Applying PEST analysis to evaluate the adoption of electronic health records in Tanzanian healthcare: A scoping review

Background

Adopting electronic health records (EHR) is critical for improving healthcare efficiency, yet implementation remains inconsistent, particularly in developing countries. This study applies a scoping review approach to evaluate the macro-environmental factors influencing EHR adoption in Tanzania using the PEST (Political, Economic, Social, and Technological) analysis framework.

Objectives

This study explores the adoption of EHR systems in Tanzanian healthcare using the PEST analysis framework to identify macro-environmental factors influencing implementation.

Methods

A scoping review methodology was employed, examining 35 studies published between 2010 and 2024. A comprehensive search was conducted in Scopus, PubMed, JSTOR, and Emerald. Reference lists of relevant studies were also reviewed for additional sources. Data were systematically extracted using a standardised framework categorising studies under political, economic, social, and technological domains. Thematic synthesis was applied to identify key patterns.

Results

The review included 35 studies, highlighting that political inconsistencies, economic constraints, social resistance, and technological limitations hinder EHR adoption. Key barriers include weak policy enforcement, unsustainable funding, workforce resistance, and poor ICT infrastructure. However, potential solutions such as strengthening governance frameworks, leveraging public-private partnerships, targeted digital literacy training, and improving ICT infrastructure were identified.

Conclusion

This study provides valuable insights into the macro-environmental challenges affecting the adoption of EHR systems in Tanzania. Addressing these barriers through a comprehensive policy and infrastructure development strategy is critical to ensuring successful digital health transformation.

Association between workplace health promotion service utilisation and depressive symptoms among workers: a nationwide survey

OBJECTIVES

Workplace-related factors are associated with the risk of depression. Despite implementation of workplace health promotion (WHP) programmes in China to promote the physical and mental well-being of workers, the relationship between WHP and depression has received limited attention. This study investigated the association between WHP service utilisation and depressive symptoms among workers.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A researcher-designed questionnaire was used to collect information on socio-demographic and occupational characteristics, WHP service utilisation, and mental health status. The Lasso method was used for variable selection to achieve dimension reduction, and logistic regression was used to assess the association between WHP service utilisation and depressive symptoms.

RESULTS

The analysis included 11,710 workers, of whom 17.0% had depressive symptoms. Lasso regression resulted in 6 of 18 WHP services showing significant negative associations with depressive symptoms, including occupational safety training, mental health services, health check-ups, sports activities, fitness rooms, and healthy canteens. The logistic regression results showed that, after adjusting for sociodemographic and occupational factors, utilisation of these six services was associated with a decreased likelihood of depressive symptoms. The adjusted odds ratio (aOR) was 0.84 (95% confidence interval [CI]: 0.73-0.96) for occupational safety training, aOR: 0.82 (95% CI: 0.68-0.99) for mental health services, aOR: 0.80 (95% CI: 0.71-0.90) for health check-ups, aOR: 0.68 (95% CI: 0.57-0.80) for sports activities, aOR: 0.59 (95% CI: 0.47-0.74) for fitness rooms and aOR: 0.72 (95% CI: 0.59-0.87) for healthy canteens.

CONCLUSIONS

Utilisation of WHP services was associated with a lower prevalence of depressive symptoms. Implementation of WHP services and the provision of a supportive workplace environment should be prioritised to benefit the mental health of workers.

Stressful Life Events, Unhealthy Eating Behaviors and Obesity among Chinese Government Employees: A Follow-Up Study

Background: The underlying mechanisms of the relationship between stressful life events and obesity among Chinese workers are unclear. Objective: This study aimed to understand the processes and mechanisms involved in stressful life events, unhealthy eating behavior, and obesity among Chinese workers. Methods: From January 2018 to December 2019, a total of 15,921 government employees were included at baseline and they were followed-up until May 2021. Stressful life events were assessed using the Life Events Scale, and unhealthy eating behavior was assessed using four items. BMI was calculated as weight (kg) divided by height (m²) using physically measured data. Results: Overeating at each mealtime (OR = 2.21, 95%CI: 1.78-2.71) at baseline led to reports of higher risk of obesity at follow up. Eating before going to bed at night sometimes (OR = 1.51, 95%CI: 1.31-1.73) or often (OR = 3.04, 95%CI: 2.28-4.05) at baseline led to reports of higher risk of obesity at follow-up. Eating out sometimes (OR = 1.74, 95%CI: 1.47-2.07) or often (OR = 1.59, 95%CI: 1.07-2.36) at baseline led to reports of higher risk of obesity at follow-up. Stressful life events were not directly associated with obesity, but unhealthy eating behaviors, including overeating at each mealtime (β = 0.010, 95%CI: 0.007-0.014; β = 0.002, 95%CI: 0.001-0.004, respectively) and irregular meal timing (β = -0.011, 95%CI: -0.015--0.008; β = -0.004, 95%CI: -0.006--0.001, respectively), significantly mediated the associations between stressful life events at baseline and obesity at both baseline and follow-up. Conclusions: Unhealthy eating behaviors mediated the relationship between stressful life events and obesity. Interventions should be provided to workers who have experienced stressful life events and unhealthy eating behaviors.

Burnout in South Asian rheumatologists in the COVID-19 pandemic: an online survey

Physician burnout is recognized as a global crisis and an epidemic. However, burnout in rheumatology is an understudied phenomenon. We explored the prevalence of physician burnout among rheumatologists from South Asia in the peri-pandemic period (2021-2022). Rheumatologists from Asian countries were invited to participate in an anonymized, validated, and pilot-tested e-survey via social media platforms from December 2021 to April 2022. Demographic information, social aspects (marital status, income, vacation time, daily exercise), substance abuse, EHR (electronic health record) use, and years in practice were obtained. In addition, burnout was estimated using Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), and intergroup comparisons were made using independent t test and one-way ANOVA using SPSS v27. Of 146 respondents who participated in the survey, 134 belonged to Asian nations. The highest number of respondents was from Pakistan (56/134, 38.36%), followed by India (49/134, 33.56%). Slightly more respondents were male, 75 (51.4%), than females, 71 (48.6%). Over two-thirds of our respondents (99/134, 67.8%) reported burnout in at least one domain. Notably, we found statistically significant increased depersonalization scores in males. (P < 0.05). Females scored significantly higher on the following items: #5 (I feel I treat some patients as if they were impersonal objects), item# 10 (I've become more insensitive toward people since I took this job and item#22 (I feel patients blame me for some of their problems) (P < 0.05). We found differences in monthly salaries among South Asian (1484 ± 2717 USD) and non-South Asian respondents (5672 ± 8874 USD) (P < 0.01). A substantial proportion of rheumatologists in our survey report burnout, suggesting a felt need to introduce organizational measures to prevent and mitigate burnout and preserve the rheumatology workforce.

Prioritizing Workplace Health Promotion Policy to Address High Blood Pressure and Obesity in a Public University in the Northern Region of Ghana

The International Labour Organization (ILO) recommends the engagement of the world of work in providing comprehensive and effective prevention strategy for noncommunicable diseases (NCDs). Workers are at risk of developing 1 or more cases of NCDs due to their exposure to risk factors at work. The ILO suggests that the work-related risk factors can be prevented by improving working conditions and integration of workplace health promotion programs. Workplace health promotion policies promote workers general health, improve working environment, work practices, and reduces the risks of common NCDs including hypertension (high blood pressure) and obesity among employees. A number of studies have described the increasing trends of hypertension and obesity among civil servants but are limited in assessing the availability and effectiveness of workplace health promotion policies to address them. We assessed the availability and effectiveness of workplace health promotion policy to address the prevalence of high blood pressure in a public university in the Northern Region of Ghana. Using a mixed method study design, 191 administrative staff were recruited and in-depth qualitative interviews conducted among 5 key informants. The study found significant number of participants with elevated and high blood pressure and overweight and obesity with no functional workplace health promotion at the time of the study. We therefore recommend the prioritization and development of a workplace health policy to reduce the prevalence of high blood pressure and obesity among staff of the university using the integrative workplace health promotion model.

Building workforce well-being capability: The findings of a wellness self-care programme

AIM

To implement and evaluate a co-designed staff well-being programme.

BACKGROUND

Working in health care can be physically and psychologically demanding. The job demands-resources model indicates job resources moderate the impact of job demands on staff well-being. Well-being initiatives introduced by organisations improve staff commitment, and reduce absences and incidents.

METHODS

A qualitative descriptive design was applied. In 2019, within an Australian local health district, 232 health care professionals across eight hospitals and two community settings attended a six-week well-being programme, which included a variety of self-care strategies, for example mindfulness. Nine 1-hr focus groups were completed 2-4 weeks post-programme. Data were analysed using thematic analysis to explore participants' thoughts and experiences.

RESULTS

Participants experienced joy from workshops and guilt for leaving peers with their workload. Participants developed strong interpersonal relationships with workshop attendees within a 'safe well-being space'. Broader impacts expressed by participants were; learnt coping mechanisms and proactive self-care practices and can be easily embedded into daily routines. Participants shared their 'toolkit' with colleagues, family and friends, positively impacting the well-being of people around them.

CONCLUSION

Participants encouraged by their new well-being 'toolkit' engaged with colleagues, better managed stressors and shared learnings.

IMPLICATIONS FOR NURSING MANAGEMENT

Building well-being capability within a health organisation requires nursing management to make staff well-being a strategic priority, use a co-design approach and embed coping mechanisms at the grassroots levels.

Caring for the carers in a public health district: A well-being initiative to support healthcare professionals

AIMS AND OBJECTIVES

To assess the impact of the proactive organisational resource allocation in terms of a 6-week well-being initiative to support public healthcare professionals' workplace engagement, well-being and job satisfaction.

BACKGROUND

Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles.

DESIGN

The study used a pre- and postsurvey of healthcare professionals who participated in the well-being initiative.

METHODS

Between February-June 2019, 172 healthcare professionals were surveyed before and after a well-being initiative. The survey included questions on workplace engagement, workplace well-being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study.

RESULTS

The well-being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well-being initiative, while the full-time staff members and highly experienced demonstrated an increase in engagement.

CONCLUSION

Well-being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees.

RELEVANCE TO CLINICAL PRACTICE

This study shows how implementing a staff well-being initiative increases workplace engagement, which benefits both the individual and the organisation.