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Haq ZU, Naeem A, Zaeem D, Sohail M, Pervaiz NUA. Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study. JMIRX MED 2024; 5:e48213. [PMID: 39087559 PMCID: PMC11300676 DOI: 10.2196/48213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
Background Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers' self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time.
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Affiliation(s)
| | | | | | - Mohina Sohail
- Alliance for Behavioural Communication & Development, Islamabad, Pakistan
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Khatri R, Rimal P, Ekstrand ML, Sapkota S, Sigdel K, Sharma D, Shrestha J, Shrestha S, Acharya B. Community health workers' barriers and facilitators to use a novel mHealth tool for motivational interviewing to improve adherence to care among youth living with HIV in rural Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002911. [PMID: 38990929 PMCID: PMC11238997 DOI: 10.1371/journal.pgph.0002911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/14/2024] [Indexed: 07/13/2024]
Abstract
Adherence to treatment regimens is a common challenge in achieving HIV control, especially among youth. Motivational Interviewing (MI) is an evidence-based intervention to facilitate behavior change (such as adherence to treatment) by focusing on the client's priorities and motivations. Community Health Workers (CHWs), who are well situated to engage clients for care, can use MI but studies have shown that they often lose MI skills. While mHealth tools can support CHWs in delivering evidence-based counseling techniques such as MI, it is important to understand the barriers and facilitators in using such tools. Our parent study includes developing and testing a novel mHealth tool called, Community based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+). In this descriptive qualitative study, we share the results from semi-structured interviews with 12 CHWs who used COMMIT+ to engage youth living with HIV, and 7 of their Community Health Nurse supervisors. Our results demonstrate the barriers and facilitators experienced by CHWs in using a mHealth tool to deliver MI for youth living with HIV in rural Nepal, and highlight that supportive supervision and user-friendly features of the tool can mitigate many of the barriers.
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Affiliation(s)
- Rekha Khatri
- Research and Innovation Function, Possible, Kathmandu, Nepal
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Pragya Rimal
- Research and Innovation Function, Possible, Kathmandu, Nepal
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Maria L Ekstrand
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, California, United States of America
| | - Sabitri Sapkota
- Research and Innovation Function, Possible, Kathmandu, Nepal
| | - Kripa Sigdel
- Research and Innovation Function, Possible, Kathmandu, Nepal
- Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Dikshya Sharma
- Research and Innovation Function, Possible, Kathmandu, Nepal
| | - Jene Shrestha
- Research and Innovation Function, Possible, Kathmandu, Nepal
| | - Srijana Shrestha
- Department of Psychology, Wheaton College, Norton, Massachusetts, United States of America
- Possible, New York, NY, United States of America
| | - Bibhav Acharya
- Possible, New York, NY, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, United States of America
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Ali Sherazi B, Läer S, Hasanbegovic S, Obarcanin E. Evaluating usability of and satisfaction with mHealth app in rural and remote areas-Germany GIZ collaboration in Bosnia-Herzegovina to optimize type 1 diabetes care. Front Digit Health 2024; 6:1338857. [PMID: 38952745 PMCID: PMC11215199 DOI: 10.3389/fdgth.2024.1338857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) management in children and adolescents requires intensive supervision and monitoring to prevent acute and late diabetes complications and to improve quality of life. Digital health interventions, in particular diabetes mobile health apps (mHealth apps) can facilitate specialized T1DM care in this population. This study evaluated the initial usability of and satisfaction with the m-Health intervention Diabetes: M app, and the ease of use of various app features in supporting T1DM care in rural and remote areas of Bosnia-Herzegovina with limited access to specialized diabetes care. Methods This cross-sectional study, performed in February-March 2023, evaluated T1DM pediatric patients who used the Diabetes: M app in a 3-month mHealth-based T1DM management program, along with their parents and healthcare providers (HCPs). All participants completed self-administered online questionnaires at the end of the 3-month period. Data were analyzed by descriptive statistics. Results The study population included 50 T1DM patients (children/parents and adolescents) and nine HCPs. The mean ± SD age of the T1DM patients was 14 ± 4.54 years, with 26 (52%) being female. The mean ± SD age of the HCPs was 43.4 ± 7.76 years; all (100%) were women, with a mean ± SD professional experience of 17.8 ± 8.81 years. The app was reported usable in the domains of ease-of-use and satisfaction by the T1DM children/parents (5.82/7.0), T1DM adolescents/young adults (5.68/7.0), and HCPs (5.22/7.0). Various app features, as well as the overall app experience, were rated positively by the participants. Conclusion The results strongly support the usability of mHealth-based interventions in T1DM care, especially in overcoming care shortage and improving diabetes management and communications between HCPs and patients. Further studies are needed to compare the effectiveness of apps used to support T1DM management with routine care.
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Affiliation(s)
- Bushra Ali Sherazi
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Düsseldorf, Germany
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Stephanie Läer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Düsseldorf, Germany
| | | | - Emina Obarcanin
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Düsseldorf, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Hailemariam T, Atnafu A, Gezie L, Kaasbøll J, Klein J, Tilahun B. Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model. JMIR Hum Factors 2024; 11:e47081. [PMID: 38437008 PMCID: PMC10949131 DOI: 10.2196/47081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. OBJECTIVE This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision. METHODS A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. RESULTS A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS. CONCLUSIONS HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.
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Affiliation(s)
- Tesfahun Hailemariam
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jens Kaasbøll
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Jorn Klein
- Department of Nursing and Health Sciences Campus Porsgrunn, University of South-Eastern Norway, Porsgrunn, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Feldacker C, Mugwanya R, Irongo D, Kathumba D, Chiwoko J, Kitsao E, Sippell K, Wasunna B, Jonas K, Samala B, Mwakanema D, Oni F, Jafa K, Tweya H. A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation. JMIR Form Res 2023; 7:e48671. [PMID: 37948102 PMCID: PMC10674144 DOI: 10.2196/48671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. OBJECTIVE This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. METHODS Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT's real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT's EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington's International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, "community-based ART retention and suppression" (CARES). CARES aims to bring EMRS-like provider benefits to NCAP's DSD clients. RESULTS CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. CONCLUSIONS Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage.
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Affiliation(s)
- Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, WA, United States
- International Training and Education Center for Health, Seattle, WA, United States
| | | | | | | | | | | | | | | | | | | | - Daniel Mwakanema
- International Training and Education Center for Health, Lilongwe, Malawi
| | | | | | - Hannock Tweya
- Department of Global Health, University of Washington, Seattle, WA, United States
- International Training and Education Center for Health, Lilongwe, Malawi
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Hailiye Teferi G, Tadele MM, Tizazu G, Hordofa ZR, Shimie AW, Assaye BT, Senishaw AF, Tizie SB. Utilization of mobile health applications and determinant factors among health science students at Debre Markos University, northwest Ethiopia in 2022. PLoS One 2023; 18:e0275689. [PMID: 37440563 PMCID: PMC10343100 DOI: 10.1371/journal.pone.0275689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND High penetration of smartphones and ownership among the young generation increased the utilization of mobile health applications for health management among university students more than ever. Compared to other health service provision mechanisms mobile health service has higher advantages in promoting a healthy lifestyle since it is not limited to time and space. Even though there are numerous studies conducted in the area of mobile health utilization, this phenomenon is not well studied among university students in Ethiopia, Hence this study aims to determine the level of mobile health applications utilization among health science students. METHOD A cross-sectional study was carried out at Debre Markos University from April 05 to June 25, 2022 among health science students. For this study, 423 students were recruited from health Science College using a systematic sampling method. The data was gathered using a self-administered questionnaire. Using SPSS version 26 software descriptive analysis, bivariate and multivariable logistic regressions were performed. A P-value of .05 at a 95% confidence interval was considered statistically significant. The questionnaire's validity was determined by expert opinion, and by calculating its reliability using cronbach alpha (α = .78). RESULT This study revealed that more than half 59% (144/244) of the study participants have installed and utilized 1-3 health-related apps. Among the students who have mobile health applications 38.6% utilize mobile health application several times a day while only 2.1% utilized rarely. Usage history shows that 40% of the study participants utilized the applications for a year, while 15.4% of the students utilized them for more than 2 years. Easiness of applications (AOR = 4.8, 95%CI: [2.1-11.2]), skill AOR = 4.2, 95%CI: [3.8-12]) and trust (AOR = 2.8, 95%CI: [1.6-4.8]) were among the factors that were associated with mobile health applications utilization. Students were asked about the barriers that limit the use mobile health applications and self-reported barriers includes Lack of knowledge and awareness of application benefits, and Lack of adequate time to use applications. CONCLUSION The study shows that mobile health applications utilization is moderate relative to previous studies. Mobile health application developers for the young generation should consider healthy lifestyle related applications like fitness and weight loss apps.
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Affiliation(s)
- Gizaw Hailiye Teferi
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Maru Meseret Tadele
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getaye Tizazu
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Zegeye Regasa Hordofa
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Aynadis Worku Shimie
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bayou Tilahun Assaye
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Andualem Fentahun Senishaw
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sefefe Birhanu Tizie
- Health Informatics Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Goodman A, Mahoney R, Spurling G, Lawler S. Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review. JMIR Mhealth Uhealth 2023; 11:e45162. [PMID: 37351947 PMCID: PMC10337452 DOI: 10.2196/45162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/07/2023] [Accepted: 04/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. OBJECTIVE This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. METHODS In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. RESULTS Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. CONCLUSIONS This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery.
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Affiliation(s)
- Andrew Goodman
- School of Public Health, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
- Australian eHealth Research Centre (AEHRC), Commonwealth Scientific and Industrial Research Organisation (CSIRO), Turrbal, Jagera Country, Herston, Australia
| | - Ray Mahoney
- College of Medicine and Public Health, Flinders University, Kaurna Country, Adelaide, Australia
| | - Geoffrey Spurling
- General Practice Clinical Unit, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
| | - Sheleigh Lawler
- School of Public Health, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
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Hailemariam T, Atnafu A, Gezie LD, Kaasbøll JJ, Klein J, Tilahun B. Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia. BMC Health Serv Res 2023; 23:644. [PMID: 37328840 DOI: 10.1186/s12913-023-09629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation. METHOD We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings. RESULTS First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders' engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis. CONCLUSION The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.
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Affiliation(s)
- Tesfahun Hailemariam
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Health Informatics, College of Health Sciences, Hawassa, Ethiopia.
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Jörn Klein
- Department of Nursing and Health Sciences Campus Porsgrunn, University of South-Eastern Norway, Porsgrunn, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bogale TN, Teklehaimanot SM, Fufa Debela T, Enyew DB, Nigusse Bedada A, Dufera Kebebew S, Nigusie Weldeab A, Wolde Daka D, Willems HJ, Bekele TA. Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia. Front Digit Health 2023; 5:1162239. [PMID: 37351371 PMCID: PMC10282640 DOI: 10.3389/fdgth.2023.1162239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023] Open
Abstract
Background The electronic community health information system (eCHIS) has been implemented in Ethiopia to support health services delivered by community health workers. Despite the many benefits of digitizing community health information systems, the implementation of the eCHIS is challenged by many barriers resulting in low uptake. This study assessed the barriers, facilitators, and motivators of eCHIS use among health workers with focus on health extension workers (HEWs) in Ethiopia. Methods Phenomenological approach was used to assess the barriers, facilitators and motivators of eCHIS use in Amhara, Harari, Oromia, Sidama, South West Ethiopia and Southern Nation Nationalities and People's regions of Ethiopia. Data were collected from 15-29 May 2022. A total of 54 face-to-face in-depth interviews were conducted among HEWs, HEW supervisors, health information technicians and managers. The interviews were audiotaped using Open Data Kit, transcribed verbatim and translated into English. OpenCode 4.03 software was used for coding and categorizing the data. Thematic analysis was used to analyze the data. Results The HEWs and other eCHIS users reported lack of infrastructure and resources; poor quality of training, follow-up, and supervision; parallel recording using the manual and electronic system; and HEWs' workload as barriers hindering eCHIS use. Data quality, retrievability, and traceability; tablet portability; encouragement from supervisors; and positive image in the community resulting from HEWs using tablets in their routine activities were the main facilitators of eCHIS use. Conclusion The study identified various barriers that adversely affect the use of eCHIS. An integrated and coordinated approach to eCHIS implementation that encompasses removing the barriers, and reinforcing facilitators is required.
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Affiliation(s)
| | | | - Tilahun Fufa Debela
- Department of Health Service Management, School of Public Health, Jimma University, Jimma, Ethiopia
| | - Daniel Berhanie Enyew
- Department of Health Informatics, School of Public Health, Haramaya University, Haramaya, Ethiopia
| | | | | | - Adane Nigusie Weldeab
- Department of Health Promotion & Health Behavior, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Dawit Wolde Daka
- Department of Health Service Management, School of Public Health, Jimma University, Jimma, Ethiopia
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Itanyi IU, Iwelunmor J, Olawepo JO, Gbadamosi S, Ezeonu A, Okoli A, Ogidi AG, Conserve D, Powell B, Onoka CA, Ezeanolue EE. Acceptability and user experiences of a patient-held smart card for antenatal services in Nigeria: a qualitative study. BMC Pregnancy Childbirth 2023; 23:198. [PMID: 36949403 PMCID: PMC10031993 DOI: 10.1186/s12884-023-05494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. METHODS Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. RESULTS The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. CONCLUSION These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.
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Affiliation(s)
- Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, USA
| | - John Olajide Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Semiu Gbadamosi
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Alexandra Ezeonu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Adaeze Okoli
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Donaldson Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, USA
| | - Byron Powell
- Brown School, Washington University in St. Louis, Washington, USA
| | - Chima Ariel Onoka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
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11
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Greuel M, Sy F, Bärnighausen T, Adam M, Vandormael A, Gates J, Harling G. Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e42023. [PMID: 36811947 PMCID: PMC9996418 DOI: 10.2196/42023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs' lack of adequate supplies. The rising penetration of "smart" technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field. OBJECTIVE This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change. METHODS We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework. RESULTS We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients-and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap. CONCLUSIONS Smart mobile devices may augment CHWs' field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point.
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Affiliation(s)
- Merlin Greuel
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Frithjof Sy
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Maya Adam
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Gates
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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12
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Addotey-Delove M, Scott RE, Mars M. Healthcare Workers' Perspectives of mHealth Adoption Factors in the Developing World: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1244. [PMID: 36673995 PMCID: PMC9858911 DOI: 10.3390/ijerph20021244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND mHealth applications provide health practitioners with platforms that enable disease management, facilitate drug adherence, facilitate drug adherence, speed up diagnosis, monitor outbreaks, take and transfer medical images, and provide advice. Many developing economies are investing more in mobile telecommunication infrastructure than in road transport and electric power generation. Despite this, mHealth has not seen widespread adoption by healthcare workers in the developing world. This study reports a scoping review of factors that impact the adoption of mHealth by healthcare workers in the developing world, and based on these findings, a framework is developed for enhancing mHealth adoption by healthcare workers in the developing world. METHODS A structured literature search was performed using PubMed and Scopus, supplemented by hand searching. The searches were restricted to articles in English during the period January 2009 to December 2019 and relevant to the developing world that addressed: mobile phone use by healthcare workers and identified factors impacting the adoption of mHealth implementations. All authors reviewed selected papers, with final inclusion by consensus. Data abstraction was performed by all authors. The results were used to develop the conceptual framework using inductive iterative content analysis. RESULTS AND DISCUSSION Of 919 articles, 181 met the inclusion criteria and, following a review of full papers, 85 reported factors that impact (promote or impede) healthcare worker adoption of mHealth applications. These factors were categorised into 18 themes and, after continued iterative review and discussion were reduced to 7 primary categories (engagement/funding, infrastructure, training/technical support, healthcare workers' mobile-cost/ownership, system utility, motivation/staffing, patients' mobile-cost/ownership), with 17 sub-categories. These were used to design the proposed framework. CONCLUSIONS Successful adoption of mHealth by healthcare workers in the developing world will depend on addressing the factors identified in the proposed framework. They must be assessed in each specific setting prior to mHealth implementation. Application of the proposed framework will help shape future policy and practice of mHealth implementation in the developing world and increase adoption by health workers.
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Affiliation(s)
- Michael Addotey-Delove
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
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13
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Sathiyamoorthy R, Chandra A, Poudel S, Kumar R, Salve HR, Yadav K, Kant S. Sub-optimal knowledge with positive attitude and belief of frontline health workers toward the use of information technologies: A mixed-method study from rural Haryana, India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:419. [PMID: 36824093 PMCID: PMC9942148 DOI: 10.4103/jehp.jehp_406_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Information technology (IT) can be used by frontline health workers (FLWs) to connect and deliver care to the community. Various studies in India have assessed the beneficial impact of IT usage by FLWs, but for the long-term sustainability, the attitude and belief toward IT usage have not been adequately studied. We conducted this study to assess the knowledge and attitude and to explore the beliefs of FLWs toward the use of IT in a rural area of Haryana. MATERIALS AND METHODS We conducted a mixed-method study (qualitative and quantitative approach) in a rural setting of Haryana, India. We included FLWs of two primary health centers (PHCs). Data were collected from October 19, 2020 to December 31, 2020. We collected data from 75 accredited social health activists (ASHAs), 37 Anganwadi workers (AWWs), 28 multi-purpose workers (MPWs), two information assistants, and two medical officers using a semi-structured interview schedule. Their knowledge about the benefits of IT use, past use of IT applications and devices, and self-rating of knowledge regarding computers or laptops were collected. We used 14 attitude statements, each with a five-point Likert scale to assess the attitude; a total score ≥35 was considered a positive attitude. We conducted eight focus group discussions (FGDs) to explore the beliefs regarding IT usage (four FGDs with ASHAs, two FGDs with AWWs, and two FGDs with MPWs). A descriptive analysis was performed for the quantitative data, and a thematic analysis was performed for qualitative data. RESULTS Knowledge about the benefits of IT use was present among 77.8% of FLWs. Among the FLWs, 79.2% self-rated their knowledge of computers/laptops as 'do not have knowledge', 16% self-rated as 'low knowledge', and 4.8% self-rated as 'good knowledge'. The median total score for attitude statements among all the FLWs (n = 144) was 54 [inter-quartile range - 48-59]. Four themes emerged for beliefs toward IT usage, namely, positive beliefs, negative beliefs, challenges anticipated in adopting IT use, and facilitation factors. The positive beliefs were related to improvement in work efficiency and social status, less paperwork, timely report generation, and better learning. The negative beliefs were related to an increase in working hours, close monitoring, and feeling over-burdened. CONCLUSION We found that FLWs had knowledge regarding the benefits of IT use, but they lacked knowledge regarding laptop/computer use. They had a satisfactory level of confidence in using smartphones, and most of them were using mobile applications. The majority of the FLWs had a positive attitude and beliefs toward IT use and wanted to use it in the future.
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Affiliation(s)
- Ramadass Sathiyamoorthy
- Department of Community Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
| | - Ankit Chandra
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sagar Poudel
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Harshal R. Salve
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Akinsulore A, Aloba O, Oginni O, Oloniniyi I, Ibigbami O, Seun-Fadipe CT, Opakunle T, Owojuyigbe AM, Olibamoyo O, Mapayi B, Okorie VO, Adewuya AO. Developing an mHealth Intervention to Reduce COVID-19-Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study. JMIR Res Protoc 2022; 11:e36174. [PMID: 36318638 PMCID: PMC9674083 DOI: 10.2196/36174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, COVID-19-related psychological distress is seriously eroding health care workers' mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19-related psychological distress among health care workers in Nigeria. OBJECTIVE Our objective is to present a study protocol to determine the level of COVID-19-related psychological distress among health care workers in Nigeria; explore health care workers' experience of COVID-19-related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). METHODS A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. RESULTS This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. CONCLUSIONS This is the first study to report the development of an mHealth-based intervention to reduce COVID-19-related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19-related psychological distress among health care workers in Nigeria. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36174.
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Affiliation(s)
- Adesanmi Akinsulore
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olutayo Aloba
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olakunle Oginni
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Ibidunni Oloniniyi
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olanrewaju Ibigbami
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Tolulope Opakunle
- Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria
| | - Afolabi Muyiwa Owojuyigbe
- Department of Anaesthesia and Intensive Care, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Anaesthesia and Intensive Care, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olushola Olibamoyo
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Victor Ogbonnaya Okorie
- Department of Agricultural Extension and Rural Development, Obafemi Awolowo University, Ile-Ife, Nigeria
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15
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van Gelder N, Ligthart S, ten Elzen J, Prins J, van Rosmalen-Nooijens K, Oertelt-Prigione S. "If I'd Had Something Like SAFE at the Time, Maybe I Would've Left Him Sooner."-Essential Features of eHealth Interventions for Women Exposed to Intimate Partner Violence: A Qualitative Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18341-NP18375. [PMID: 34355982 PMCID: PMC9554282 DOI: 10.1177/08862605211036108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Approximately one in three women worldwide experiences intimate partner violence and abuse (IPVA) in her lifetime. Despite its frequent occurrence and severe consequences, women often refrain from seeking help. eHealth has the potential to remove some of the barriers women face in help seeking and disclosing. To guarantee the client-centeredness of an (online) intervention it is important to involve the target group and people with expertise in the development process. Therefore, we conducted an interview study with survivors and professionals, in order to assess needs, obstacles, and wishes with regard to an eHealth intervention for women experiencing IPVA. Semi-structured interviews were conducted with 16 women (8 survivors and 8 professionals) between 22 and 52 years old, with varied experiences of IPVA and help. Qualitative data was analyzed using a grounded theory approach and open thematic coding. During analysis we identified a third stakeholder group within the study population: survivor-professionals, with both personal experiences of and professional knowledge on IPVA. All stakeholder groups largely agree on the priorities for an eHealth intervention: safety, acknowledgment, contact with fellow survivors, and help. Nevertheless, the groups offer different perspectives, with the survivor-professionals functioning as a bridge group between the survivors and professionals. The groups prioritize different topics. For example, survivors and survivor-professionals highlighted the essential need for safety, while professionals underlined the importance of acknowledgment. Survivor-professionals were the only ones to emphasize the importance of addressing various life domains. The experiences of professionals and survivors highlight a broad range of needs and potential obstacles for eHealth interventions. Consideration of these findings could improve the client-centeredness of existing and future (online) interventions for women experiencing IPVA.
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Affiliation(s)
| | | | | | - Judith Prins
- Radboud University Medical Center,
Nijmegen, Netherlands
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16
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Jembai JVJ, Wong YLC, Bakhtiar NAMA, Lazim SNM, Ling HS, Kuan PX, Chua PF. Mobile health applications: awareness, attitudes, and practices among medical students in Malaysia. BMC MEDICAL EDUCATION 2022; 22:544. [PMID: 35836223 PMCID: PMC9282901 DOI: 10.1186/s12909-022-03603-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The popularity of mobile health (mHealth) applications (or apps) in the field of health and medical education is rapidly increasing, especially since the COVID-19 pandemic. We aimed to assess awareness, attitudes, practices, and factors associated with the mHealth app usage among medical students. METHODS We conducted a cross-sectional study involving medical students at a government university in Sarawak, Malaysia, from February to April 2021. Validated questionnaires were administered to all consenting students. These questionnaires included questions on basic demographic information as well as awareness, attitude toward, and practices with mHealth apps concerned with medical education, health and fitness, and COVID-19 management. RESULTS Respondents had favorable attitudes toward mHealth apps (medical education [61.8%], health and fitness [76.3%], and COVID-19 management [82.7%]). Respondents' mean attitude scores were four out of five for all three app categories. However, respondents used COVID-19 management apps more frequently (73.5%) than those for medical education (35.7%) and fitness (39.0%). Usage of all three app categories was significantly associated with the respondent's awareness and attitude. Respondents in the top 20% in term of household income and study duration were more likely to use medical education apps. The number of respondents who used COVID-19 apps was higher in the top 20% household income group than in the other income groups. The most common barrier to the use of apps was uncertainty regarding the most suitable apps to choose. CONCLUSION Our study highlighted a discrepancy between awareness of mHealth apps and positive attitudes toward them and their use. Recognition of barriers to using mHealth apps by relevant authorities may be necessary to increase the usage of these apps.
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Affiliation(s)
| | - Yi Lin Charlene Wong
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Saramahan, Sarawak, Malaysia
| | | | - Siti Nursuraya Md Lazim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Saramahan, Sarawak, Malaysia
| | - Hwei Sung Ling
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Saramahan, Sarawak, Malaysia
| | - Pei Xuan Kuan
- Digital Health Research and Innovation, Institute for Clinical Research, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Pin Fen Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Saramahan, Sarawak, Malaysia.
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17
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Rodrigues SM, Kanduri A, Nyamathi A, Dutt N, Khargonekar P, Rahmani AM. Digital Health-Enabled Community-Centered Care: Scalable Model to Empower Future Community Health Workers Using Human-in-the-Loop Artificial Intelligence. JMIR Form Res 2022; 6:e29535. [PMID: 35384853 PMCID: PMC9021941 DOI: 10.2196/29535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/29/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Abstract
Digital health-enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker-delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Anil Kanduri
- Department of Computing, University of Turku, Turku, Finland
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Nikil Dutt
- Department of Computer Science, University of California, Irvine, CA, United States
| | - Pramod Khargonekar
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
| | - Amir M Rahmani
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
- Department of Computer Science, University of California, Irvine, CA, United States
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
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18
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Stokes K, Oronti B, Cappuccio FP, Pecchia L. Use of technology to prevent, detect, manage and control hypertension in sub-Saharan Africa: a systematic review. BMJ Open 2022; 12:e058840. [PMID: 35383086 PMCID: PMC8984054 DOI: 10.1136/bmjopen-2021-058840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA). DESIGN Systematic review. DATA SOURCES Medline, Embase, Scopus and Web of Science. ELIGIBILITY CRITERIA Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA. METHODS Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool. RESULTS 1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified. CONCLUSIONS There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies. PROSPERO REGISTRATION NUMBER CRD42020223043.
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Affiliation(s)
- Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | - Busola Oronti
- School of Engineering, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
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Li S, Yin Z, Lesser J, Li C, Choi BY, Parra-Medina D, Flores B, Dennis B, Wang J. A Community Health Worker-Led mHealth-Enabled Diabetes Self-Management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial (Preprint). JMIR Diabetes 2022; 7:e37534. [PMID: 35635752 PMCID: PMC9153909 DOI: 10.2196/37534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. Objective We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. Methods This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention’s effect on weight loss and hemoglobin A1c (HbA1c). Results All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60%). The retention rate at posttest was 14 of 15 (93%). On average, the participants completed 37 of 42 (88%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89%) step tracking, 71/91 days (78%) food logging, 43/91 days (47%) blood glucose self-monitoring, and 74/91 days (81%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91%, SD 1.28%) to posttest (7.04%, SD 1.66%; P=.668). Conclusions A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control.
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Affiliation(s)
- Shiyu Li
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Zenong Yin
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Janna Lesser
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Chengdong Li
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Deborah Parra-Medina
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - Belinda Flores
- South Coastal Area Health Education Center, Corpus Christi, TX, United States
| | - Brittany Dennis
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, United States
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Sowon K, Maliwichi P, Chigona W. The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review. JMIR Mhealth Uhealth 2022; 10:e22093. [PMID: 35084356 PMCID: PMC8832263 DOI: 10.2196/22093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/16/2021] [Accepted: 11/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness.
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Affiliation(s)
- Karen Sowon
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
| | - Priscilla Maliwichi
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
- Department of Computer Science and Information Technology, Malawi University of Science and Technology, Limbe, Malawi
| | - Wallace Chigona
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
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Melo WSD, Sousa IES, Mariano SPS, Barbosa AS, Feitosa DSLL, Freire VECDS, Melo ESJ, Monteiro FPM. Wise Infant Development®: creation of a software for teaching in pediatric nursing education. Rev Bras Enferm 2022; 75:e20210466. [DOI: 10.1590/0034-7167-2021-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to create a software application for nursing education on child development assessment. Methods: this is a methodological applied research developed in three stages: analysis, design, and development. Product quality characteristics from the ISO/IEC 25010 standards were adopted. The programming language used was JavaScript. The educational software was developed based on a constructivist cognitive theory. Results: it was possible to create the software from the following quality metrics: functional suitability, reliability, usability, performance efficiency, compatibility, security, maintainability, and portability. The technology addresses child development in physical, cognitive, and psychosocial domains and how this assessment should be carried out in Brazil. The software has pre and posttests, 5 learning modules, certificate issuance, support for doubts, and an administrative panel. Final Considerations: it is concluded that the software adds to the existing tools for child development monitoring, facilitating students’ knowledge acquisition in promoting child health.
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22
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Dinakrisma AA, Laksmi PW, Abdiel T, Fernandez JP, Indahwati N, Susanto AP, Indrajaya Lukmana AA, Yusuf PA. The role of digital mobile technology in elderly health management among health care workers in Indonesia: Analysis of knowledge, attitudes, and practice. Digit Health 2022; 8:20552076221102771. [PMID: 35646377 PMCID: PMC9131384 DOI: 10.1177/20552076221102771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Technology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers. Methods This was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020. Results There were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients. Conclusions The current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.
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Affiliation(s)
- Anastasia A. Dinakrisma
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Purwita Wijaya Laksmi
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teofilus Abdiel
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Johannes P. Fernandez
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nuri Indahwati
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anindya Pradipta Susanto
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Prasandhya Astagiri Yusuf
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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eHealth and mHealth Development in Spain: Promise or Reality? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413055. [PMID: 34948664 PMCID: PMC8700823 DOI: 10.3390/ijerph182413055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
In the last decades, the use of Information and Communication Technologies (ICTs) has progressively spread to society and public administration. Health is one of the areas in which the use of ICTs has more intensively developed through what is now known as eHealth. That area has recently included mHealth. Spanish health system has stood out as one of the benchmarks of this technological revolution. The development of ICTs applied to health, especially since the outbreak of the pandemic caused by SARS Cov-2, has increased the range of health services delivered through smartphones and the development of subsequent specialized apps. Based on the data of a Survey on Use and Attitudes regarding eHealth in Spain, the aim of this research was to conduct a comparative analysis of the different eHealth and mHealth user profiles. The results show that the user profile of eHealth an mHealth services in Spain is not in a majority. Weaknesses are detected both in the knowledge and use of eHealth services among the general population and in the usability or development of their mobile version. Smartphones can be a democratizing vector, as for now, access to eHealth services is only available to wealthy people, widening inequality.
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KÜRTÜNCÜ M, KURT A, ARSLAN N. AN EXAMINATION OF NURSES’ ACCEPTANCE OF MOBILE HEALTH APPLICATIONS. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.905574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nkosi-Gondwe T, Robberstad B, Mukaka M, Idro R, Opoka RO, Banda S, Kühl MJ, O. Ter Kuile F, Blomberg B, Phiri KS. Adherence to community versus facility-based delivery of monthly malaria chemoprevention with dihydroartemisinin-piperaquine for the post-discharge management of severe anemia in Malawian children: A cluster randomized trial. PLoS One 2021; 16:e0255769. [PMID: 34506503 PMCID: PMC8432777 DOI: 10.1371/journal.pone.0255769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background The provision of post-discharge malaria chemoprevention (PMC) in children recently admitted with severe anemia reduces the risk of death and re-admissions in malaria endemic countries. The main objective of this trial was to identify the most effective method of delivering dihydroartemesinin-piperaquine to children recovering from severe anemia. Methods This was a 5-arm, cluster-randomized trial among under-5 children hospitalized with severe anemia at Zomba Central Hospital in Southern Malawi. Children were randomized to receive three day treatment doses of dihydroartemesinin-piperaquine monthly either; 1) in the community without a short text reminder; 2) in the community with a short message reminder; 3) in the community with a community health worker reminder; 4) at the facility without a short text reminder; or 5) at the facility with a short message reminder. The primary outcome measure was adherence to all treatment doses of dihydroartemesinin-piperaquine and this was assessed by pill-counts done by field workers during home visits. Poisson regression was utilized for analysis. Results Between March 2016 and October 2018, 1460 clusters were randomized. A total of 667 children were screened and 375 from 329 clusters were eligible and enrolled from the hospital. Adherence was higher in all three community-based compared to the two facility-based delivery (156/221 [70·6%] vs. 78/150 [52·0%], IRR = 1·24,95%CI 1·06–1·44, p = 0·006). This was observed in both the SMS group (IRR = 1·41,1·21–1·64, p<0·001) and in the non-SMS group (IRR = 1·37,1·18–1·61, p<0·001). Although adherence was higher among SMS recipients (98/148 66·2%] vs. non-SMS 82/144 (56·9%), there was no statistical evidence that SMS reminders resulted in greater adherence ([IRR = 1·03,0·88–1·21, p = 0·68). When compared to the facility-based non-SMS arm (control arm), community-based delivery utilizing CHWs resulted in higher adherence [39/76 (51·3%) vs. 54/79 (68·4%), IRR = 1·32, 1·14–1·54, p<0·001]. Interpretation Community-based delivery of dihydroartemesinin-piperaquine for post-discharge malaria chemoprevention in children recovering from severe anemia resulted in higher adherence compared to facility-based methods. Trial registration NCT02721420; ClinicalTrials.gov.
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Affiliation(s)
- Thandile Nkosi-Gondwe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard Idro
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert O. Opoka
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Saidon Banda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Melf-Jakob Kühl
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Feiko O. Ter Kuile
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bjorn Blomberg
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kamija S. Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis. HEALTH EDUCATION 2021. [DOI: 10.1108/he-12-2020-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Physicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).
Design/methodology/approach
In-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.
Findings
The perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.
Originality/value
Studies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.
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Ward V, Abdalla S, Raheel H, Weng Y, Godfrey A, Dutt P, Mitra R, Sastry P, Chamberlain S, Shannon M, Mehta K, Bentley J, Darmstadt Md GL. Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India. BMJ Glob Health 2021; 6:bmjgh-2021-005538. [PMID: 34312155 PMCID: PMC8728373 DOI: 10.1136/bmjgh-2021-005538] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION As part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care. METHODS Data from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed. RESULTS Exposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others. CONCLUSION BBC Media Action's mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings. TRIAL REGISTRATION NUMBER NCT02726230.
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Affiliation(s)
- Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Hina Raheel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitaitve Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | - Kala Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jason Bentley
- Quantitaitve Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Gary L Darmstadt Md
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Yoon S, Goh H, Nadarajan GD, Sung S, Teo I, Lee J, Ong MEH, Graves N, Teo TL. Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study. J Med Internet Res 2021; 23:e26282. [PMID: 33979296 PMCID: PMC8168635 DOI: 10.2196/26282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. OBJECTIVE This study aimed to explore frontline workers' experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. METHODS We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies-those commonly used for mHealth development-to assess participants' preferences for particular features and their reasoning. RESULTS A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. CONCLUSIONS Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Sharon Sung
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Irene Teo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Jungup Lee
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Marcus E H Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Tess Lin Teo
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Whitaker J, O'Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, Davies JI. Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021; 6:e004324. [PMID: 33975885 PMCID: PMC8118008 DOI: 10.1136/bmjgh-2020-004324] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles. METHODS We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment. RESULTS Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment. CONCLUSIONS Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Max Denning
- Department of Surgery and Cancer, Imperial College London, London, UK
- Stanford Graduate School of Business, Stanford University, Stanford, California, USA
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Winders WT, Garbern SC, Bills CB, Relan P, Schultz ML, Trehan I, Kivlehan SM, Becker TK, McQuillan R. The effects of mobile health on emergency care in low- and middle-income countries: A systematic review and narrative synthesis. J Glob Health 2021; 11:04023. [PMID: 33828846 PMCID: PMC8021077 DOI: 10.7189/jogh.11.04023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In resource-constrained settings, mobile health (mHealth) has varied applications. While there is strong evidence for its use in chronic disease management, the applications of mHealth for management of acute illness in low- and middle-income countries (LMICs) are not as well described. This review systematically explores current available evidence on the effectiveness of mHealth interventions at improving health outcomes in emergency care settings in LMICs. METHODS A systematic search of the literature was performed in accordance with PRISMA guidelines, utilizing seven electronic databases and manual searches to identify peer-reviewed literature containing each of three search elements: mHealth, emergency care (EC), and LMICs. Articles quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS After removing duplicates, 6498 studies met initial search criteria; 108 were eligible for full text review and 46 met criteria for inclusion. Thirty-six pertained to routine emergency care, and 10 involved complex humanitarian emergencies. Based on the GRADE criteria, 15 studies were rated as "Very Low" quality, 24 as "Low" quality, 6 as "Moderate" quality, and 1 as "High" quality. Eight studied data collection, 9 studied decision support, 15 studied direct patient care, and 14 studied health training. All 46 studies reported positive impacts of mHealth on EC in LMICs. CONCLUSIONS Mobile health interventions can be effective in improving provider-focused and patient-centered outcomes in both routine and complex EC settings. Future investigations focusing on patient-centered outcomes are needed to further validate these findings.
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Affiliation(s)
- W Tyler Winders
- School of Public Health, University of Edinburgh, Edinburgh, UK
| | - Stephanie C Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Pryanka Relan
- Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA
| | - Megan L Schultz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Indi Trehan
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Ruth McQuillan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, Still CH, Wang TY, Wenger NK. Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2021; 14:e000103. [PMID: 33793309 DOI: 10.1161/hcq.0000000000000103] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.
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Jansen R, Reid M. Interest in Communication Technology by Rural Caregivers of Adolescents with Mental Health Issues in South Africa: The Mmogo-Method ®. Issues Ment Health Nurs 2021; 42:24-37. [PMID: 32633169 DOI: 10.1080/01612840.2020.1774017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Caregivers determine the level of care adolescents with mental issues receive; however, caregivers' own needs are often unmet. Communication technology can be tailored to address these challenges, especially in a rural environment. This study aimed to explore caregivers' interest in using communication technology to provide support to address challenges. This study involved a visual-based narrative inquiry that gathered data through the Mmogo-method®. Three (n = 3) groups were held with rural caregivers (n = 17) of adolescents with mental health issues in a rural area in the Free State province of South Africa during 2017. Three themes captured challenges confronting caregivers, namely, psychosocial, social resources, and informational challenges. Interest in communication technology was captured in a fourth theme. The findings indicate that communication technology can address caregivers' challenges by providing support and information to caregivers in rural areas. Communication technology, including mobile phones, electronic devices, and the Internet, has transformed healthcare services and proved to be valuable in resource constraint environments.
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Affiliation(s)
- Ronelle Jansen
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Ramakrishnan R, Rao S, He JR. Perinatal health predictors using artificial intelligence: A review. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211046132. [PMID: 34519596 PMCID: PMC8445524 DOI: 10.1177/17455065211046132] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Advances in public health and medical care have enabled better pregnancy and birth outcomes. The rates of perinatal health indicators such as maternal mortality and morbidity; fetal, neonatal, and infant mortality; low birthweight; and preterm birth have reduced over time. However, they are still a public health concern, and considerable disparities exist within and between countries. For perinatal researchers who are engaged in unraveling the tangled web of causation for maternal and child health outcomes and for clinicians involved in the care of pregnant women and infants, artificial intelligence offers novel approaches to prediction modeling, diagnosis, early detection, and monitoring in perinatal health. Machine learning, a commonly used artificial intelligence method, has been used to predict preterm birth, birthweight, preeclampsia, mortality, hypertensive disorders, and postpartum depression. Real-time electronic health recording and predictive modeling using artificial intelligence have found early success in fetal monitoring and monitoring of women with gestational diabetes especially in low-resource settings. Artificial intelligence-based methodologies have the potential to improve prenatal diagnosis of birth defects and outcomes in assisted reproductive technology too. In this scenario, we envision artificial intelligence for perinatal research to be based on three goals: (1) availability of population-representative, routine clinical data (rich multimodal data of large sample size) for perinatal research; (2) modification and application of current state-of-the-art artificial intelligence for prediction and classification in health care research to the field of perinatal health; and (3) development of methods for explaining the decision-making processes of artificial intelligence models for perinatal health indicators. Achieving these three goals via a multidisciplinary approach to the development of artificial intelligence tools will enable trust in these tools and advance research, clinical practice, and policies to ensure optimal perinatal health.
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Affiliation(s)
- Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shishir Rao
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Jian-Rong He
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Bechtel JM, Lepoire E, Bauer AM, Bowen DJ, Fortney JC. Care manager perspectives on integrating an mHealth app system into clinical workflows: A mixed methods study. Gen Hosp Psychiatry 2021; 68:38-45. [PMID: 33310012 DOI: 10.1016/j.genhosppsych.2020.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE mHealth can be a valuable means of monitoring symptoms and supporting care for rural patients, but barriers to implementation remain. This study aimed to examine care manager perspectives on the adoption, use and impact of an mHealth system deployed within a pragmatic Collaborative Care trial for rural patients with PTSD and/or Bipolar Disorder. METHOD Sixteen care managers at 12 Federally Qualified Health Centers in 3 states participated in semi-structured interviews. Interviews were transcribed, coded, and thematically analyzed using the Unified Theory of Adoption and Use of Technology as a conceptual framework. App metadata was used to assess the frequency of a care manager reported phenomenon, clinically disengaged app use. RESULTS 4 themes were identified: infrastructural limitations; redundant and incompatible clinical and mHealth workflows; cross platform and web access; and patient engagement and clinically disengaged app use. Most users had a period of consistently submitting symptom measures via the app while disengaged from care for >4 weeks.
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Affiliation(s)
- Jared M Bechtel
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA.
| | - Erin Lepoire
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - Amy M Bauer
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - Deborah J Bowen
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - John C Fortney
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
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Butler S, Sculley D, Santos DS, Fellas A, Gironès X, Singh-Grewal D, Coda A. Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review. JMIR Pediatr Parent 2020; 3:e15833. [PMID: 33258786 PMCID: PMC7738264 DOI: 10.2196/15833] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/27/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. OBJECTIVE This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. RESULTS A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. CONCLUSIONS The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Dean Sculley
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Derek Santos Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Antoni Fellas
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xavier Gironès
- Director of Research and Innovation, University of Vic-Central University of Catalonia, Manresa (Barcelona), Spain
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children's Hospitals Network, Randwick and Westmead, Sydney, New South Wales, Australia
- Department of Rheumatology, John Hunter Children's Hospital, Newcastle, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Andrea Coda
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
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Thindwa D, Farooq YG, Shakya M, Saha N, Tonks S, Anokwa Y, Gordon MA, Hartung C, Meiring JE, Pollard AJ, Heyderman RS. Electronic data capture for large scale typhoid surveillance, household contact tracing, and health utilisation survey: Strategic Typhoid Alliance across Africa and Asia. Wellcome Open Res 2020; 5:66. [PMID: 32934993 PMCID: PMC7471626 DOI: 10.12688/wellcomeopenres.15811.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Abstract
Electronic data capture systems (EDCs) have the potential to achieve efficiency and quality in collection of multisite data. We quantify the volume, time, accuracy and costs of an EDC using large-scale census data from the STRATAA consortium, a comprehensive programme assessing population dynamics and epidemiology of typhoid fever in Malawi, Nepal and Bangladesh to inform vaccine and public health interventions. A census form was developed through a structured iterative process and implemented using Open Data Kit Collect running on Android-based tablets. Data were uploaded to Open Data Kit Aggregate, then auto-synced to MySQL-defined database nightly. Data were backed-up daily from three sites centrally, and auto-reported weekly. Pre-census materials' costs were estimated. Demographics of 308,348 individuals from 80,851 households were recorded within an average of 14.7 weeks range (13-16) using 65 fieldworkers. Overall, 21.7 errors (95% confidence interval: 21.4, 22.0) per 10,000 data points were found: 13.0 (95% confidence interval: 12.6, 13.5) and 24.5 (95% confidence interval: 24.1, 24.9) errors on numeric and text fields respectively. These values meet standard quality threshold of 50 errors per 10,000 data points. The EDC's total variable cost was estimated at US$13,791.82 per site. In conclusion, the EDC is robust, allowing for timely and high-volume accurate data collection, and could be adopted in similar epidemiological settings.
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Affiliation(s)
- Deus Thindwa
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Yama G Farooq
- Centre for Clinical Vaccinology and Tropical Medicine, Department of Paediatrics, University of Oxford and the National Institute for Health, Oxford, UK
| | - Mila Shakya
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Nirod Saha
- International Centre for Diarrhoeal Diseases Research., Dhaka, Bangladesh
| | - Susan Tonks
- Centre for Clinical Vaccinology and Tropical Medicine, Department of Paediatrics, University of Oxford and the National Institute for Health, Oxford, UK
| | | | - Melita A Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - James E Meiring
- Centre for Clinical Vaccinology and Tropical Medicine, Department of Paediatrics, University of Oxford and the National Institute for Health, Oxford, UK
| | - Andrew J Pollard
- Centre for Clinical Vaccinology and Tropical Medicine, Department of Paediatrics, University of Oxford and the National Institute for Health, Oxford, UK
| | - Robert S Heyderman
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Division of Infection and Immunity, University College London, London, UK
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37
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Hunt X, Tomlinson M, Sikander S, Skeen S, Marlow M, du Toit S, Eisner M. Artificial Intelligence, Big Data, and mHealth: The Frontiers of the Prevention of Violence Against Children. Front Artif Intell 2020; 3:543305. [PMID: 33733202 PMCID: PMC7861328 DOI: 10.3389/frai.2020.543305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022] Open
Abstract
Violence against children is a global public health threat of considerable concern. At least half of all children worldwide experience violence every year; globally, the total number of children between the ages of 2 and 17 years who have experienced violence in any given year is one billion. Based on a review of the literature, we argue that there is substantial potential for AI (and associated machine learning and big data), and mHealth approaches to be utilized to prevent and address violence at a large scale. This potential is particularly marked in low- and middle-income countries (LMIC), although whether it could translate into effective solutions at scale remains unclear. We discuss possible entry points for Artificial Intelligence (AI), big data, and mHealth approaches to violence prevention, linking these to the World Health Organization's seven INSPIRE strategies. However, such work should be approached with caution. We highlight clear directions for future work in technology-based and technology-enabled violence prevention. We argue that there is a need for good agent-based models at the level of entire cities where and when violence can occur, where local response systems are. Yet, there is a need to develop common, reliable, and valid population- and individual/family-level data on predictors of violence. These indicators could be integrated into routine health or other information systems and become the basis of Al algorithms for violence prevention and response systems. Further, data on individual help-seeking behavior, risk factors for child maltreatment, and other information which could help us to identify the parameters required to understand what happens to cause, and in response to violence, are needed. To respond to ethical issues engendered by these kinds of interventions, there must be concerted, meaningful efforts to develop participatory and user-led work in the AI space, to ensure that the privacy and profiling concerns outlined above are addressed explicitly going forward. Finally, we make the case that developing AI and other technological infrastructure will require substantial investment, particularly in LMIC.
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Affiliation(s)
- Xanthe Hunt
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Marguerite Marlow
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Stefani du Toit
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
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Narla NP, Surmeli A, Kivlehan SM. Agile Application of Digital Health Interventions during the COVID-19 Refugee Response. Ann Glob Health 2020; 86:135. [PMID: 33117656 PMCID: PMC7566526 DOI: 10.5334/aogh.2995] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.
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Affiliation(s)
- Nirmala P. Narla
- Division of Medical Critical Care, Boston Children’s Hospital and Harvard Medical School, MA, US
| | - Aral Surmeli
- Medical Rescue Association of Turkey (MEDAK), Istanbul, TR
| | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, US
- Harvard Humanitarian Initiative, Cambridge, MA, US
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Aw M, Ochieng BO, Attambo D, Opot D, Aw J, Francis S, Hawkes MT. Critical appraisal of a mHealth-assisted community-based cardiovascular disease risk screening program in rural Kenya: an operational research study. Pathog Glob Health 2020; 114:379-387. [PMID: 32896232 DOI: 10.1080/20477724.2020.1816286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Community health workers (CHWs) can participate in the cascade of hypertension and diabetes management in low and middle-income countries (LMICs). Their services may be enhanced with mobile health (mHealth) tools. In this operational research study, we describe the AFYACHAT mHealth-assisted cardiovascular health screening program in rural Kenya. In this study, A CHW screened a convenience sample of adults ≥ 40 years old in rural Kenya for cardiovascular disease (CVD) risk using the two-way AFYACHAT mHealth instrument. AFYACHAT analyzes a patient's age, sex, smoking, diabetes and systolic blood pressure and provides a four-tiered 10-year CVD risk score. User acceptability was assessed by an end-of-study interview with the CWH. Automated error logs were analyzed. Patient satisfaction was measured with a six-question satisfaction questionnaire. Screened participants with high CVD risk were followed-up via telephone to explore any actions taken following screening. In 24 months, one CHW screened 1650 participants using AFYACHAT. The 10-year risk of CVD was <10% for 1611 (98%) patients, 10 to <20% for 26 (1.6%), 20 to <30% in 12 (0.7%), and ≥30% for 1 (0.1%). The point prevalence of hypertension and diabetes was 27% and 1.9%, respectively. Seventy-five percent of participants with elevated CVD risk sought further medical care. There was high acceptability, a 15% miscode error rate, and high participant satisfaction with the screening program. Our operational research outlines how AFYACHAT mHealth tool can assist CHW perform rapid CVD screening; this provides a model framework for non-communicable disease screening in LMICs.
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Affiliation(s)
- Michael Aw
- Department of Medicine, McMaster University , Hamilton, Ontario, Canada
| | - Benard Omondi Ochieng
- Department of community engagement, Kenya Medical Research Institute , Kisumu, Kenya
| | - Daniel Attambo
- Department of community engagement, Lewa Wildlife Conservancy , Isiolo District, Kenya
| | - Danet Opot
- Department of community engagement, Kenya Medical Research Institute , Kisumu, Kenya
| | - James Aw
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada
| | - Stacy Francis
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada
| | - Michael T Hawkes
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada.,Department of Pediatrics, University of Alberta , Edmonton, Canada.,School of Public Health, University of Alberta , Edmonton, Canada.,Distinguished Researcher, Stollery Science Lab, University of Alberta , Edmonton, Canada.,Member, Women and Children's Research Institute, University of Alberta , Edmonton, Canada
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40
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Lee S, Kim E, Desta TB. Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis. JMIR Mhealth Uhealth 2020; 8:e20848. [PMID: 32897231 PMCID: PMC7509634 DOI: 10.2196/20848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/24/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background In Ethiopia, health extension workers (HEWs) are deployed across the country by the government to meet public health needs. Team communication is important for effective teamwork, but community health workers in low-resource settings like Ethiopia may face challenges in carrying out team meetings to compile service statistics. This is due to the nature of their outreach activities, which requires extensive travel. Objective This study aimed to identify gaps in team communication about service statistics among HEWs in Ethiopia. Considering mobile communication and data collection as tools for bridging these gaps, we examined disparities in access to electricity, which has been identified as one of the major barriers to this approach. Methods Data from the most recent Performance Monitoring and Accountability 2020 service delivery point survey were used for our analysis. Logistic regression analysis was performed to identify disparities in team communication on service statistics for family planning, which is a major component of the HEW’s job. Disparities were examined across health facilities with different levels of HEW integration in their staffing structure (ie, no HEWs, at least one HEW, or only HEWs). Additionally, a chi-square test was conducted to examine disparities in access to electricity to explore the potential of mobile communication and data collection integration. Results In total, 427 health facilities of four different types (ie, hospitals, health centers, health posts, and health clinics) were included in our analysis. At most health posts (84/95, 88%), only HEWs were employed; none of the health clinics integrated the HEW model into their staffing structure. Among the 84 health posts, the odds of having team meetings on family planning service statistics in the past 12 months were 0.48 times the odds of those without HEWs (P=.02). No statistically significant differences were found between HEW-only facilities and facilities with at least one HEW. Most health facilities (69/83, 83.13%) with HEWs as the only staff had no electricity at the time of the survey while 71.25% (57/80) had intermittent access (ie, service disruption lasting 2 or more hours that day). There were statistically significant differences in electricity access among health facilities with different levels of HEW integration (P<.001). Conclusions Facilities employing only HEWs were less likely to have regular team meetings to discuss service statistics. Since their responsibilities involve extensive outreach activities, travel, and paper-based recordkeeping, empowering HEWs with mobile communication and data collection can be a workable solution. The empirical evidence regarding disparities in electricity access also supports the need for and the feasibility of this approach.
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Affiliation(s)
| | - Eunji Kim
- Yonsei University, Wonju, Republic of Korea
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Garnweidner-Holme L, Henriksen L, Flaathen EM, Klette Bøhler T, Lukasse M. Midwives' Attitudes Toward and Experience With a Tablet Intervention to Promote Safety Behaviors for Pregnant Women Reporting Intimate Partner Violence: Qualitative Study. JMIR Mhealth Uhealth 2020. [PMID: 32432553 DOI: 10.2196/168288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Violence against women is considered a global health problem, and intimate partner violence (IPV) around the time of childbirth can have severe consequences for mother and child. Prenatal care is considered a window of opportunity to address IPV and ask women about exposure to violence since women are in regular contact with health care providers. Mobile health (mHealth) interventions might overcome the barriers to talking about IPV face-to-face. OBJECTIVE Our objective was to explore midwives' attitudes toward a tablet intervention consisting of information about IPV and safety behaviors as well as their experiences with recruiting pregnant women of different ethnic backgrounds in a randomized controlled trial (RCT). METHODS Individual interviews were conducted with 9 midwives who recruited participants for an RCT to test a video to promote safety behaviors delivered on a tablet during prenatal care. Analysis was guided by thematic analysis. RESULTS Midwives perceived the tablet intervention as an appropriate supplement during prenatal care to provide information about IPV and promote safety behaviors. They participated in the RCT primarily to obtain more knowledge regarding how to communicate about IPV. The intervention was perceived as an anonymous door-opener to talk about IPV and a good solution to ensure that every woman gets the same information. However, the content of the intervention had to be trustworthy and align with the information the midwives provide to women. Given the sensitivity of IPV, midwives outlined the importance of following the intervention with face-to-face communication. Midwives reported technical problems and a high demand on their time as the main challenges to recruiting women. They experienced challenges recruiting women of different ethnic backgrounds due to linguistic barriers and the women's skepticism about scientific research. CONCLUSIONS The tablet intervention might help midwives communicate about IPV. Although the video was considered as an anonymous door-opener to talk about IPV, midwives outlined the importance of following the intervention with face-to-face communication. The scarcity of midwives' time during consultations has to be considered when implementing the intervention. Further research is needed to overcome barriers that limit inclusion of women from different ethnic backgrounds. TRIAL REGISTRATION ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277.
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Affiliation(s)
- Lisa Garnweidner-Holme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Eva Marie Flaathen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tone Klette Bøhler
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Campus Vestfold, Borre, Norway
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Garnweidner-Holme L, Henriksen L, Flaathen EM, Klette Bøhler T, Lukasse M. Midwives' Attitudes Toward and Experience With a Tablet Intervention to Promote Safety Behaviors for Pregnant Women Reporting Intimate Partner Violence: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e16828. [PMID: 32432553 PMCID: PMC7270855 DOI: 10.2196/16828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 01/28/2023] Open
Abstract
Background Violence against women is considered a global health problem, and intimate partner violence (IPV) around the time of childbirth can have severe consequences for mother and child. Prenatal care is considered a window of opportunity to address IPV and ask women about exposure to violence since women are in regular contact with health care providers. Mobile health (mHealth) interventions might overcome the barriers to talking about IPV face-to-face. Objective Our objective was to explore midwives’ attitudes toward a tablet intervention consisting of information about IPV and safety behaviors as well as their experiences with recruiting pregnant women of different ethnic backgrounds in a randomized controlled trial (RCT). Methods Individual interviews were conducted with 9 midwives who recruited participants for an RCT to test a video to promote safety behaviors delivered on a tablet during prenatal care. Analysis was guided by thematic analysis. Results Midwives perceived the tablet intervention as an appropriate supplement during prenatal care to provide information about IPV and promote safety behaviors. They participated in the RCT primarily to obtain more knowledge regarding how to communicate about IPV. The intervention was perceived as an anonymous door-opener to talk about IPV and a good solution to ensure that every woman gets the same information. However, the content of the intervention had to be trustworthy and align with the information the midwives provide to women. Given the sensitivity of IPV, midwives outlined the importance of following the intervention with face-to-face communication. Midwives reported technical problems and a high demand on their time as the main challenges to recruiting women. They experienced challenges recruiting women of different ethnic backgrounds due to linguistic barriers and the women’s skepticism about scientific research. Conclusions The tablet intervention might help midwives communicate about IPV. Although the video was considered as an anonymous door-opener to talk about IPV, midwives outlined the importance of following the intervention with face-to-face communication. The scarcity of midwives’ time during consultations has to be considered when implementing the intervention. Further research is needed to overcome barriers that limit inclusion of women from different ethnic backgrounds. Trial Registration ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277
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Affiliation(s)
- Lisa Garnweidner-Holme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Eva Marie Flaathen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tone Klette Bøhler
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Campus Vestfold, Borre, Norway
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Thindwa D, Farooq YG, Shakya M, Saha N, Tonks S, Anokwa Y, Gordon MA, Hartung C, Meiring JE, Pollard AJ, Heyderman RS. Electronic data capture for large scale typhoid surveillance, household contact tracing, and health utilisation survey: Strategic Typhoid Alliance across Africa and Asia. Wellcome Open Res 2020; 5:66. [DOI: 10.12688/wellcomeopenres.15811.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/25/2022] Open
Abstract
Electronic data capture systems (EDCs) have the potential to achieve efficiency and quality in collection of multisite data. We quantify the volume, time, accuracy and costs of an EDC using large-scale census data from the STRATAA consortium, a comprehensive programme assessing population dynamics and epidemiology of typhoid fever in Malawi, Nepal and Bangladesh to inform vaccine and public health interventions. A census form was developed through a structured iterative process and implemented using Open Data Kit Collect running on Android-based tablets. Data were uploaded to Open Data Kit Aggregate, then auto-synced to MySQL-defined database nightly. Data were backed-up daily from three sites centrally, and auto-reported weekly. Pre-census materials’ costs were estimated. Demographics of 308,348 individuals from 80,851 households were recorded within an average of 14.7 weeks range (13-16) using 65 fieldworkers. Overall, 21.7 errors (95% confidence interval: 21.4, 22.0) per 10,000 data points were found: 13.0 (95% confidence interval: 12.6, 13.5) and 24.5 (95% confidence interval: 24.1, 24.9) errors on numeric and text fields respectively. These values meet standard quality threshold of 50 errors per 10,000 data points. The EDC’s total variable cost was estimated at US$13,791.82 per site. In conclusion, the EDC is robust, allowing for timely and high-volume accurate data collection, and could be adopted in similar epidemiological settings.
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Thomas DS, Daly K, Nyanza EC, Ngallaba SE, Bull S. Health worker acceptability of an mHealth platform to facilitate the prevention of mother-to-child transmission of HIV in Tanzania. Digit Health 2020; 6:2055207620905409. [PMID: 32076575 PMCID: PMC7003162 DOI: 10.1177/2055207620905409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Health workers (HWs) are increasingly using mobile health (mHealth) technologies in low-resource settings. Understanding HW acceptability of mHealth is critical to increasing the scale of mHealth solutions. We examined pre- and post-pilot clinical knowledge and acceptability of a tablet-based platform, the Tanzania Health Information System (T-HIT), targeting HWs delivering prevention of mother-to-child transmission (PMTCT) of HIV services in seven health facilities in Misungwi District, Tanzania. Methods We developed a survey based on the diffusion of innovation theory and administered it to 27 HWs before and after a 3-month pilot of T-HIT. Using a Wilcoxon signed-rank test, we analyzed changes in acceptability defined as attitudes towards and self-efficacy for system use comparing pre- and post-test assessment scores and changes in knowledge of clinical care. Using analysis of variance, we explored these changes, stratifying health facilities by level of care and by distance from the district hospital. Results Post-pilot scores showed statistically significant improvement from pre-test for the total survey (Z = −2.67, p < 0.008) and for questions concerning system attitude (Z = −2.63, p < 0.008). HWs in hospitals and health centers exhibited a lower initial level of system acceptability in attitude than those in dispensaries and a significant improvement in overall mean acceptability over the pilot (95% CI 0.004–0.0187). HWs working more than 20 km from the hospital had a lower initial level of both system knowledge and acceptability than their less remote counterparts, but demonstrated larger improvements in knowledge and acceptability over time, although this change was not statistically significant. Conclusions The pilot demonstrates that HWs in PMTCT in Misungwi have a high acceptability of mHealth solutions. Using an mHealth solution can facilitate HW delivery of PMTCT care in rural and remote settings. Consideration of acceptability is important for fostering mHealth scale and program sustainability.
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Affiliation(s)
- Deborah Sk Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, USA
| | - Kristen Daly
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, USA
| | - Elias C Nyanza
- School of Public Health, Catholic University of Health and Allied Sciences, Tanzania
| | - Sospatro E Ngallaba
- School of Public Health, Catholic University of Health and Allied Sciences, Tanzania
| | - Sheana Bull
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, USA
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Brown SE, Krishnan A, Ranjit YS, Marcus R, Altice FL. Assessing mobile health feasibility and acceptability among HIV-infected cocaine users and their healthcare providers: guidance for implementing an intervention. Mhealth 2020; 6:4. [PMID: 32190615 PMCID: PMC7063267 DOI: 10.21037/mhealth.2019.09.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) can provide innovative, cost-effective strategies to improve medication adherence and optimize HIV treatment outcomes. Very little, however, is known about the acceptability and feasibility of mHealth among people with HIV (PWH) who use drugs. Our study objective was to assess feasibility, acceptability, and barriers and facilitators of implementing an mHealth intervention among PWH who are cocaine users, a group for whom no pharmacological treatment to reduce cocaine use is available. METHODS Five focus groups (FGs) (N=20) were conducted with PWH who self-reported cocaine use in the past 30 days, with 3 groups (N=8) of healthcare providers. Topics included previous experience with smartphones; barriers and facilitators of mobile technology for health purposes; and attitudes toward receiving types of feedback about adherence. RESULTS Patients preferred text reminders over phone calls for reasons of privacy, accessibility and economizing phone minutes. Direct communication via text messages and phone calls was considered more appropriate for social workers and case managers, who have greater frequency of communication and deeper relationships with patients, and less so for doctors, who see patients less regularly than community health workers. Patients seem particular about who has what information, and overall, they seem to prefer that their medical information, especially HIV-related, stay within the confines of patient-provider relationships. CONCLUSIONS HIV still provokes stigma and makes health information particularly sensitive for both providers and patients. The rise of mobile technology and related applications such as mHealth, means that new norms have to be established for its use. Participants' suggestions and feedback informed the design of a subsequent mHealth pilot randomized control trial to improve medication adherence.
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Affiliation(s)
- Shan-Estelle Brown
- Department of Anthropology, Rollins College, Winter Park, FL, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Archana Krishnan
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Communication, University at Albany, State University of New York, Albany, NY, USA
| | - Yerina S. Ranjit
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Communication, University of Missouri, Columbia, MO, USA
| | - Ruthanne Marcus
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L. Altice
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Steege R, Waldman L, Datiko DG, Kea AZ, Taegtmeyer M, Theobald S. 'The phone is my boss and my helper' - A gender analysis of an mHealth intervention with Health Extension Workers in Southern Ethiopia. J Public Health (Oxf) 2019; 40:ii16-ii31. [PMID: 30551130 PMCID: PMC6294039 DOI: 10.1093/pubmed/fdy199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is considerable optimism in mHealth’s potential to overcome health system deficiencies, yet gender inequalities can weaken attempts to scale-up mHealth initiatives. We report on the gendered experiences of an mHealth intervention, in Southern Ethiopia, realised by the all-female cadre of Health Extension Workers (HEWs). Methodology Following the introduction of the mHealth intervention, in-depth interviews (n = 19) and focus group discussions (n = 8) with HEWs, supervisors and community leaders were undertaken to understand whether technology acted as an empowering tool for HEWs. Data was analysed iteratively using thematic analysis informed by a socio-ecological model, then assessed against the World Health Organisation’s gender responsive assessment scale. Results HEWs reported experiencing: improved status after the intervention; respect from community members and were smartphone gatekeepers in their households. HEWs working alone at health posts felt smartphones provided additional support. Conversely, smartphones introduced new power dynamics between HEWs, impacting the distribution of labour. There were also negative cost implications for the HEWs, which warrant further exploration. Conclusion MHealth has the potential to improve community health service delivery and the experiences of HEWs who deliver it. The introduction of this technology requires exploration to ensure that new gender and power relations transform, rather than disadvantage, women. Keywords communities, e-health, gender
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Affiliation(s)
- Rosalind Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Linda Waldman
- Institute of Development studies, Library Road, Brighton BN1 9RE, UK
| | | | | | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
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Mengesha W, Steege R, Kea AZ, Theobald S, Datiko DG. Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia? J Public Health (Oxf) 2019; 40:ii74-ii86. [PMID: 30551131 PMCID: PMC6294041 DOI: 10.1093/pubmed/fdy200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Health extension workers (HEWs) are the key cadre within the Ethiopian Health Extension Programme extending health care to rural communities. National policy guidance supports the use of mHealth to improve data quality and use. We report on a mobile Health Management Information system (HMIS) with HEWs and assess its impact on data use, community health service provision and HEWs' experiences. Methodology We used a mixed methods approach, including an iterative process of intervention development for 2 out of 16 essential packages of health services, quantitative analysis of new registrations, and qualitative research with HEWs and their supervisors. Results The iterative approach supported ownership of the intervention by health staff, and 8833 clients were registered onto the mobile HMIS by 62 trained HEWs. HEWs were positive about using mHealth and its impact on data quality, health service delivery, patient follow-up and skill acquisition. Challenges included tensions over who received a phone; worries about phone loss; poor connectivity and power failures in rural areas; and workload. Discussion Mobile HMIS developed through collaborative and locally embedded processes can support quality data collection, flow and better patient follow-up. Scale-up across other community health service packages and zones is encouraged together with appropriate training, support and distribution of phones to address health needs and avoid exacerbating existing inequalities. Keywords CHWs, equity, ethics, Ethiopia, Health Management Information system, HEP, maternal health, mHealth, TB.
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Affiliation(s)
| | - R Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - A Z Kea
- REACH Ethiopia, Hawassa, Ethiopia
| | - S Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Mishra SR, Lygidakis C, Neupane D, Gyawali B, Uwizihiwe JP, Virani SS, Kallestrup P, Miranda JJ. Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature. Health Policy Plan 2019; 34:55-66. [PMID: 30668690 DOI: 10.1093/heapol/czy099] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/13/2022] Open
Abstract
The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for tackling non-communicable diseases (NCDs) in low- and middle-income countries (LMICs). We conducted a review of literature covering two databases: PubMED and Embase. A total of 97 articles were abstracted for full text review of which 26 are included in the analysis. Existing theories were used to construct a conceptual framework for understanding how digitalization affects the prospects of CHW programmes for NCDs. The results are divided into two themes: (1) the benefits of digitalization and (2) the challenges to the prospects of digitalization. We also conducted supplemental search in non-peer reviewed literature to identify and map the digital platforms currently in use in CHW programmes. We identified three benefits and three challenges of digitalization. Firstly, it will help improve the access and quality of services, notwithstanding its higher establishment and maintenance costs. Secondly, it will add efficiency in training and personnel management. Thirdly, it will leverage the use of data generated across grass-roots platforms to further research and evaluation. The challenges posed are related to funding, health literacy of CHWs and systemic challenges related to motivating CHWs. Several dozens of digital platforms were mapped, including mobile-based networking devices (used for behavioural change communication), Web-applications (used for contact tracking, reminder system, adherence tracing, data collection and decision support), videoconference (used for decision support) and mobile applications (used for reminder system, supervision, patients' management, hearing screening and tele-consultation). The digitalization efforts of CHW programmes are afflicted by many challenges, yet the rapid technological penetration and acceptability coupled with the gradual fall in costs constitute encouraging signals for the LMICs. Both CHWs interventions and digital technologies are not inexpensive, but they may provide better value for the money when applied at the right place and time.
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Affiliation(s)
- Shiva Raj Mishra
- COBIN Project, Nepal Development Society, Bharatpur-10, Narayani Zone, Chitwan, Nepal
| | - Charilaos Lygidakis
- Research Unit INSIDE, University of Luxembourg, Porte des Sciences L Esch-sur-Alzette, Luxembourg
| | - Dinesh Neupane
- COBIN Project, Nepal Development Society, Bharatpur-10, Narayani Zone, Chitwan, Nepal
| | - Bishal Gyawali
- COBIN Project, Nepal Development Society, Bharatpur-10, Narayani Zone, Chitwan, Nepal.,Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark
| | - Jean Paul Uwizihiwe
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center; Cardiovascular Disease Section, Baylor College of Medicine; and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center; Houston, TX, United States
| | - Per Kallestrup
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark
| | - J Jaime Miranda
- Director, CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Armendáriz 497, 2do piso, Miraflores, Lima 18, Perú
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Jo Y, LeFevre AE, Healy K, Singh N, Alland K, Mehra S, Ali H, Shaikh S, Haque R, Christian P, Labrique AB. Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh. PLoS One 2019; 14:e0223004. [PMID: 31574133 PMCID: PMC6773420 DOI: 10.1371/journal.pone.0223004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022] Open
Abstract
Objective We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. Methods Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women’s care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation. Results The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19–81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh’s GDP per capita. Conclusion mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.
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Affiliation(s)
- Youngji Jo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Amnesty E. LeFevre
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine Healy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Neelu Singh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelsey Alland
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sucheta Mehra
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hasmot Ali
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | | | - Rezawanul Haque
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | - Parul Christian
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alain B. Labrique
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Abstract
Mylène Lagarde, Luis Huicho, and Irene Papanicolas discuss different strategies policy makers can use to motivate health providers in order to improve quality of care
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Affiliation(s)
- Mylène Lagarde
- Department of Health Policy, London School of Economics, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Irene Papanicolas
- Department of Health Policy, London School of Economics, London, UK
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
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