{"id":"https://openalex.org/W7150976216","doi":"https://doi.org/10.1371/journal.pdig.0001340","title":"The implementation realities of a digital antenatal care improvement intervention: Insights from ethnographic work in primary health facilities in Nepal","display_name":"The implementation realities of a digital antenatal care improvement intervention: Insights from ethnographic work in primary health facilities in Nepal","publication_year":2026,"publication_date":"2026-04-06","ids":{"openalex":"https://openalex.org/W7150976216","doi":"https://doi.org/10.1371/journal.pdig.0001340","pmid":"https://pubmed.ncbi.nlm.nih.gov/41941510"},"language":"en","primary_location":{"id":"doi:10.1371/journal.pdig.0001340","doi":"https://doi.org/10.1371/journal.pdig.0001340","is_oa":true,"landing_page_url":"https://doi.org/10.1371/journal.pdig.0001340","pdf_url":null,"source":{"id":"https://openalex.org/S4210221150","display_name":"PLOS Digital Health","issn_l":"2767-3170","issn":["2767-3170"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310315706","host_organization_name":"Public Library of Science","host_organization_lineage":["https://openalex.org/P4310315706"],"host_organization_lineage_names":["Public Library of Science"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"PLOS Digital Health","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1371/journal.pdig.0001340","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5101816248","display_name":"Sulata Karki","orcid":"https://orcid.org/0000-0002-2141-1517","observed_orcids":["https://orcid.org/0000-0002-2141-1517"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":true,"raw_author_name":"Sulata Karki","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal"],"raw_orcid":"https://orcid.org/0000-0002-2141-1517","affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5101513088","display_name":"Seema Das","orcid":"https://orcid.org/0000-0001-5170-1622","observed_orcids":["https://orcid.org/0000-0001-5170-1622"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Seema Das","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5004358688","display_name":"Emma Radovich","orcid":"https://orcid.org/0000-0002-8975-8015","observed_orcids":["https://orcid.org/0000-0002-8975-8015"]},"institutions":[{"id":"https://openalex.org/I4210089966","display_name":"London School of Hygiene & Tropical Medicine","ror":"https://ror.org/00a0jsq62","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I4210089966"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Emma Radovich","raw_affiliation_strings":["London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom","institution_ids":["https://openalex.org/I4210089966"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5102883676","display_name":"Abha Shrestha","orcid":"https://orcid.org/0009-0008-7511-1190","observed_orcids":["https://orcid.org/0009-0008-7511-1190","https://orcid.org/0000-0002-8465-0590"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Abha Shrestha","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","Kathmandu University School of Medical Sciences, Department of Community Medicine, Dhulikhel, Nepal","Kathmandu University School of Medical Sciences, Department of Obstetrics and Gynecology, Dhulikhel, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]},{"raw_affiliation_string":"Kathmandu University School of Medical Sciences, Department of Community Medicine, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I47881588"]},{"raw_affiliation_string":"Kathmandu University School of Medical Sciences, Department of Obstetrics and Gynecology, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5017943229","display_name":"Rajani Shakya","orcid":"https://orcid.org/0009-0008-0894-0589","observed_orcids":["https://orcid.org/0009-0008-0894-0589"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Rajani Shakya","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5102883676","display_name":"Abha Shrestha","orcid":"https://orcid.org/0009-0008-7511-1190","observed_orcids":["https://orcid.org/0009-0008-7511-1190","https://orcid.org/0000-0002-8465-0590"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Abha Shrestha","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","Kathmandu University School of Medical Sciences, Department of Community Medicine, Dhulikhel, Nepal","Kathmandu University School of Medical Sciences, Department of Obstetrics and Gynecology, Dhulikhel, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]},{"raw_affiliation_string":"Kathmandu University School of Medical Sciences, Department of Community Medicine, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I47881588"]},{"raw_affiliation_string":"Kathmandu University School of Medical Sciences, Department of Obstetrics and Gynecology, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5069803996","display_name":"Ona McCarthy","orcid":"https://orcid.org/0000-0002-9902-6248","observed_orcids":["https://orcid.org/0000-0002-9902-6248"]},"institutions":[{"id":"https://openalex.org/I4210089966","display_name":"London School of Hygiene & Tropical Medicine","ror":"https://ror.org/00a0jsq62","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I4210089966"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Ona L. McCarthy","raw_affiliation_strings":["London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom","institution_ids":["https://openalex.org/I4210089966"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5071445474","display_name":"Oona M. R. Campbell","orcid":"https://orcid.org/0000-0002-9311-0115","observed_orcids":["https://orcid.org/0000-0002-9311-0115"]},"institutions":[{"id":"https://openalex.org/I4210089966","display_name":"London School of Hygiene & Tropical Medicine","ror":"https://ror.org/00a0jsq62","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I4210089966"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Oona M. R. Campbell","raw_affiliation_strings":["London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom","institution_ids":["https://openalex.org/I4210089966"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5103186425","display_name":"Biraj Man Karmacharya","orcid":"https://orcid.org/0000-0002-7312-5758","observed_orcids":["https://orcid.org/0000-0002-7312-5758","https://orcid.org/0000-0001-8983-0235"]},"institutions":[{"id":"https://openalex.org/I2800596572","display_name":"Dhulikhel Hospital","ror":"https://ror.org/01abdqw97","country_code":"NP","type":"healthcare","lineage":["https://openalex.org/I2800596572"]},{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Biraj Man Karmacharya","raw_affiliation_strings":["Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","Kathmandu University School of Medical Sciences, Department of Public Health and Community Programs, Dhulikhel, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dhulikhel Hospital Kathmandu University Hospital, Research and Development Division, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"]},{"raw_affiliation_string":"Kathmandu University School of Medical Sciences, Department of Public Health and Community Programs, Dhulikhel, Nepal","institution_ids":["https://openalex.org/I47881588"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5004763683","display_name":"Loveday Penn\u2010Kekana","orcid":"https://orcid.org/0000-0002-9758-4529","observed_orcids":["https://orcid.org/0000-0002-9758-4529"]},"institutions":[{"id":"https://openalex.org/I4210089966","display_name":"London School of Hygiene & Tropical Medicine","ror":"https://ror.org/00a0jsq62","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I4210089966"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Loveday Penn-Kekana","raw_affiliation_strings":["London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom","institution_ids":["https://openalex.org/I4210089966"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5101816248"],"corresponding_institution_ids":["https://openalex.org/I2800596572","https://openalex.org/I47881588"],"apc_list":{"value":3043,"currency":"USD","value_usd":3043},"apc_paid":{"value":3043,"currency":"USD","value_usd":3043},"fwci":16.5067,"has_fulltext":true,"cited_by_count":2,"citation_normalized_percentile":{"value":0.98694349,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":96,"max":97},"biblio":{"volume":"5","issue":"4","first_page":"e0001340","last_page":"e0001340"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10629","display_name":"Health Policy Implementation Science","score":0.7348999977111816,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10629","display_name":"Health Policy Implementation Science","score":0.7348999977111816,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.12240000069141388,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11446","display_name":"Mobile Health and mHealth Applications","score":0.0471000000834465,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/prenatal-care","display_name":"prenatal care","score":0.9110000133514404},{"id":"https://openalex.org/keywords/decision-support-system","display_name":"decision support system","score":0.9330000281333923},{"id":"https://openalex.org/keywords/mobile-health","display_name":"mobile health","score":0.7699999809265137},{"id":"https://openalex.org/keywords/auxiliary-nurse-midwives","display_name":"auxiliary nurse midwives","score":0.7680000066757202},{"id":"https://openalex.org/keywords/implementation-barriers","display_name":"implementation barriers","score":0.7490000128746033},{"id":"https://openalex.org/keywords/primary-health-care-center","display_name":"primary health centers","score":0.7229999899864197},{"id":"https://openalex.org/keywords/street-level-bureaucracy","display_name":"street-level bureaucracy","score":0.7889999747276306},{"id":"https://openalex.org/keywords/record-keeping","display_name":"record keeping","score":0.5130000114440918},{"id":"https://openalex.org/keywords/case-referral","display_name":"case referral","score":0.5320000052452087},{"id":"https://openalex.org/keywords/nepal","display_name":"Nepal","score":0.6800000071525574}],"concepts":[{"id":"https://openalex.org/C2779343474","wikidata":"https://www.wikidata.org/wiki/Q3109175","display_name":"Context (archaeology)","level":2,"score":0.5932999849319458},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.5870000123977661},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.5372999906539917},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5317999720573425},{"id":"https://openalex.org/C179454799","wikidata":"https://www.wikidata.org/wiki/Q132151","display_name":"Ethnography","level":2,"score":0.49079999327659607},{"id":"https://openalex.org/C56995899","wikidata":"https://www.wikidata.org/wiki/Q1126687","display_name":"Focus group","level":2,"score":0.48510000109672546},{"id":"https://openalex.org/C51575053","wikidata":"https://www.wikidata.org/wiki/Q72468","display_name":"Bureaucracy","level":3,"score":0.4781999886035919},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.4657000005245209},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4410000145435333},{"id":"https://openalex.org/C163432668","wikidata":"https://www.wikidata.org/wiki/Q623543","display_name":"Primary health care","level":3,"score":0.3952000141143799},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.3555000126361847},{"id":"https://openalex.org/C2780433410","wikidata":"https://www.wikidata.org/wiki/Q5276090","display_name":"Digital health","level":3,"score":0.3540000021457672},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.34779998660087585},{"id":"https://openalex.org/C72497813","wikidata":"https://www.wikidata.org/wiki/Q110051588","display_name":"Implementation research","level":3,"score":0.34040001034736633},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.3278000056743622},{"id":"https://openalex.org/C68595000","wikidata":"https://www.wikidata.org/wiki/Q2274177","display_name":"Service delivery framework","level":3,"score":0.3224000036716461},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.32179999351501465},{"id":"https://openalex.org/C2779363104","wikidata":"https://www.wikidata.org/wiki/Q17069079","display_name":"mHealth","level":3,"score":0.30979999899864197},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.3068999946117401},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.29910001158714294},{"id":"https://openalex.org/C190248442","wikidata":"https://www.wikidata.org/wiki/Q839486","display_name":"Qualitative research","level":2,"score":0.2896000146865845},{"id":"https://openalex.org/C24756922","wikidata":"https://www.wikidata.org/wiki/Q1757694","display_name":"Data quality","level":3,"score":0.28529998660087585},{"id":"https://openalex.org/C129047720","wikidata":"https://www.wikidata.org/wiki/Q175185","display_name":"Rural area","level":2,"score":0.2842000126838684},{"id":"https://openalex.org/C5395021","wikidata":"https://www.wikidata.org/wiki/Q1061410","display_name":"Program evaluation","level":2,"score":0.2777000069618225},{"id":"https://openalex.org/C121752807","wikidata":"https://www.wikidata.org/wiki/Q1981388","display_name":"Reproductive health","level":3,"score":0.2687999904155731},{"id":"https://openalex.org/C83864248","wikidata":"https://www.wikidata.org/wiki/Q177323","display_name":"Developing country","level":2,"score":0.2671999931335449},{"id":"https://openalex.org/C2775949068","wikidata":"https://www.wikidata.org/wiki/Q4260475","display_name":"Health facility","level":4,"score":0.26170000433921814},{"id":"https://openalex.org/C2779891985","wikidata":"https://www.wikidata.org/wiki/Q46994","display_name":"Telemedicine","level":3,"score":0.26170000433921814},{"id":"https://openalex.org/C2986740045","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health services","level":3,"score":0.25870001316070557},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.2529999911785126}],"mesh":[],"locations_count":6,"locations":[{"id":"doi:10.1371/journal.pdig.0001340","doi":"https://doi.org/10.1371/journal.pdig.0001340","is_oa":true,"landing_page_url":"https://doi.org/10.1371/journal.pdig.0001340","pdf_url":null,"source":{"id":"https://openalex.org/S4210221150","display_name":"PLOS Digital Health","issn_l":"2767-3170","issn":["2767-3170"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310315706","host_organization_name":"Public Library of Science","host_organization_lineage":["https://openalex.org/P4310315706"],"host_organization_lineage_names":["Public Library of Science"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"PLOS Digital Health","raw_type":"journal-article"},{"id":"pmid:41941510","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41941510","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"PLOS digital health","raw_type":"Journal Article"},{"id":"pmh:oai:researchonline.lshtm.ac.uk:4681883","doi":null,"is_oa":true,"landing_page_url":"https://orcid.org/0000-0002-2141-1517>;","pdf_url":"https://researchonline.lshtm.ac.uk/id/eprint/4681883/1/Karki-etal-2026-the-implementation-realities-of-a-digital-antenatal-care-improvement-intervention.pdf","source":{"id":"https://openalex.org/S4306402527","display_name":"LSHTM Research Online (London School of Hygiene and Tropical Medicine)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I4210089966","host_organization_name":"London School of Hygiene & Tropical Medicine","host_organization_lineage":["https://openalex.org/I4210089966"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Article"},{"id":"pmh:oai:doaj.org/article:1e58e5a1ba844908b5b9932fcafade79","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/1e58e5a1ba844908b5b9932fcafade79","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"PLOS Digital Health, Vol 5, Iss 4, p e0001340 (2026)","raw_type":"article"},{"id":"pmh:oai:doaj.org/article:f5fbd9df8cff4ec9922c765cf8acecc5","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/f5fbd9df8cff4ec9922c765cf8acecc5","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"PLOS Digital Health, Vol 5, Iss 4 (2026)","raw_type":"article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13052878","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13052878/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"PLOS Digit Health","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1371/journal.pdig.0001340","doi":"https://doi.org/10.1371/journal.pdig.0001340","is_oa":true,"landing_page_url":"https://doi.org/10.1371/journal.pdig.0001340","pdf_url":null,"source":{"id":"https://openalex.org/S4210221150","display_name":"PLOS Digital Health","issn_l":"2767-3170","issn":["2767-3170"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","norway-1"],"host_organization":"https://openalex.org/P4310315706","host_organization_name":"Public Library of Science","host_organization_lineage":["https://openalex.org/P4310315706"],"host_organization_lineage_names":["Public Library of Science"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"PLOS Digital Health","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9537000060081482,"id":"https://metadata.un.org/sdg/3"}],"sustainable_development_goals_aurora":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":25,"referenced_works":["https://openalex.org/W1986639038","https://openalex.org/W1998134118","https://openalex.org/W2000630136","https://openalex.org/W2016378685","https://openalex.org/W2058869603","https://openalex.org/W2100643950","https://openalex.org/W2112201131","https://openalex.org/W2115441252","https://openalex.org/W2125555375","https://openalex.org/W2127293276","https://openalex.org/W2143543192","https://openalex.org/W2144606360","https://openalex.org/W2163023921","https://openalex.org/W2514496257","https://openalex.org/W2520800636","https://openalex.org/W2537576125","https://openalex.org/W2938066460","https://openalex.org/W2945775391","https://openalex.org/W2986565205","https://openalex.org/W3137036255","https://openalex.org/W3144272167","https://openalex.org/W4318068393","https://openalex.org/W4385326478","https://openalex.org/W4406199157","https://openalex.org/W4407718965"],"related_works":[],"abstract_inverted_index":{"Nepal":[0],"has":[1],"significantly":[2],"improved":[3],"maternal":[4],"health":[5,21,89,260],"service":[6],"coverage,":[7],"including":[8],"antenatal":[9],"care":[10,25,167,182,202],"(ANC),":[11],"with":[12,166,171,209,242,285],"a":[13,51,83,210,273],"growing":[14],"focus":[15],"on":[16,127,135],"quality":[17,38,189,235],"care.":[18],"The":[19,129,229],"mobile":[20],"Integrated":[22],"Rural":[23],"Antenatal":[24],"(mIRA)":[26],"project":[27],"evaluated":[28],"an":[29,192],"electronic":[30],"decision":[31],"support":[32],"system":[33],"(EDSS)":[34],"to":[35,56,67,122,124,215,218,232],"improve":[36,233],"ANC":[37,237,257,277],"in":[39,86,150,258,279],"primary":[40,88,259],"healthcare":[41],"facilities.":[42,261],"This":[43,206],"sub-study":[44],"was":[45,147,190],"undertaken":[46],"within":[47],"the":[48,64,71,77,94,143,157,226,234,253,270,282,289,296],"context":[49],"of":[50,76,153,175,236,255,291],"mixed-method":[52],"evaluation.":[53],"It":[54],"aimed":[55],"explore":[57],"how":[58],"auxiliary":[59],"nurse":[60],"midwives":[61],"(ANMs)":[62],"implemented":[63,93],"EDSS":[65,158,227,230],"and":[66,74,102,105,117,125,162,186,252,294,300],"provide":[68],"insight":[69,275],"into":[70,276],"real-world":[72],"challenges":[73,283],"processes":[75],"mIRA":[78],"implementation":[79],"project.":[80],"We":[81],"conducted":[82],"focused":[84],"ethnography":[85],"four":[87],"facilities,":[90],"where":[91],"ANMs":[92,139,155,177],"EDSS.":[95],"Data":[96],"were":[97,131,198,247],"collected":[98,266],"between":[99,298],"December":[100],"2021":[101],"January":[103],"2023":[104],"involved":[106],"repeat":[107],"ethnographic":[108],"observations,":[109],"informal":[110],"conversations,":[111],"formal":[112],"interviews":[113],"(n":[114],"=":[115],"16),":[116],"validation":[118],"workshops":[119],"for":[120,160,183],"participants":[121],"respond":[123],"reflect":[126],"findings.":[128],"data":[130,265],"analyzed":[132],"thematically,":[133],"drawing":[134],"street-level":[136],"bureaucracy":[137],"theory.":[138],"verbalized":[140],"they":[141,195,197],"valued":[142],"EDSS,":[144],"but":[145],"this":[146],"not":[148,164,191,239],"reflected":[149],"their":[151,172,204],"use":[152],"it.":[154],"adopted":[156],"primarily":[159],"recordkeeping":[161],"did":[163,238],"comply":[165],"recommendations":[168,231],"that":[169,188],"conflicted":[170],"usual":[173,244],"way":[174],"working.":[176],"viewed":[178],"themselves":[179],"as":[180,194],"providing":[181],"normal":[184],"pregnancies":[185],"believed":[187],"issue,":[193],"felt":[196],"already":[199],"delivering":[200],"good":[201],"at":[203],"level.":[205],"perception,":[207],"coupled":[208],"risk-averse":[211],"attitude,":[212],"led":[213],"them":[214],"refer":[216],"cases":[217],"doctors":[219],"or":[220],"higher":[221],"centers":[222],"rather":[223],"than":[224],"implement":[225],"recommendations.":[228],"align":[240],"well":[241],"ANMs'":[243],"practices,":[245],"which":[246],"influenced":[248],"by":[249],"contextual":[250],"factors":[251],"complexities":[254],"organizing":[256],"By":[262],"triangulating":[263],"longitudinal":[264],"through":[267],"multiple":[268],"methods,":[269],"study":[271],"provided":[272],"comprehensive":[274],"provision":[278],"Nepal,":[280],"revealing":[281],"associated":[284],"improving":[286],"quality,":[287],"unpacking":[288],"realities":[290],"intervention":[292],"implementation,":[293],"highlighting":[295],"disconnects":[297],"rhetoric":[299],"practice.":[301]},"counts_by_year":[{"year":2026,"cited_by_count":2}],"updated_date":"2026-10-14T16:39:01.820549","created_date":"2026-04-07T00:00:00"}