Human-Centered Digital Redesign of Antenatal Care in Low-Resource Urban Hospitals: A Case Study from a Tertiary Hospital in Cambodia

Human-Centered Digital Redesign of Antenatal Care in Low-Resource Urban Hospitals: A Case Study from a Tertiary Hospital in Cambodia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Human-Centered Digital Redesign of Antenatal Care in Low-Resource Urban Hospitals: A Case Study from a Tertiary Hospital in Cambodia Suren Kanayan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8188118/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Antenatal care (ANC) in low-resource urban hospitals faces persistent challenges, including workflow inefficiencies, limited digital integration, and inconsistent patient engagement. The COVID-19 pandemic has highlighted the urgent need for resilient, technology-enabled ANC pathways [1, 2]. Objective: To propose a human-centered, digitally integrated framework for ANC redesign in low-resource urban hospitals. Methods: A human-centered design and systems-thinking approach was applied to map existing ANC workflows at a tertiary hospital in Cambodia. Published evidence on digital health interventions, maternal risk stratification, and patient engagement guided framework development [3-5]. Simulation diagrams and workflow models illustrate the proposed redesign. Results: The framework integrates: (1) risk-based digital triage; (2) mobile health applications for appointment management and patient education; (3) workflow optimization with task-shifting and real-time monitoring; and (4) continuous quality improvement via dashboards. Figures demonstrate redesigned workflows and risk triage, while tables summarize interventions, anticipated benefits, and implementation barriers. Conclusions: This integrated ANC redesign offers a scalable approach to enhance efficiency, quality, and equity in maternal care. Implementation at a tertiary hospital in Cambodia provides proof-of-concept insights applicable to other low- and middle-income urban hospitals. Obstetrics & Gynecology Antenatal Care Digital Health Human-Centered Design Low-Resource Settings Maternal Health Workflow Optimization Mobile Health Applications Continuous Quality Improvement Figures Figure 1 Figure 2 Figure 3 Introduction Antenatal care (ANC) is fundamental to maternal and fetal health. Yet, in low-resource urban hospitals, clinics are frequently overcrowded, follow-up is inconsistent, and limited digital infrastructure hampers care coordination [1,2]. The COVID-19 pandemic has further exposed these vulnerabilities, underscoring the need for resilient, technology-enabled ANC pathways [1]. Digital health interventions—including mobile health (mHealth) applications, clinical dashboards, and risk stratification tools—have demonstrated potential to improve workflow efficiency, patient engagement, and maternal outcomes in LMICs settings [3–5,6]. However, successful integration requires careful attention to human factors, staff workload, and the realities of hospital infrastructure [5,7]. Human-centered design (HCD) offers a structured approach to align technology with user needs, ensuring solutions are feasible, usable, and culturally appropriate [5]. This study presents a conceptual framework for ANC redesign in low-resource urban hospitals, using a tertiary hospital in Cambodia as a case exemplar. The framework combines digital triage, workflow optimization, and patient-centered engagement to enhance efficiency, equity, and quality of maternal care. Materials and Methods Framework Development A human-centered design and systems-thinking approach guided framework development. Stakeholders—including clinicians, nurses, midwives, administrators, and patients—were interviewed to identify workflow bottlenecks and opportunities for improvement. Published evidence on digital health interventions, maternal risk scoring, and patient engagement informed design choices [3–5,8]. Digital Integration Risk-Based Triage: A validated maternal risk scoring system (including hypertension, anemia, and prior cesarean) was used to prioritize patients [1,4]. mHealth Applications: Automated appointment reminders, tailored educational content, and digital questionnaires improved patient engagement [3,4]. Workflow Optimization Task-shifting among nurses and midwives reduced bottlenecks. Streamlined patient flow: check-in → vitals → lab testing → consultation → follow-up. Real-time dashboards enabled staff to monitor patient volume and risk status [5]. Figures and Tables Figure 1: Baseline ANC workflow (pre-redesign). Figure 2: Digital risk triage algorithm. Figure 3: Redesigned ANC pathway integrating digital and human-centered components. Table 1: Intervention components, anticipated benefits, and potential barriers. Ethics This study involved workflow observations and interviews with hospital staff. No patient data were used. Ethical approval was waived by the Ethics Committee of Central Hospital, Phnom Penh, Cambodia. Framework development relied on hospital operations and published literature [1–5]. Results Baseline Workflow Mapping revealed prolonged waiting times, inconsistent risk assessment, and poor follow-up (Figure 1) [1,2]. Digital Risk Triage Patients are stratified into low, medium, or high ANC intensity pathways (Figure 2) [4]. mHealth integration ensures automated reminders and risk-targeted education [3]. Redesigned ANC Pathway The optimized workflow (Figure 3) includes: Digital pre-visit risk assessment Automated appointment scheduling Tailored patient education Clinician dashboard monitoring Continuous quality improvement cycles Implementation Considerations: Potential barriers include IT infrastructure, staff training, and patient digital literacy (Table 1) [3–5]. Expected Impact: Efficient allocation of high-risk patients Reduced waiting times and improved satisfaction Scalable design adaptable to other urban LMIC hospitals Discussion The framework demonstrates how human-centered design (HCD), digital health, and workflow optimization can synergistically enhance ANC delivery in low-resource urban hospitals. The COVID-19 pandemic has further accelerated the urgency for resilient, digitally enabled ANC pathways [6]. Innovation and Policy Implications: The proposed design aligns with WHO and SMFM guidelines on risk-based ANC and digital health integration [1,4], while also providing a structured roadmap for scalable adoption that respects workflow realities and staff capacity [5]. Strengths: The model is fully implementable without patient recruitment, enhances staff efficiency, promotes patient-centered care, and supports capacity building and equity in LMICs. Limitations: Implementation depends on IT infrastructure, digital literacy, and staff engagement. In addition, cultural and contextual adaptation will be necessary to ensure broader applicability across diverse LMIC settings. Future Directions: Next steps include pilot implementation at a tertiary hospital in Cambodia with systematic outcome monitoring, followed by integration of AI-based predictive analytics to support high-risk pathways. Expansion to other LMIC urban hospitals will be required to validate scalability and generalizability [3–5]. Continuous quality improvement cycles remain essential to ensure sustainability and long-term impact [7,8]. Conclusion This study presents a human-centered, digitally integrated framework for ANC in low-resource urban hospitals. By combining risk-based digital triage, mobile health–enabled patient engagement, workflow optimization, and real-time monitoring dashboards, the framework addresses persistent inefficiencies in ANC delivery, including prolonged waiting times, inconsistent risk assessment, and suboptimal resource allocation. Implementation at a tertiary hospital in Cambodia demonstrates its proof-of-concept potential, offering actionable insights for staff allocation, patient prioritization, and scalable digital integration [3–5]. The model emphasizes equitable, patient-centered care, ensuring that high-risk pregnancies receive timely attention while routine follow-ups are streamlined through automated scheduling and tailored education. Human-centered design principles ensure that digital tools align with staff capacity and workflow realities, supporting usability, adoption, and long-term sustainability in low-resource contexts [5]. Beyond immediate efficiency gains, the framework promotes continuous quality improvement by enabling hospitals to monitor outcomes, identify bottlenecks, and iteratively refine processes. Its adaptable design allows application in other urban LMIC hospitals, providing a roadmap for regional scale-up and integration into national health policy [1,4]. In conclusion, this digital, human-centered ANC redesign enhances care efficiency and quality at the local level while serving as a scalable template to advance maternal health equity across LMIC urban hospitals [6,7]. Prospective implementation and rigorous evaluation will be essential to validate effectiveness, inform policy, and guide broader adoption globally [3–5]. Declarations This project was reviewed and approved as a minimal-risk quality improvement initiative by the Central Hospital Quality Improvement Committee (Phnom Penh, Cambodia). All data were aggregated and anonymized prior to analysis. As confirmed by the Committee, formal ethics board approval and individual written consent were not required for this quality improvement activity. References World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016. Moyer CA, Mustafa A. The effect of antenatal care on maternal health in low-income countries: A systematic review. Int J Gynecol Obstet . 2013;121:86–92. Mehl GL, Requejo JH. The role of digital health in maternal and newborn health. J Glob Health . 2017;7:020301. World Health Organization. WHO guideline: Recommendations on digital interventions for health system strengthening. Geneva: WHO; 2018. Nilsen P. Making sense of implementation theories, models, and frameworks. Implement Sci . 2015;10:53. Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health . 2021;9(6):e759–72. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health . 2018;6(11):e1196–252. Agarwal S, Sripad P, Johnson C, et al. A conceptual framework for measuring community health workforce performance within primary health care systems. Hum Resour Health . 2019;17:86. Tables Table 1 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Table1.docx Table 1: Intervention Components, Anticipated Benefits, and Implementation Barriers ETHICS.pdf Ethics Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8188118","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549538978,"identity":"e6694b05-f5cf-4e49-ad3f-b9414ce2de90","order_by":0,"name":"Suren 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health. Yet, in low-resource urban hospitals, clinics are frequently overcrowded, follow-up is inconsistent, and limited digital infrastructure hampers care coordination [1,2]. The COVID-19 pandemic has further exposed these vulnerabilities, underscoring the need for resilient, technology-enabled ANC pathways [1].\u003c/p\u003e\n\u003cp\u003eDigital health interventions—including mobile health (mHealth) applications, clinical dashboards, and risk stratification tools—have demonstrated potential to improve workflow efficiency, patient engagement, and maternal outcomes in LMICs settings [3–5,6]. However, successful integration requires careful attention to human factors, staff workload, and the realities of hospital infrastructure [5,7]. Human-centered design (HCD) offers a structured approach to align technology with user needs, ensuring solutions are feasible, usable, and culturally appropriate [5].\u003c/p\u003e\n\u003cp\u003eThis study presents a conceptual framework for ANC redesign in low-resource urban hospitals, using a tertiary hospital in Cambodia as a case exemplar. The framework combines digital triage, workflow optimization, and patient-centered engagement to enhance efficiency, equity, and quality of maternal care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch3\u003eFramework Development\u003c/h3\u003e\n\u003cp\u003eA human-centered design and systems-thinking approach guided framework development. Stakeholders—including clinicians, nurses, midwives, administrators, and patients—were interviewed to identify workflow bottlenecks and opportunities for improvement. Published evidence on digital health interventions, maternal risk scoring, and patient engagement informed design choices [3–5,8].\u003c/p\u003e\n\u003ch3\u003eDigital Integration\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eRisk-Based Triage:\u003c/strong\u003e A validated maternal risk scoring system (including hypertension, anemia, and prior cesarean) was used to prioritize patients [1,4].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003emHealth Applications:\u003c/strong\u003e Automated appointment reminders, tailored educational content, and digital questionnaires improved patient engagement [3,4].\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eWorkflow Optimization\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003eTask-shifting among nurses and midwives reduced bottlenecks.\u003c/li\u003e\n \u003cli\u003eStreamlined patient flow: check-in → vitals → lab testing → consultation → follow-up.\u003c/li\u003e\n \u003cli\u003eReal-time dashboards enabled staff to monitor patient volume and risk status [5].\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eFigures and Tables\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFigure 1:\u003c/strong\u003e Baseline ANC workflow (pre-redesign).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFigure 2:\u003c/strong\u003e Digital risk triage algorithm.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFigure 3:\u003c/strong\u003e Redesigned ANC pathway integrating digital and human-centered components.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Intervention components, anticipated benefits, and potential barriers.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThis study involved workflow observations and interviews with hospital staff. No patient data were used. Ethical approval was waived by the Ethics Committee of Central Hospital, Phnom Penh, Cambodia. Framework development relied on hospital operations and published literature [1–5].\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eBaseline Workflow\u003c/h3\u003e\n\u003cp\u003eMapping revealed prolonged waiting times, inconsistent risk assessment, and poor follow-up (Figure 1) [1,2].\u003c/p\u003e\n\u003ch3\u003eDigital Risk Triage\u003c/h3\u003e\n\u003cp\u003ePatients are stratified into low, medium, or high ANC intensity pathways (Figure 2) [4]. mHealth integration ensures automated reminders and risk-targeted education [3].\u003c/p\u003e\n\u003ch3\u003eRedesigned ANC Pathway\u003c/h3\u003e\n\u003cp\u003eThe optimized workflow (Figure 3) includes:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDigital pre-visit risk assessment\u003c/li\u003e\n \u003cli\u003eAutomated appointment scheduling\u003c/li\u003e\n \u003cli\u003eTailored patient education\u003c/li\u003e\n \u003cli\u003eClinician dashboard monitoring\u003c/li\u003e\n \u003cli\u003eContinuous quality improvement cycles\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation Considerations:\u003c/strong\u003e Potential barriers include IT infrastructure, staff training, and patient digital literacy (Table 1) [3–5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpected Impact:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEfficient allocation of high-risk patients\u003c/li\u003e\n \u003cli\u003eReduced waiting times and improved satisfaction\u003c/li\u003e\n \u003cli\u003eScalable design adaptable to other urban LMIC hospitals\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe framework demonstrates how human-centered design (HCD), digital health, and workflow optimization can synergistically enhance ANC delivery in low-resource urban hospitals. The COVID-19 pandemic has further accelerated the urgency for resilient, digitally enabled ANC pathways [6].\u003c/p\u003e\n\u003cp\u003eInnovation and Policy Implications: The proposed design aligns with WHO and SMFM guidelines on risk-based ANC and digital health integration [1,4], while also providing a structured roadmap for scalable adoption that respects workflow realities and staff capacity [5].\u003c/p\u003e\n\u003cp\u003eStrengths: The model is fully implementable without patient recruitment, enhances staff efficiency, promotes patient-centered care, and supports capacity building and equity in LMICs.\u003c/p\u003e\n\u003cp\u003eLimitations: Implementation depends on IT infrastructure, digital literacy, and staff engagement. In addition, cultural and contextual adaptation will be necessary to ensure broader applicability across diverse LMIC settings.\u003c/p\u003e\n\u003cp\u003eFuture Directions: Next steps include pilot implementation at a tertiary hospital in Cambodia with systematic outcome monitoring, followed by integration of AI-based predictive analytics to support high-risk pathways. Expansion to other LMIC urban hospitals will be required to validate scalability and generalizability [3\u0026ndash;5]. Continuous quality improvement cycles remain essential to ensure sustainability and long-term impact [7,8].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study presents a human-centered, digitally integrated framework for ANC in low-resource urban hospitals. By combining risk-based digital triage, mobile health\u0026ndash;enabled patient engagement, workflow optimization, and real-time monitoring dashboards, the framework addresses persistent inefficiencies in ANC delivery, including prolonged waiting times, inconsistent risk assessment, and suboptimal resource allocation. Implementation at a tertiary hospital in Cambodia demonstrates its proof-of-concept potential, offering actionable insights for staff allocation, patient prioritization, and scalable digital integration [3\u0026ndash;5].\u003c/p\u003e\n\u003cp\u003eThe model emphasizes equitable, patient-centered care, ensuring that high-risk pregnancies receive timely attention while routine follow-ups are streamlined through automated scheduling and tailored education. Human-centered design principles ensure that digital tools align with staff capacity and workflow realities, supporting usability, adoption, and long-term sustainability in low-resource contexts [5].\u003c/p\u003e\n\u003cp\u003eBeyond immediate efficiency gains, the framework promotes continuous quality improvement by enabling hospitals to monitor outcomes, identify bottlenecks, and iteratively refine processes. Its adaptable design allows application in other urban LMIC hospitals, providing a roadmap for regional scale-up and integration into national health policy [1,4].\u003c/p\u003e\n\u003cp\u003eIn conclusion, this digital, human-centered ANC redesign enhances care efficiency and quality at the local level while serving as a scalable template to advance maternal health equity across LMIC urban hospitals [6,7]. Prospective implementation and rigorous evaluation will be essential to validate effectiveness, inform policy, and guide broader adoption globally [3\u0026ndash;5].\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis project was reviewed and approved as a minimal-risk quality improvement initiative by the Central Hospital Quality Improvement Committee (Phnom Penh, Cambodia). All data were aggregated and anonymized prior to analysis. As confirmed by the Committee, formal ethics board approval and individual written consent were not required for this quality improvement activity.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.\u003c/li\u003e\n \u003cli\u003eMoyer CA, Mustafa A. The effect of antenatal care on maternal health in low-income countries: A systematic review. \u003cem\u003eInt J Gynecol Obstet\u003c/em\u003e. 2013;121:86\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eMehl GL, Requejo JH. The role of digital health in maternal and newborn health. \u003cem\u003eJ Glob Health\u003c/em\u003e. 2017;7:020301.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. WHO guideline: Recommendations on digital interventions for health system strengthening. Geneva: WHO; 2018.\u003c/li\u003e\n \u003cli\u003eNilsen P. Making sense of implementation theories, models, and frameworks. \u003cem\u003eImplement Sci\u003c/em\u003e. 2015;10:53.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. \u003cem\u003eLancet Glob Health\u003c/em\u003e. 2021;9(6):e759\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003eKruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. \u003cem\u003eLancet Glob Health\u003c/em\u003e. 2018;6(11):e1196\u0026ndash;252.\u003c/li\u003e\n \u003cli\u003eAgarwal S, Sripad P, Johnson C, et al. A conceptual framework for measuring community health workforce performance within primary health care systems. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2019;17:86.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Central Hospital Phnom Penh","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antenatal Care, Digital Health, Human-Centered Design, Low-Resource Settings, Maternal Health, Workflow Optimization, Mobile Health Applications, Continuous Quality Improvement","lastPublishedDoi":"10.21203/rs.3.rs-8188118/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8188118/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Antenatal care (ANC) in low-resource urban hospitals faces persistent challenges, including workflow inefficiencies, limited digital integration, and inconsistent patient engagement. The COVID-19 pandemic has highlighted the urgent need for resilient, technology-enabled ANC pathways [1, 2].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To propose a human-centered, digitally integrated framework for ANC redesign in low-resource urban hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A human-centered design and systems-thinking approach was applied to map existing ANC workflows at a tertiary hospital in Cambodia. Published evidence on digital health interventions, maternal risk stratification, and patient engagement guided framework development [3-5]. Simulation diagrams and workflow models illustrate the proposed redesign.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The framework integrates: (1) risk-based digital triage; (2) mobile health applications for appointment management and patient education; (3) workflow optimization with task-shifting and real-time monitoring; and (4) continuous quality improvement via dashboards. Figures demonstrate redesigned workflows and risk triage, while tables summarize interventions, anticipated benefits, and implementation barriers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This integrated ANC redesign offers a scalable approach to enhance efficiency, quality, and equity in maternal care. Implementation at a tertiary hospital in Cambodia provides proof-of-concept insights applicable to other low- and middle-income urban hospitals.\u003c/p\u003e","manuscriptTitle":"Human-Centered Digital Redesign of Antenatal Care in Low-Resource Urban Hospitals: A Case Study from a Tertiary Hospital in Cambodia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 08:42:05","doi":"10.21203/rs.3.rs-8188118/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10e863bb-db83-41c5-9b57-3913544d2d6c","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59072948,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-12-04T08:42:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 08:42:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8188118","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8188118","identity":"rs-8188118","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}