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Constantine A, Fantaye AW, Buh A, Obegu P, Fournier K, Kasonde M, Jacobs C, Clementina P, Gobina R, Kibu O, Foretia D, Nkangu M, Yaya S. Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol. PLoS One 2024; 19:e0295437. [PMID: 38446819 PMCID: PMC10917244 DOI: 10.1371/journal.pone.0295437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.
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Affiliation(s)
- Asahngwa Constantine
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Pamela Obegu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Fournier
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Ronald Gobina
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Odette Kibu
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Denis Foretia
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Miriam Nkangu
- Bruyere Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Delmotte L, Desebbe O, Alexander B, Kouz K, Coeckelenbergh S, Schoettker P, Turgay T, Joosten A. Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study. J Pers Med 2023; 14:15. [PMID: 38276230 PMCID: PMC10817276 DOI: 10.3390/jpm14010015] [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: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.
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Affiliation(s)
- Lila Delmotte
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Olivier Desebbe
- Department of Anesthesiology & Perioperative Medicine, Sauvegarde Clinic, Ramsay Santé, 69009 Lyon, France;
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, CA 92103, USA;
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 94800 Villejuif, France
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Patrick Schoettker
- Biospectal SA, 1003 Lausanne, Switzerland;
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Tuna Turgay
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Alexandre Joosten
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Tamrat T, Setiyawati YD, Barreix M, Gayatri M, Rinjani SO, Pasaribu MP, Geissbuhler A, Shankar AH, Tunçalp Ö. Exploring perceptions and operational considerations for use of a smartphone application to self-monitor blood pressure in pregnancy in Lombok, Indonesia: protocol for a qualitative study. BMJ Open 2023; 13:e073875. [PMID: 38110387 DOI: 10.1136/bmjopen-2023-073875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal deaths globally and require close monitoring of blood pressure (BP) to mitigate potential adverse effects. Despite the recognised need for research on self-monitoring of blood pressure (SMBP) among pregnant populations, there are very few studies focused on low and middle income contexts, which carry the greatest burden of HDPs. The study aims to understand the perceptions, barriers, and operational considerations for using a smartphone software application to perform SMBP by pregnant women in Lombok, Indonesia. METHODS AND ANALYSIS This study includes a combination of focus group discussions, in-depth interviews and workshop observations. Pregnant women will also be provided with a research version of the smartphone BP application to use in their home and subsequently provide feedback on their experiences. The study will include pregnant women with current or past HDP, their partners and the healthcare workers involved in the provision of antenatal care services within the catchment area of six primary healthcare centres. Data obtained from the interviews and observations will undergo thematic analyses using a combination of both inductive and deductive approaches. ETHICS AND DISSEMINATION The study was approved by the World Health Organization (WHO) and Human Reproduction Programme (HRP) Research Project Review Panel and WHO Ethical Review Committee (A65932) as well as the Health Research Ethics Committee, Faculty of Medicine, Universitas Mataram in Indonesia (004/UN18/F7/ETIK/2023).Findings will be disseminated through research publications and communicated to the Lombok district health offices. The analyses from this study will also inform the design of a subsequent impact evaluation.
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Affiliation(s)
- Tigest Tamrat
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mergy Gayatri
- Summit Institute for Development, Mataram, Indonesia
- Brawijaya University, Malang, Indonesia
| | | | | | | | - Anuraj H Shankar
- Summit Institute for Development, Mataram, Indonesia
- Oxford University Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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LaMonica HM, Crouse JJ, Song YJC, Alam M, Wilson CE, Hindmarsh G, Yoon A, Boulton KA, Ekambareshwar M, Loblay V, Troy J, Torwali M, Guastella AJ, Banati RB, Hickie IB. Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children's Socioemotional and Cognitive Development in Afghanistan: Co-Design Study. JMIR Form Res 2023; 7:e44267. [PMID: 37610805 PMCID: PMC10483291 DOI: 10.2196/44267] [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: 11/24/2022] [Revised: 06/24/2023] [Accepted: 07/23/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. OBJECTIVE This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. METHODS The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed; detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. RESULTS The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents; however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children's screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. CONCLUSIONS Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children's lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children's developmental potential despite the security concerns and situational stressors.
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Affiliation(s)
- Haley M LaMonica
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Yun J C Song
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Mafruha Alam
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Chloe E Wilson
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Gabrielle Hindmarsh
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Adam Yoon
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Kelsie A Boulton
- Clinic for Autism and Neurodevelopment Research, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Mahalakshmi Ekambareshwar
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Victoria Loblay
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
- The Australian Prevention Partnership Centre, Sydney, Australia
| | - Jakelin Troy
- Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Mujahid Torwali
- Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopment Research, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Richard B Banati
- Medical Imaging Sciences, Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Australian Nuclear Science and Technology Organisation, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Amaro JS, Pessalli MRTFB, da Cunha LB, Betrán AP, Torloni MR, Siaulys MM. The Godmother Project: A Virtual Initiative to Support Pregnant and Postpartum Women in Brazil During the COVID-19 Pandemic. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200500. [PMID: 37116933 PMCID: PMC10141421 DOI: 10.9745/ghsp-d-22-00500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased maternal distress and demand for social support and educational services, while restriction measures decreased the availability of these services. PROJECT DESCRIPTION The Godmother Project, a person-centered, WhatsApp-based support and health education initiative, was created after all in-person perinatal educational activities offered at 3 Brazilian hospitals were canceled in 2020. The project was developed in response to pregnant/postpartum women who called the hospitals with questions for health care professionals (HCPs). Health education nurses teamed up with staff from the communication department to design a project to (1) provide a direct communication channel between women and HCPs to answer health-related questions, (2) offer reliable virtual health education material, (3) identify women in need of additional assessment/referrals, (4) offer each woman continuous support from a specific nurse educator (Godmother), and (5) offer a virtual forum where women going through similar experiences could interact. PROJECT DEVELOPMENT AND ROLLOUT The project provides direct communication between WhatsApp groups of 25-30 pregnant/postpartum women and a Godmother. It also offers access to a virtual library of educational materials prepared in response to women's needs/demands. The project, which began in July 2020 with 1 WhatsApp group of 5 women and 1 Godmother, currently has 305 groups, 6,942 active participants, and 4 Godmothers. Enrollments and WhatsApp groups continued to increase despite reestablishment of in-person educational activities in 2022. The vast majority of 232 participants surveyed in December 2021 were very satisfied with the project, the Godmothers, and the educational materials. CONCLUSIONS Our findings suggest that WhatsApp groups of pregnant/postpartum women led by dedicated nurse educators can be an important tool to educate and support women during the perinatal period. This type of initiative may be especially important in contexts of physical distancing requirements or situations where social support is unavailable.
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Affiliation(s)
- Juliana S Amaro
- Communication and Marketing Department, Grupo Santa Joana, São Paulo, Brazil
| | | | - Lissandra B da Cunha
- Department of Health Education and Training, Grupo Santa Joana, São Paulo, Brazil
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Tahan C, Dobbins T, Hyslop F, Lingam R, Richmond R. Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis. BMJ Open 2023; 13:e060549. [PMID: 36963792 PMCID: PMC10040078 DOI: 10.1136/bmjopen-2021-060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum. SETTINGS Any healthcare setting servicing pregnant women, including any country globally. PARTICIPANTS Pregnant women of any social, ethnic or geographical background who smoke. METHODS We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence. RESULTS We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision. CONCLUSION NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
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Affiliation(s)
- Chadi Tahan
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Paediatric Population Health, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
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Affiliation(s)
- Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Patil SR, Nimmagadda S, Gopalakrishnan L, Avula R, Bajaj S, Diamond-Smith N, Paul A, Fernald L, Menon P, Walker D. Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India. BMJ Glob Health 2022; 6:bmjgh-2021-007298. [PMID: 35835476 PMCID: PMC9296874 DOI: 10.1136/bmjgh-2021-007298] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months. Methods We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages. Results Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices. Conclusion The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers. Trial registration number ISRCTN83902145.
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Affiliation(s)
- Sumeet R Patil
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
| | - Sneha Nimmagadda
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | | | - Rasmi Avula
- International Food Policy Research Institute, New Delhi, India
| | - Sumati Bajaj
- International Food Policy Research Institute, New Delhi, India
| | - Nadia Diamond-Smith
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Anshuman Paul
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
| | - Lia Fernald
- Community Health Sciences, School of Public Health, UC Berkeley, Berkeley, CA, USA
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | - Dilys Walker
- Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
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Rahman MO, Yamaji N, Nagamatsu Y, Ota E. Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e34061. [PMID: 35451987 PMCID: PMC9077501 DOI: 10.2196/34061] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/15/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear. OBJECTIVE This review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs. METHODS We conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach. RESULTS A total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty). CONCLUSIONS mHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses. TRIAL REGISTRATION PROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7.
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Affiliation(s)
- Md Obaidur Rahman
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.,Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Noyuri Yamaji
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yasuko Nagamatsu
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.,Tokyo Foundation for Policy Research, Tokyo, Japan
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Sakamoto JL, Carandang RR, Kharel M, Shibanuma A, Yarotskaya E, Basargina M, Jimba M. Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review. BMJ Open 2022; 12:e056807. [PMID: 35168981 PMCID: PMC8852716 DOI: 10.1136/bmjopen-2021-056807] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the roles of mobile health, or mHealth, in the psychosocial health of pregnant women and mothers. METHODS A systematic search was conducted in databases and grey literature including MEDLINE, Web of Science, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, SocINDEX, Central Register of Controlled Trials, The Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Health Technology Assessment, UNICEF and WHO databases. Two searches were conducted to include original research articles published in English until 15 November 2021. Several tools were used to assess the risk of bias: revised Cochrane risk of bias tool for randomised trials, Risk of Bias in Non-randomized Studies of Interventions, National Heart, Lung, and Blood Institute quality assessment tool for cohort and cross-sectional studies, Critical Appraisal Skills Program checklist for qualitative studies and Mixed Methods Appraisal Tool for mixed-methods studies. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. Due to the high heterogeneity and variability of the included studies, data synthesis was conducted narratively. RESULTS 44 studies were included among 11 999 identified articles. Most studies reported mixed findings on the roles of mHealth interventions in the psychosocial health of pregnant women and mothers; mHealth improved self-management, acceptance of pregnancy/motherhood and social support, while mixed results were observed for anxiety and depressive symptoms, perceived stress, mental well-being, coping and self-efficacy. Furthermore, pregnant women and mothers from vulnerable populations benefited from the use of mHealth to improve their psychosocial health. CONCLUSIONS The findings suggest that mHealth has the potential to improve self-management, acceptance of pregnancy/motherhood and social support. mHealth can also be a useful tool to reach vulnerable pregnant women and mothers with barriers to health information and facilitate access to healthcare services. However, the high heterogeneity limited the certainty of evidence of these findings. Therefore, future studies should identify the context under which mHealth could be more effective.
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Affiliation(s)
- Jennifer Lisa Sakamoto
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rogie Royce Carandang
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Madhu Kharel
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ekaterina Yarotskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Milana Basargina
- Department of Neonatal Pathology, National Medical Research Center for Children's Health, Moscow, Russian Federation
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Dol J, Aston M, McMillan D, Tomblin Murphy G, Campbell-Yeo M. Participants perceptions of Essential Coaching for Every Mother, a Canadian text-message postpartum program: Process evaluation of a randomized controlled trial (Preprint). JMIR Form Res 2022; 6:e36821. [PMID: 35559855 PMCID: PMC9143775 DOI: 10.2196/36821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background “Essential Coaching for Every Mother” is a Canadian text message–based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program’s effectiveness in terms of the participants’ experience to guide refinement and modification. Objective This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality. Methods Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program’s text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis. Results Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement. Conclusions Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program. Trial Registration ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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12
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Segers S, Mertes H, Pennings G. An ethical exploration of pregnancy related mHealth: does it deliver? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:677-685. [PMID: 34228303 DOI: 10.1007/s11019-021-10039-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 05/21/2023]
Abstract
Many pregnant women use pregnancy related mHealth (PRmHealth) applications, encompassing a variety of pregnancy apps and wearables. These are mostly directed at supporting a healthier fetal development. In this article we argue that the increasing dominance of PRmHealth stands in want of empirical knowledge affirming its beneficence in terms of improved pregnancy outcomes. This is a crucial ethical issue, especially in the light of concerns about increasing pressures and growing responsibilities ascribed to pregnant women, which may, in turn, be reinforced by PRmHealth. A point can be made that it would be ethically askew if PRmHealth does not lead to improved pregnancy outcomes, while at the same time increasing maternal duties to closely monitor fetal development. We conclude that more research is needed to get a view on the benefits and burdens of PRmHealth in order to ethically assess whether the latter are proportionate to the former. If not, there is a case in saying that endorsement of PRmHealth is overdemanding.
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Affiliation(s)
- Seppe Segers
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & METAMEDICA, Ghent University, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & METAMEDICA, Ghent University, Ghent, Belgium
| | - Guido Pennings
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
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13
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Wu KK, Lopez C, Nichols M. Virtual Visits in Prenatal Care: An Integrative Review. J Midwifery Womens Health 2021; 67:39-52. [PMID: 34767317 DOI: 10.1111/jmwh.13284] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Addressing gaps in access to prenatal care is an important step to reversing rising rates of maternal and neonatal morbidity and mortality and invites the exploration of innovative care models. This integrative review of published literature explores the patient, health care provider, and organizational experience of integrating virtual visits in prenatal care. METHODS A literature search to identify original studies and quality improvement projects published between 2010 and 2020 was conducted in PubMed, Scopus, CINAHL, and Google Scholar using keywords associated with both telemedicine and prenatal care. Inclusion criteria specified articles pertaining to synchronous virtual visits between pregnant patients and health care providers, and articles were excluded if visits were not pregnancy-centric or pertaining to telemonitoring or mobile applications. Reference lists of identified reviews were screened, and a hand search of 4 applicable journals was also conducted. Findings were organized according to the factors of the social ecological model: individual, interpersonal, organizational, community, and public policy. RESULTS The search identified 2666 articles after duplicates were removed, of which 13 met all criteria. Findings across these 13 articles indicated strong patient and health care provider satisfaction with virtual care related to cost savings and convenience, with clinic wait times and cancellation rates also improving. Health care provider input and thoughtful organizational planning were key to a smooth telemedicine implementation process. There were notably no significant differences in clinical outcomes for those who used virtual care. DISCUSSION Although data are limited, offering an integrated model that uses both virtual visits and in-person visits has been well-received by patients and health care providers and could improve access to care well into the future. Virtual visits in prenatal care have been well-received by patients and health care providers, showing promise as an emerging model for improving access to care.
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Affiliation(s)
- Katrina K Wu
- Bethel University, Saint Paul, Minnesota.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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14
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Ahmed KY, Agho KE, Page A, Arora A, Ogbo FA. Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review. BMJ Open 2021; 11:e048700. [PMID: 34400457 PMCID: PMC8370540 DOI: 10.1136/bmjopen-2021-048700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia. SOURCE OF INFORMATION A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021. STUDY ELIGIBILITY CRITERIA Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included. STUDY APPRAISAL AND SYNTHESIS All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study. RESULTS Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention. CONCLUSION Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia. PROTOCOL REGISTRATION NUMBER PROSPERO, CRD42020155519.
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Affiliation(s)
- Kedir Y Ahmed
- Department of Public Health, Samara University, Samara, Afar, Ethiopia
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- School of Health Sciences, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- School of Health Sciences, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- Oral Health Services, Sydney Dental Hospital, Surry Hills, New South Wales, Australia
- Health Equity Laboratory, Campbelltown, New South Wales, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, South Australia, Australia
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15
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Dol J, Richardson B, Murphy GT, Aston M, McMillan D, Campbell-Yeo M. Impact of mobile health interventions during the perinatal period on maternal psychosocial outcomes: a systematic review. JBI Evid Synth 2021; 18:30-55. [PMID: 31972680 DOI: 10.11124/jbisrir-d-19-00191] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this review was to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries. INTRODUCTION The perinatal period is an exciting yet challenging period for mothers that requires physical, emotional and social adjustment to new norms and expectations. In recent years, there has been an increase in the use of mHealth by new mothers who are seeking health information through online or mobile applications. While there have been systematic reviews on the impact of mHealth interventions on maternal and newborn health in low- and middle-income countries, the impact of these interventions on maternal psychosocial health outcomes in high-income countries remains uncertain. INCLUSION CRITERIA This review considered studies of mHealth education interventions targeting mothers in high-income countries (as defined by the World Bank) during the perinatal period. Interventions must have started between the antenatal period (conception through birth) through six weeks postpartum. All experimental study designs were included. Outcomes included self-efficacy, social support, postpartum anxiety and postpartum depression. METHODS PubMed, CINAHL, PsycINFO and Embase were searched for published studies in English on December 16, 2018. Gray literature was also searched for non-peer reviewed articles, including Google Scholar, mHealth intelligence and clinical trials databases. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. All conflicts were solved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan. Where statistical pooling was not possible, findings were reported narratively. RESULTS Of the 1,607 unique articles identified, 106 full-text papers were screened and 24 articles were critically appraised, with 21 included in the final review. Eleven were quasi-experimental and 10 were randomized controlled trials. The mHealth intervention approach varied, with text message and mobile applications being the most common. Length of intervention ranged from four weeks to six months. The topics of the mHealth intervention varied widely, with the most common topic being postpartum depression. Mothers who received an mHealth intervention targeting postpartum depression showed a decreased score on the Edinburgh Postnatal Depression Scale when measured post-intervention (odds ratio = -6.01, 95% confidence interval = -8.34 to -3.67, p < 0.00001). The outcomes related to self-efficacy, social support and anxiety showed mixed findings of effectiveness (beneficial and no change) across the studies identified. CONCLUSIONS This review provides insight into the effectiveness of mHealth interventions targeting mothers in high-income countries in the perinatal period to enhance four psychosocial outcomes: self-efficacy, social support, anxiety and depression. Despite a wide variety of outcome measurements used, the predominant findings suggest that there are insufficient data to conclude that mHealth interventions can improve self-efficacy and anxiety outcomes. Potential benefits on social support were related to interventions targeting postnatal behaviors. Postpartum depression was the mostly commonly reported outcome. Findings related to the comparison of pre-post outcomes and intervention versus control demonstrated that mHealth interventions targeting postpartum depression were associated with a reduction in postpartum depression.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Brianna Richardson
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Gail Tomblin Murphy
- World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Megan Aston
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Marsha Campbell-Yeo
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
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16
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Chawla D, Thukral A, Kumar P, Deorari A. Harnessing mobile technology to deliver evidence-based maternal-infant care. Semin Fetal Neonatal Med 2021; 26:101206. [PMID: 33612418 DOI: 10.1016/j.siny.2021.101206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
mHealth, the use of wireless and portable communication technology to improve the health status of the population, has seen widespread adoption in low- and middle-income countries. It has been used to increase awareness and knowledge of healthcare, to collect health-related data, to deliver healthcare information such as results of investigations or appointment reminders, to aid decision-making by healthcare providers, and to improve communication between various stakeholders of the health system. Developing countries face an immense challenge of periodically updating the professional knowledge of their huge pool of community and facility level healthcare workers. Nearly universal possession of mobile phones, low-cost internet data, and high growth rate of smartphones has facilitated the use of mHealth in delivering evidence-based guidelines and decision-aids to frontline healthcare workers. This review describes the current evidence on the use of mHealth educational interventions targeting maternal and neonatal healthcare providers in low- and middle-income countries. Recent efforts of the National Neonatology Forum of India in integration of mHealth for development and dissemination of clinical practice guidelines are also presented.
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Anu Thukral
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Kumar
- Divison of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Deorari
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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17
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Peter Kibe
- African Population and Health Research
Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical
Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College
of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s
College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental
Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Omar Rahman
- University of Liberal Arts
Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia
and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South
Africa
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18
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Dol J, Richardson B, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Impact of mHealth interventions during the perinatal period on maternal psychosocial outcomes: a systematic review protocol. ACTA ACUST UNITED AC 2020; 17:2491-2498. [PMID: 31356572 DOI: 10.11124/jbisrir-d-19-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries. INTRODUCTION Mobile health (i.e. mHealth) is defined as the use of mobile devices to transmit health content and services. The use of mHealth to provide education and support to mothers is a growing field of health innovation. Mothers seek health information online during the postpartum period to learn about health concerns and get advice and support. Despite the potential benefits of mHealth, the potential impact on maternal psychosocial outcomes requires further evaluation. INCLUSION CRITERIA The review will consider studies that include mHealth interventions targeting mothers in high-income countries. The mHealth education interventions must occur during the antenatal or postnatal period. This review will consider studies that compare the intervention to any comparators. Studies published in English from 2000 will be included. METHODS The search strategy will aim to locate both published and unpublished studies. Following the search, all identified citations will be collated and duplicates removed. Titles and abstracts will be screened and full text of selected citations will then be assessed in detail against inclusion criteria. The results of the search will be reported in full in the final systematic review. Eligible studies will be critically appraised by two independent reviewers. Data extracted will include specific details about the interventions, populations, study methods and outcomes. Studies will be pooled in statistical meta-analysis or presented in narrative form including tables and figures.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
| | - Brianna Richardson
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | | | - Megan Aston
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Marsha Campbell-Yeo
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
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19
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Casilang CG, Stonbraker S, Japa I, Halpern M, Messina L, Steenhoff AP, Lowenthal ED, Fleisher L. Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic. JMIR Pediatr Parent 2020; 3:e20312. [PMID: 32821063 PMCID: PMC7474414 DOI: 10.2196/20312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. OBJECTIVE This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. METHODS Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. RESULTS All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. CONCLUSIONS There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.
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Affiliation(s)
- Clarisse G Casilang
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Centro de Salud Divina Providencia, Consuelo, Dominican Republic.,Clínica de Familia La Romana, La Romana, Dominican Republic.,Children's Hospital of Orange County, Orange, CA, United States
| | - Samantha Stonbraker
- Clínica de Familia La Romana, La Romana, Dominican Republic.,School of Nursing, Columbia University, New York, NY, United States
| | - Ingrid Japa
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Luz Messina
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Andrew P Steenhoff
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elizabeth D Lowenthal
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Linda Fleisher
- Fox Chase Cancer Center, Philadelphia, PA, United States
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Shukla VV, Carlo WA. Review of the evidence for interventions to reduce perinatal mortality in low- and middle-income countries. Int J Pediatr Adolesc Med 2020; 7:2-8. [PMID: 32373695 PMCID: PMC7193071 DOI: 10.1016/j.ijpam.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Low- and middle-income countries contribute to the overwhelming majority of the global perinatal and neonatal mortality. There is a growing amount of literature focused on interventions aimed at reducing the healthcare gaps and thereby reducing perinatal and neonatal mortality in low- and middle-income countries. The current review synthesizes available evidence for interventions that have shown to improve perinatal and neonatal outcomes. Reduction in important gaps in the availability and utilization of perinatal care practices is needed to end preventable deaths of newborns.
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Affiliation(s)
- Vivek V. Shukla
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
| | - Waldemar A. Carlo
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
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