawanangwa & Kaasbøll, Jens Johan (2018). Complimenting DHIS2 Tracker browser app with medical sensors for maternal health care delivery. Full text in Research Archive
• Kaasbøll, Jens Johan; Kanjo, Chipo & Kimaro, Honest Christopher (2018). Sustainable Health Informatics Master Programmes In Low And Middle Income Countries. Full text in Research Archive Show summary

  We present the process, outcomes and lessons learnt in sustaining Master Programmes implemented across a number of low and middle-income countries in collaboration with the University of Oslo (UiO) where the Health Information System Programme (HISP) is hosted. UiO has been engaged in supporting health information systems in developing countries for two decades. One necessary component has been educating health informatics specialists, of which research education was deemed necessary. This led to introduction of 9 Master programmes in 6 countries between 2001–2014. STRATEGIES AND CHALLENGES The programmes have gone through three stages: 1) planning and application for funds; 2) implementation with project funding; 3) continued implementation after project closure. The three stages and the assessment of programme outcomes were guided by the Collaborative Governance Model. 1. STRATEGY FOR BUILDING LOCAL COMPETENCE A strategy was devised to have lecturers from UiO and other partners teaching and supervising in the programmes together with local lecturers at the start of Stage 2 and phasing out the international support when the local lecturers could take over. Some lecturers from the partner universities would at the same time be enrolled in PhD studies at UiO to build their capacity. A number of thesis supervisors were recruited from local organisations to reduce the burden of the faculty members and to broaden the scope of topics. This plan worked until there were local lecturers with sufficient background to take over the courses. In some instances, the locals were not up to it, and these course modules were thus abandoned in Stage 3. 2. CHALLENGES The planning Stage (1) encountered two main challenges; lack of local competence to run the programmes, and challenge with funding after the initial support ceased. In Stage 2, two other challenges surfaced; where it was noted that students were not having time for thesis work and another hiccup was the locals being overburdened by both trying to teach in the master programme whilst doing their own PhD. Since teaching is a short horizon activity, this was often prioritized, and the PhD was consequently delayed. Fortunately, UiO could extend their PhD scholarship (Norwegian State Educational Loan Fund rates, not salaries) until they completed. When Stage 3 arrived, enough local competence had been built to continue the teaching. UiO staff have contributed in supervising a few master students of mutual interest in Stage 3. 3. SUSTAINED FUNDING The initial funding covered salaries for partner university staff, scholarships for 4-8 students per cohort and running costs, including UiO staff travels. The partner universities needed 15-20 tuition fee paying students per cohort for sustainable funding in Stage 3. To achieve sufficient number of applicants, the partner universities had a deliberate strategy where they announced the programmes with tuition fees from the start of the project. The number of applicants were around twice the number of scholarships, hence the universities received additional income from the start of Stage 2. The students and graduates spread information about the programmes through word of mouth, and this has secured the number of fee paying students after the initial funding ceased. 4. FULL TIME WORKING STUDENTS Nearly all students enrolled work full time, and have immediate and extended families take care of. Coursework force most of them into a structured setting such that they pass their exams. Finding time needed for concentrating on thesis writing has been difficult and impossible for some students. Completion time is therefore extended in some cases up to four years and a significant portion of the students only end up with a diploma confirming their coursework. One way of improving completion has been to organize one week thesis workshops where the students work intensively, discuss with each other and with supervisors. Additional retreats

• Kanjo, Chipo; Msiska, Brown Chawanangwa & Kaasbøll, Jens Johan (2018). Complimenting DHIS2 Tracker browser app with medical sensors for maternal health care delivery. Full text in Research Archive Show summary

  The EU Horizon funded project mHealth4Afrika (2015-2019) aimed at developing a system to support quality community-based primary maternal healthcare delivery at semi-urban, rural and deep rural clinics for 4 African countries; Ethiopia, Kenya, Malawi and South Africa. In its initial phase, mHealth4Afrika developed an antenatal care system only. Currently, it has been expanded to all reproductive health services (maternity, postnatal, and under five). Other than the timely capturing of data and systematic storage of important data points in the patient electronic record; mHealth4Afrika utilises sensors. The sensors are used to identify non-communicable diseases (hypertension, diabetes) at the point of care and facilitate triage (not currently practiced at clinic level). mHealth4Afrika therefore contributes with a custom browser app and sensors. Unlike the standard Tracker Capture app, the mHealth4Afrika app has a user interface adapted to the workers in health clinics. The app has been developed by the University of Malawi and Nelson Mandela University. A basic design feature of DHIS2 is a separation between input and output. Input is done in a data capture app, and output is presented in reports apps and the dashboard the next day, after the system has run analytics during the night. Much as the separation of input and output works for routine reporting, point-of-care systems require patient outputs to be displayed immediately. The alerts and other program rules provide some output at the data entry screen, but display of graphs and other visuals are to be done with separate apps. Point-of-care systems need a user interface more like a spreadsheet than that of searching and retrieving. The mHealth4Afrika app mixes input and output, eg, displaying oxygen saturation (SpO2) and pulse rate While there is a general shortage of medical equipment in resource poor settings, some sensors are reasonably priced and useful for maternal health. The sensors as shown in fig 3 have been identified for use: Visiomed sensors for blood pressure, Oximeter (foxygen and pulse rate), and temperature. The sensors uploads data to an Android app, which forwards the data to the DHIS2 through its API.

• Tronerud, Kristoffer; Vassbotten, Martin Theodor; Kaasbøll, Jens Johan & Sæbø, Johan Ivar (2017). Usability for novices and experts: A layered design in a case study in Malawi. In Cunningham, Paul & Cunningham, Miriam (Ed.), IST-Africa 2017 Conference Proceedings. IIMC International Information Management Corporation. ISSN 9781905824564. p. 1–9. doi: 10.23919/ISTAFRICA.2017.8102298. Full text in Research Archive Show summary

  This paper presents initial findings from a project in Malawi to develop and implement a simple application for making league tables in the health sector. League tables, sometimes also called scorecards, are tables that compare various entities according to several indicators, and rank them from best to worst performers. Prior work in Malawi has suggested that these tables would be useful at both national and local levels, and should therefore be customizable so that different users can make their own tables, based on the health indicators of their choice. A main finding from this project is that usability and learnability for novice users must be balanced against the request for more advanced features from expert users. This was achieved through designing the app with a novice and an expert layer. The expert layer concerned configuration of the league tables. Configuration or customization is a general functionality in many applications and may thus be segregated in an expert layer.

• Kaasbøll, Jens (2014). Implementation and implementation research in District Health Informatics. Full text in Research Archive
• Kaasbøll, Jens (2014). Evaluation of longitudinal processes consisting of many projects. Full text in Research Archive
• Saugene, Zeferino & Kaasbøll, Jens (2014). Foregrounding invisible work practices: The customization of generic software systems. Full text in Research Archive
• Shidende, Nima Herman; Chawani, Marlen Stacey & Kaasbøll, Jens (2014). Challenges in participation and implications on human development: Experiences from Health Information Systems implementations in Tanzania and Malawi. Full text in Research Archive
• Kanjo, Chipo & Kaasbøll, Jens Johan (2011). Data, Information, and Knowledge: The Greatest of All is Knowledge. Full text in Research Archive
• Chawani, Marlen Stacey; Mwakilama, Shawo; Kanjo, Chipo & Kaasbøll, Jens Johan (2011). A SCRUTINY OF THE INTEGRATION STATUS AND STANDARDIZATION PROCESS OF ELECTRONIC MEDICAL RECORD SYSTEMS IN MALAWI. Full text in Research Archive Show summary

  Achieving integration remains a challenge in many developed countries partly attributed to the presence of many different EMR systems which makes standardization and achieving interoperability a difficult and complex undertaking. Unfortunately, there is a lack of literature on whether and how developing countries in Africa are addressing issues related to integration of EMRs in their HIS agendas. A study was therefore conducted to assess the integration status, efforts and strategies in the implementation of EMR systems in Malawi in order to identify integration strategies and processes appropriate for the Malawian context. Thus, this paper presents the integration status and standardization efforts in Malawi and makes recommendations on how to progress towards standardization.

• Kanjo, Chipo & Kaasbøll, Jens Johan (2011). Influence of Information Generated from Traditional Practices on Health Information Systems. Full text in Research Archive
• Kaasbøll, Jens Johan (2009). Integration and scaling of health information systems to strengthen vaccination services delivery in India. Full text in Research Archive
• Galimoto, Marlen Stacey; Kaasbøll, Jens Johan; Hamre, Gro Alice & Sandvand, Jon (2008). Competencies and learning for management information systems – the case of a health information system in Malaŵi. Full text in Research Archive Show summary

  Previous research has established that users need competence in both computing and the context of the software. Information systems often fail due to low competence amongst users, and no study is known to provide a systematic account of the user competence needed. This research concerns competence needs amongst users of a management information system where there is no operational IS from which to obtain data for the MIS. The study shows that three subject matter areas of user competence are needed for IS, domain knowledge, work competence and computer literacy, and numeracy is a fourth area needed for MIS. Nonaka’s (1994) model of organisational learning distinguishes between tacit competence learnt through internalisation and socialisation and explicit knowledge developed through externalisation and combination. Work competence, being management in this case, is basically tacit competence, while domain knowledge, computer literacy and numeracy are based on explicit concepts. User training should therefore start with practice in the case of work competence and presentation of concepts in the three other subject matter areas.

• Mørch, Anders Irving; Nygård, Kathrine Amundsen; Kaasbøll, Jens Johan & Mushtaq, Shazia (2008). Multiple Design Techniques for Participatory and Evolutionary Design. Full text in Research Archive
• Lagebo, Birkinesh & Kaasbøll, Jens Johan (2007). ICT solutions for human resource capacity building in the Health Sector: case Ethiopia. Full text in Research Archive
• Samuelsen, Terje & Kaasbøll, Jens (2007). Hvordan veiledning kan bidra til problemløsing og begrepsbygging innenfor objektorientert programmering. Full text in Research Archive
• Kaasbøll, Jens Johan & Lagebo, Birkinesh Woldeyohannes (2006). Factors Influencing User Training and Possible Strategies to Remove Obstacles. Full text in Research Archive
• Kaasbøll, Jens Johan; Monteiro, Eric & Asah, Flora Nah (2021). Challenges and Approaches of Implementing Standard Health Indicators in Hierarchical Organizations: A multisited study. Universitetet i Oslo. Full text in Research Archive Show summary

  This thesis explores challenges associated with implementing standard health indicators in hierarchical organizations, and which approaches can be employed to mitigate these challenges. Hierarchical organizations are entrenched in fragmented healthcare system, coupled with fragmented information systems, and multiple stakeholders and partners with different views and perspective, a common scenario for low and middle-income countries (LMIC). The study was guided by a main research question and two sub-research questions: What challenges are associated with implementing standard health indicators in hierarchical organizations, and which approaches can be employed to mitigate these challenges? Sub-RQ1: What are the challenges associated with implementing standard health indicators in hierarchical organizations? Sub-RQ2: What approaches could be employed to mitigate the challenges of implementing standard health indicators in hierarchical organizations? The research was qualitative, interpretative, and multi-sited study, in three empirical sites – Cameroon, Ghana, and South Africa. However, the study in Cameroon laid the foundation for this study, and the findings from Cameroon influenced the selection of the other two sites. Mixed methods were used to collect data, and the study applied both qualitative and quantitative data analysis methods. Data analysis was done when writing individual papers and writing the thesis, which followed five key steps; preliminary data analysis, preparing and familiarizing oneself with data, coding, creating categories, and identifying themes. The findings showed that although implementing standard health indicators is one of the strategies to curb fragmented information systems, the process is embedded in several challenges, which hinder the generation and eventually the use of data to support decision-making, particularly among staff at the peripheral level in hierarchical and centralized organizations. This thesis contributed to developing a new analytical framework to understanding the challenges associated in implementing standard health indicators in hierarchical and centralized organizations. The thesis builds on the rich understanding of boundary objects to discuss and outline approaches that could help resolve different opinions, interests, and opinions among the different partners and stakeholder involved in IS/HIS in the healthcare domain. The thesis contributed to IS training literature by demonstrating the capabilities of Community of Practices (CoP) in building local capacity. Practically, the thesis adopted and extended the concepts of CoP by providing measures to building local capacity on HIS.

• Landén, Esther Namatovu & Kaasbøll, Jens Johan (2019). MHealth systems, Transformations in Work and Implications for Sustainability. Universitetet i Oslo. Full text in Research Archive Show summary

  There is an immense proliferation in mobile health innovations in healthcare, also referred to as mHealth systems. These innovations have taken root in developing countries with ambitions to revamp healthcare service provision through mobile technologies that are a cheaper alternative, widely used and reach a clear majority of regions in the developing world. However, the ambitious benefits associated with mHealth implementations have proven difficult to achieve and the mHealth systems, difficult to sustain. Without sustainability, there is no optimization of the potential benefits of mHealth systems and failures impact already weak Health Information Systems in these contexts. This thesis is positioned within the Information and Communication Technology for Development (ICT4D) field that has indicated sustainability as both hard to actualize and conceptualize. The thesis develops a refined understanding of mHealth sustainability by using material from two interpretive case studies in Uganda and Malawi. In Uganda, the mHealth system was designed to support weekly reporting on maternal and Infant health data and was rolled out to Village Health Teams in over ten districts. The Case in Malawi was designed for decision support and rolled out to Health Surveillance Assistants in two districts. Through this work, the thesis proposes a reorientation of the way the concept of sustainability is dealt with by positioning work practices as an integral part of the concept. mHealth sustainability in this thesis is translated into a need to understand work transformations that occur in the work practices of community health workers. The thesis draws inferences from these transformations to identify how local sustainability is achieved and then broadly links local sustainability to the health system organization by identifying organization structures that should be in place to maintain both the mHealth systems and the work practices they support. This work contributes to literature concerning Information Technology for Development by uncovering micro-level based social activities and how they generate reinventions in work and the technology to sustain mHealth solutions. The thesis also contributes by further linking work transformations to broader health system organizational structures of sustainability. By linking local practices to broader organizational structures, the thesis also makes practical contributions to health providers and policy makers by deemphasizing controlled approaches to mHealth systems development and implementation to enabling more open strategies that accommodate learning to identify locally relevant solutions. This can guide policy to make corresponding modifications in the organization structures to sustain mHealth initiatives.

• Øgland, Petter; Kaasbøll, Jens; Henfridsson, Ola & Bratthall, Lars (2013). Mechanism design for total quality management: Using the bootstrap algorithm for changing the control game. Akademika forlag. Full text in Research Archive Show summary

  As society continues to develop in technological ways, side-effects of yesterday’s solutions are becoming today’s problems and systems tend to fail in increasingly spectacular ways. The more severe the consequences of organisational failure are, the greater is the need for approaches like total quality management (TQM) to control the organisation from a holistic perspective, but to design and implement optimal control can be difficult, and about 80% of all TQM implementation projects tend to fail. High failure rates in environments characterised by technological complexity and social distrust can be understood through game theory. Management and workforce are involved in a control game, and the TQM designer is playing a game with the organisation as a whole in trying to change the economic mechanisms that define the control game. The goal is to design mechanisms that make the control game align with TQM philosophy, but the easiest and most stable solution to this game often end up being both TQM designer and organisation developing policies and quality systems while forgetting to implement or only pretending to do so. By thinking more widely about the quality management system supporting the TQM policy as information infrastructure (II), however, and making use of the Monopoly game model for understanding the growth and development of II, the II design strategy known as the bootstrap algorithm (BA) becomes an interesting option to explore. The hypothesis in this study is that the BA is an optimal strategy for gradually changing the game in a manner that will lead to sustainable TQM at the highest level of excellence. The claim is analysed by looking at twenty years of information systems action research that involves three Norwegian public sector organisations. The outcome of research reports experiences in BA design using Total Systems Intervention (TSI) implementation methodology. Although the research focuses on challenges and weaknesses in the practical BA designs, resulting in problems and partial failures in TQM implementation, the outcome supports the BA hypothesis. The analysis is based on considering three levels of gameplay. On the shop floor level, an audit game is played out between the TQM auditor and IT personnel. The “what gets measured gets done” motivational theory is a key to success for TQM implementation on this level, but depends on having established management commitment by winning the trust game on higher organisational levels. As the trust game is not a single-shot game, various techniques have to be used to gain trust in various situations for various elapses of time. Different game models are introduced and discussed for elaborating useful ways of thinking about different conflicts and challenges. The highest level of gameplay is the mechanism design game where the TQM designer fights the resistance of the organisation by trying to change the strategy sets and payoffs of the trust game and audit game in order to increase the basis of attraction for the game equilibrium that suggests walking the TQM talk and reducing the basis of attraction for TQM talk without walk. The research makes contributions to II/BA and TSI theory through the Monopoly model of II dynamics, the reformulation of the BA as a genetic algorithm, and by suggesting game theory as an overall theoretical framework for TSI action research. The implications for practice are reduced failure rates for TQM implementation.

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