Transformational Feedback: Breaking the vicious cycle of information use in Health Information Systems-A case from Malawi

Abstract

The thesis has been motivated by the weak and inconsistent feedback practices and strategies in health information systems in developing countries. This affects the quality of reporting by those that gather the data and the use of information by policy makers and health managers. A circular relationship exists between fostering data use and increased data quality. Limited information use is thus both a cause and a result of poor data quality, a vicious cycle that is hard to break. The vicious cycle concept can be used to understand the circular relationships between the data collection and reporting routines on the one hand and the information use routines on the other. The thesis introduces the concept of transformational feedback with its related dimensions of information transparency, two-way dialogue and networks for learning to help in breaking the vicious cycle of information use. This study was conducted in Malawi within the context of Health Information Systems Programme (HISP), a global research and development initiative on health information systems in developing countries. The initiative, which is in more than 50 countries, is aimed at contributing to the generation of knowledge as well as implementation of interventions to solve problems in health information systems in developing countries. The study was guided by two research questions: (i) how can transformational feedback be conceptualized in the context of HMIS in developing countries? and (ii) what approaches can be used to implement transformational feedback to break the vicious cycle of information use in the context of HMIS in developing countries? The thesis adopted primarily an interpretive and critical tradition in order to increase the understanding of feedback practices and at the same time implemented change in feedback practices and processes. It used a pluralist action research approach involving the mixing of action research with other research methods. The multi-method approaches to research adopted action research as the dominant approach and was supported by case study and field experiment research methods. A multiplicity of methods for data collection was used including semi-structured and in depth interviews using open-ended questions and focused group discussions targeting district health managers and district data officers; participant observations; and document analysis. Findings were presented in five conference and journal papers. The thesis primarily contributes to practice by developing guidelines on how transformational feedback can be implemented to influence information use. Based on insights from Malawi, it proposes three promising implementation approaches to transformational feedback: league tables, peer based reviews and mobile reporting. The thesis also contributes to theory through the development of the concept of transformational feedback.