The Guideline Uptake in Digital Ecosystems (GUIDE) study: protocol for implementation research on the impact of WHO SMART guidelines digital adaptation kits to improve quality of care

Background: Despite the potential for digital tools to facilitate guideline uptake, translating paper-based narrative guidelines into digital formats is resource-intensive and may compromise the fidelity to the recommended content. The World Health Organization (WHO) launched the SMART Guidelines initiative, in which digital adaptation kits (DAKs) are a foundational component. DAKs comprise software requirements documentation, including detailed data dictionary and algorithms--derived from WHO guidelines =for encoding within digital systems. Methods: This implementation research consists of a formative assessment and impact evaluation on integrating DAKs within national digital systems to improve service delivery outcomes for antenatal care (ANC), family planning, and HIV in two countries (Ethiopia and Ghana). The formative phase will assess the requirements to customize the DAKs to align with the national protocols and subsequently incorporate the localized DAKs’ content into the respective nationally endorsed digital systems: Bahmni in Ethiopia and DHIS2 tracker in Ghana. The impact evaluation will assess the effect of using the DAK-upgraded digital systems using pre–post designs in Ethiopia and Ghana. Primary outcomes of adherence to guideline recommendations will be assessed when digital systems incorporate country-adapted DAK content in comparison with the existing practice. Guideline knowledge questionnaires and in-depth interviews with software developers, health workers and facility managers will supplement the impact evaluation. Discussion: This research represents one of the first impact evaluations focused on integrating DAKs into existing national digital systems and the effect on service delivery outcomes. The mixed-methods study design will provide learnings for future scale-up and replication across other countries. We expect final results to be available in 2026, and preliminary findings will be shared at relevant fora. Trial registrationhttps://www.isrctn.com/ISRCTN18394724. Registration date: 21 December 2022.