This community innovation has been accepted at the 2025 DHIS2 Annual Conference
Methodological Tensions in DHIS2 implementations
The ePOSIT project presents a unique methodological approach by integrating two distinct yet interdependent objectives: a randomized controlled trial (RCT) evaluating the transition from four to eight antenatal care (ANC) visits and the implementation of a digital ANC registry. This dual-purpose design introduces methodological tensions, particularly in balancing structured trial protocols with the adaptive nature of digital health implementation. A key challenge lies in reconciling diverse methodological perspectives within the team, which includes expertise in RCTs, implementation research, action research, and pragmatic implementation with minimal research components. These differing epistemological foundations influence decision-making, evaluation metrics, and adaptation strategies. Using software engineering as an analogy, the project operates within both waterfall and agile paradigms. The RCT framework requires predefined protocols, structured implementation plans, and fixed milestones, akin to a waterfall model. Conversely, real-world digital health implementations demand flexibility, iterative adaptations, and responsiveness to contextual challenges, aligning with an agile approach. The interplay between these methodologies necessitates careful navigation to maintain scientific rigor while ensuring practical feasibility. A central question is how to manage these tensions effectively. Potential strategies may include better planning and communication, iterative evaluations, and stakeholder engagement. Ultimately, ePOSIT serves as a case study in methodological integration, highlighting the need for dynamic frameworks that accommodate both structured research design and the evolving nature of digital health interventions.
Primary Author: Mahima Venkateswaran
Keywords:
digital health interventions, agile implementation, action research, trials