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Vadrevu L, Jain M, Parsekar SS. Analyzing the usage of theories of change for routine immunization programs -- a review of impact evaluations from LMICs. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:141. [PMID: 39252041 PMCID: PMC11386364 DOI: 10.1186/s41043-024-00615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/11/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND In this article we analyzed the extent of the usage of Theories of Change (TOCs) and causal pathways in the evaluation of immunization programs to identify the challenges to generating evidence on how interventions improve immunization. METHODS We analyzed the use of the TOC in impact evaluations (IEs) of immunization interventions published after 2010, and its associated articles. The review includes studies from Evidence Gap Map and Yale review that were conducted in May and March of 2020, respectively. We synthesized data on six domains using NVIVO - program theory, context, assumptions, usage of TOC, use in evaluation, and description causal pathways. RESULTS Our review included 47 large-scale and 45 small-to medium-scale interventions. Of the included studies, 19% used a TOC, 56% described a causal pathway or used a conceptual diagram with varying degrees of detail, and 25% of the IEs did not provide any information on how their intervention was expected to affect change. Only 19 of the 92 IEs explicitly outlined any assumptions associated with the implementation of the interventions. Forty studies measured the outputs or intermediate outcomes leading to improved immunization coverage. CONCLUSION Future implementers and evaluators need to develop clear TOCs that are based on established theory and have clearly articulated the underlying assumptions. Large-scale health system strengthening initiatives implemented by governments, also need to build TOCs and integrate them into their results frameworks. Additionally, there is a need to combine both impact and process evaluations to understand the how context affects the causal pathways.
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Affiliation(s)
- Lalitha Vadrevu
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India.
| | - Monica Jain
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India
| | - Shradha S Parsekar
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India
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Sadore AA, Kebede Y, Birhanu Z. Effectiveness of engaging religious leaders in maternal health education for improving maternal health service utilization in Ethiopia: cluster randomized controlled trial. Front Public Health 2024; 12:1399472. [PMID: 39135926 PMCID: PMC11317292 DOI: 10.3389/fpubh.2024.1399472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction High mortality rates for pregnant women and their new-borns are one of Africa's most intractable public health issues today, and Ethiopia is one of the countries most afflicted. Behavioral interventions are needed to increase maternal health service utilizations to improve outcomes. Hence, this trial aimed to evaluate effectiveness of trained religious leaders' engagement in maternal health education on maternal health service utilization. Methods The study employed a cluster-randomized controlled community trial that included baseline and end-line measurements. Data on end points were gathered from 593 pregnant mothers, comprising 292 and 301 individuals in the intervention and control groups, respectively. In the intervention group, the trained religious leaders delivered the behavioral change education on maternal health based on intervention protocol. Unlike the other group, the control group only received regular maternal health information and no additional training from religious leaders. Binary generalized estimating equation regression analysis adjusted for baseline factors were used to test effects of the intervention on maternal health service utilization. Results Following the trial's implementation, the proportion of optimal antenatal care in the intervention arm increased by 21.4% from the baseline (50.90 vs. 72.3, p ≤ 0.001) and the proportion of institutional delivery in the intervention group increased by 20% from the baseline (46.1% vs. 66.1%, p ≤ 0.001). Pregnant mothers in the intervention group significantly showed an increase of proportion of PNC by 22.3% from baseline (26% vs. 48.3%, p ≤ 0.001). A statistically significant difference was observed between in ANC4 (AOR = 2.09, 95% CI: 1.69, 2.57), institutional delivery (AOR = 2.36, 95% CI: 1.94, 2.87) and postnatal care service utilization (AOR = 2.26, 95% CI: 1.79, 2.85) between the intervention and control groups. Conclusion This research indicated that involving religious leaders who have received training in maternal health education led to positive outcomes in enhancing the utilization of maternal health services. Leveraging the influential position of these religious leaders could be an effective strategy for improving maternal health service utilization. Consequently, promoting maternal health education through religious leaders is advisable to enhance maternal health service utilization.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05716178].
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Affiliation(s)
- Abinet Arega Sadore
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaina, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Kurnaz D, Şenoğlu A, Karaçam Z. The impact of antenatal telehealth services on maternal and neonatal outcomes, a comparison of results before and during the COVID-19 pandemic: A systematic review and meta-analysis (The impact of telehealth services on maternal and neonatal outcomes). Midwifery 2024; 134:104017. [PMID: 38714075 DOI: 10.1016/j.midw.2024.104017] [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: 12/16/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE This review was conducted to examine the effectiveness of antenatal follow-up using telehealth in the pre-COVID-19 and active pandemic periods. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Searches were conducted from inception to September 2023 through PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, all via Ovid SP, the National Thesis Center, TR Index, Turkiye Clinics, and DergiPark Academic. Data were combined in the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS The meta-analysis examining the effectiveness of antenatal telehealth services included 35 studies with a total sample size of 16 033. The combined results of the studies revealed that antenatal telehealth services were similar to face-to-face follow-ups for many maternal and newborn health outcomes. Maternal outcomes included abortion, preterm delivery, gestational diabetes, weight gain, hypertensive disorders, maternal hospitalization, number of antenatal follow-ups, use of induction, vaginal and instrumental delivery, planned and emergency cesarean section, shoulder dystocia, episiotomy, perineal laceration, childbirth under the supervision of qualified personnel, breastfeeding problems and postpartum depression. Neonatal outcomes included an APGAR score of <7, neonatal hypoglycemia, hyperbilirubinemia, admission into the neonatal intensive care unit, respiratory distress syndrome, neonatal death, birth weight, low birth weight and macrosomia. However, statistically significant reductions in excessive weight gain (p<0.001) and a 1.23-fold increase in vaccination administration (p=0.001) were observed with telehealth services. Additionally, the effects of telehealth services on preterm and cesarean delivery rates were similar in the pre-pandemic and pandemic periods. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH This review reveals that while antenatal telehealth services are comparable to face-to-face care in terms of multiple pregnancy, delivery, and neonatal outcomes, they contribute to improvements in preventing extreme weight gain and vaccination hesitancy. These findings suggest that the telehealth method can be used as an alternative to face-to-face monitoring in antenatal follow-ups.
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Affiliation(s)
- Döndü Kurnaz
- Assist. Prof. Dr. Döndü Kurnaz, PhD, Marmara University Faculty of Health Sciences Midwifery Department, Istanbul, Turkey.
| | - Ayşe Şenoğlu
- PhD., Ministry of Health Adana Provincial Directorate of Health Emergency Health Services, Adana,Turkey.
| | - Zekiye Karaçam
- Prof. Dr., Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
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Knop MR, Nagashima-Hayashi M, Lin R, Saing CH, Ung M, Oy S, Yam ELY, Zahari M, Yi S. Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review. BMC Med 2024; 22:196. [PMID: 38750486 PMCID: PMC11095039 DOI: 10.1186/s12916-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years. METHODS A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures. RESULTS From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive. CONCLUSIONS This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.
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Affiliation(s)
- Marianne Ravn Knop
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ruixi Lin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Esabelle Lo Yan Yam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA.
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Jain M, Duvendack M, Shisler S, Parsekar SS, Leon MDA. Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews. BMJ Open 2024; 14:e074370. [PMID: 38365291 PMCID: PMC10875475 DOI: 10.1136/bmjopen-2023-074370] [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] [Received: 04/05/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs). DESIGN A systematic review of systematic reviews, or an umbrella review. DATA SOURCES We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021. ELIGIBILITY CRITERIA We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs. DATA EXTRACTION AND SYNTHESIS Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews. RESULTS 62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes. CONCLUSION Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.
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Affiliation(s)
- Monica Jain
- International Initiative for Impact Evaluation, New Delhi, Delhi, India
| | | | - Shannon Shisler
- International Initiative for Impact Evaluation, Washington, DC, 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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Bekyieriya E, Isang S, Baguune B. Mobile health technology in providing maternal health services - Awareness and challenges faced by pregnant women in upper West region of Ghana. PUBLIC HEALTH IN PRACTICE 2023; 6:100407. [PMID: 37449294 PMCID: PMC10336575 DOI: 10.1016/j.puhip.2023.100407] [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: 11/10/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives The study assessed awareness on Mobile Health (mhealth) Technology as well as challenges pregnant women encounter in the utilization of mhealth technology to improve maternal health in rural settings in the Upper West Region (UWR) of Ghana. Study design The study was an exploratory design that employed the qualitative method of data collection. Methods Semi-structured interview guide was used to conduct six (6) Focus Group Discussions (FGDs) and nine (9) Key Informant Interviews (KIIs) among pregnant women and health workers respectively from three (3) selected rural districts in the Upper West Region. Data was collected in August 2020. Thematic analysis was conducted and some statements from participants were presented verbatim to illustrate the themes realized. Results Participants were aware of the mhealth intervention that had been implemented by Savanna Signatures in their districts. Major sources of information on the mhealth services were from durbars, health education sessions and health care providers. Challenges faced by pregnant women, in the mhealth technology intervention were; financial challenges, lack of mobile network connectivity, lack of electricity in some rural areas, low female literacy rate at household level and cultural barriers. Conclusion The Savanna Signatures mhealth intervention is widely known but some challenges exist that impede the smooth implementation of the intervention. The mhealth technology intervention implementers should partner with other sectors and policy makers to address the challenges identified by the study.
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Affiliation(s)
- E. Bekyieriya
- REJ Institute, Research and ICT Consultancy Services, P.O. Box TL1139, Tamale, Ghana
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
| | - S. Isang
- Ghana School of Law, Kwame Nkrumah University Science Technology, Kumasi, Ghana
| | - B. Baguune
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
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Dao BTT, Trinh HT, Lai PH, Elsner T, Kane S, Nguyen L. A Cluster Randomised Control Trial of an SMS-Based Intervention to Promote Antenatal Health amongst Pregnant Women in a Remote, Highland Region of Vietnam. Healthcare (Basel) 2023; 11:2407. [PMID: 37685444 PMCID: PMC10487153 DOI: 10.3390/healthcare11172407] [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: 06/19/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Although Vietnam has achieved significant improvements in maternal, newborn, and children's health, outcomes for ethnic minorities living in remote mountainous areas continue to lag. Interventions that leverage the extensive mobile networks in the country have been proposed as a way to overcome some of these challenges. A cluster randomised controlled trial (cRCT) was conducted to assess the effectiveness of an intervention comprising tailored SMS messages for promoting antenatal care knowledge and behaviours amongst ethnic minority (EM) pregnant women. The cRCT was implemented across eight intervention communes (640 women) and four control communes (315 women) in Northern Vietnam. Maternal health-related knowledge and behaviour outcomes and self-rated health status were assessed through questionnaires administered pre- and post-intervention. Difference-in-difference and logistic regression analysis found that the intervention group showed significant improvements in awareness about the danger signs of pregnancy and the importance of nutritional supplements. Significant improvements were seen in antenatal care-seeking behaviours and the intake of nutritional supplements. Mobile messaging-based behaviour change interventions can significantly improve maternal health-related knowledge and care-seeking amongst women residing in marginalised, hard-to-reach populations.
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Affiliation(s)
- Binh Thi Thanh Dao
- Faculty of Management and Tourism, Hanoi University, Hanoi 100000, Vietnam;
| | - Huong Thi Trinh
- Faculty of Mathematical Economics, Thuongmai University, Hanoi 100000, Vietnam
| | - Phuong Hoai Lai
- Faculty of Management and Tourism, Hanoi University, Hanoi 100000, Vietnam;
| | - Tahli Elsner
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (T.E.); (S.K.)
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (T.E.); (S.K.)
| | - Liem Nguyen
- Institute of Population, Health and Development, Hanoi 100000, Vietnam;
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Chaney SC, Mechael P. So Many Choices, How Do I Choose? Considerations for Selecting Digital Health Interventions to Support Immunization Confidence and Demand. J Med Internet Res 2023; 25:e47713. [PMID: 37223980 DOI: 10.2196/47713] [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: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
Childhood vaccines are a safe, effective, and essential component of any comprehensive public health system. Successful and complete child immunization requires sensitivity and responsiveness to community needs and concerns while reducing barriers to access and providing respectful quality services. Community demand for immunization is influenced by multiple complex factors, involving attitudes, trust, and the dynamic relationship between caregivers and health workers. Digital health interventions have the potential to help reduce barriers and enhance opportunities for immunization access, uptake, and demand in low- and middle-income countries. But with limited evidence and many interventions to choose from, how do decision makers identify promising and appropriate tools? Early evidence and experiences with digital health interventions for immunization demand are presented in this viewpoint to help stakeholders make decisions, guide investment, coordinate efforts, as well as design and implement digital health interventions to support vaccine confidence and demand.
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Mohan S, Chaudhry M, McCarthy O, Jarhyan P, Calvert C, Jindal D, Shakya R, Radovich E, Kondal D, Penn-Kekana L, Basany K, Roy A, Tandon N, Shrestha A, Shrestha A, Karmacharya B, Cairns J, Perel P, Campbell OMR, Prabhakaran D. A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol. BMC Pregnancy Childbirth 2023; 23:72. [PMID: 36703109 PMCID: PMC9878774 DOI: 10.1186/s12884-022-05249-y] [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: 10/03/2022] [Accepted: 11/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers - Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers). METHODS This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities-one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist. DISCUSSION To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries. TRIAL REGISTRATION CLINICALTRIALS gov, NCT03700034, registered 9 Oct 2018, https://www. CLINICALTRIALS gov/ct2/show/NCT03700034 CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27.
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Affiliation(s)
- Sailesh Mohan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Monica Chaudhry
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Ona McCarthy
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Prashant Jarhyan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Clara Calvert
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK ,grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Devraj Jindal
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Rajani Shakya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Emma Radovich
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dimple Kondal
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Loveday Penn-Kekana
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Kalpana Basany
- grid.501907.a0000 0004 1792 1113SHARE (Sci Health Allied Res Education), MediCiti Institute of Medical Sciences Campus, Medchal-Malkajgiri, Hyderabad, Telangana 501401 India
| | - Ambuj Roy
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Nikhil Tandon
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Biraj Karmacharya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - John Cairns
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Pablo Perel
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Oona M. R. Campbell
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dorairaj Prabhakaran
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India ,grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
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11
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Clouse K, Noholoza S, Ngcobo N, Madwayi S, Mrubata M, Camlin CS, Myer L, Phillips TK. Cohort profile: CareConekta: a pilot study of a smartphone application to improve engagement in postpartum HIV care in South Africa. BMJ Open 2022; 12:e064946. [PMID: 36414286 PMCID: PMC9685000 DOI: 10.1136/bmjopen-2022-064946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pregnant and postpartum women living with HIV in South Africa are at high risk of dropping out of care, particularly after delivery. Population mobility may contribute to disruptions in HIV care, and postpartum women are known to be especially mobile. To improve engagement in HIV care during the peripartum period, we developed CareConekta, a smartphone application (app) that uses GPS coordinates to characterise mobility and allow for real-time intervention. We conducted a randomised controlled pilot study to assess feasibility, acceptability and initial efficacy of the app intervention to improve engagement in HIV care. This cohort profile describes participant enrolment and follow-up, describes the data collected and provides participant characteristics. PARTICIPANTS We enrolled 200 pregnant women living with HIV attending routine antenatal care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Eligible women must have owned smartphones that met the app's technical requirements. Seven participants were withdrawn near enrolment, leaving 193 in the cohort. FINDINGS TO DATE Data were collected from detailed participant questionnaires at enrolment and follow-up (6 months after delivery), as well as GPS data from the app, and medical records. Follow-up is complete; initial analyses have explored smartphone ownership, preferences and patterns of use among women screened for eligibility and those enrolled in the study. FUTURE PLANS Additional planned analyses will characterise mobility in the population using the phone GPS data and participant self-reported data. We will assess the impact of mobility on engagement in care for the mother and infant. We also will describe the acceptability and feasibility of the study, including operational lessons learnt. By linking this cohort to the National Health Laboratory Service National HIV Cohort in South Africa, we will continue to assess engagement in care and mobility outcomes for years to come. Collaborations are welcome. TRIAL REGISTRATION NUMBER NCT03836625.
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Affiliation(s)
- Kate Clouse
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandisiwe Noholoza
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nkosinathi Ngcobo
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sindiswa Madwayi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Megan Mrubata
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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12
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Paduano S, Incerti F, Borsari L, Benski AC, Ernest A, Mwampagatwa I, Lilungulu A, Masoi T, Bargellini A, Stornelli F, Stancanelli G, Borella P, Rweyemamu MA. Use of a mHealth System to Improve Antenatal Care in Low and Lower-Middle Income Countries: Report on Patients and Healthcare Workers' Acceptability in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15342. [PMID: 36430061 PMCID: PMC9691201 DOI: 10.3390/ijerph192215342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Antenatal care (ANC) is considered a cornerstone of reproductive health programmes, but many women face difficulties in accessing these services, particularly in some sub-Saharan African countries, such as Tanzania. This study aimed to test ANC visit acceptability using mHealth system PANDA (Pregnancy And Newborn Diagnostic Assessment) in the Mufindi district (Tanzania). We investigated the ANC visit acceptability of pregnant women and healthcare workers (HCWs) in an intervention area using the PANDA system compared with a control area. An ad hoc questionnaire was administered to pregnant women in an implementation area (n = 52) and in a control area (n = 46). In the implementation area, group interviews with 50 pregnant women were conducted and five HCWs evaluated ANC visits through a questionnaire. The implementation group was significantly more satisfied with the ANC visit compared with the control group. All the 52 women and the HCWs declared that PANDA icons were useful in understanding and remembering the provided information and the PANDA app was able to improve the ANC quality and to positively influence the relationship of HCWs and pregnant women. HCWs reported that the PANDA app was "easy-to-use" and "able to improve the adherence to ANC WHO recommendations". In underserved areas, many pregnant women could benefit from the PANDA system increasing their access to high-quality ANC and overcoming language and/or literacy barriers.
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Affiliation(s)
- Stefania Paduano
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Federica Incerti
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Lucia Borsari
- Department of Public Health, AUSL Modena, 41126 Modena, Italy
| | - Anne Caroline Benski
- Service d’Obstétrique-Département de la Femme, de l’Enfant et de l’Adolescent-Hôpitaux Universitaires de Genève, 1205 Genève, Switzerland
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Alex Ernest
- Department of Obstetrics and Gynecology, University of Dodoma, Dodoma 41218, Tanzania
| | - Ipyana Mwampagatwa
- Department of Obstetrics and Gynecology, University of Dodoma, Dodoma 41218, Tanzania
| | - Athanase Lilungulu
- Department of Obstetrics and Gynecology, University of Dodoma, Dodoma 41218, Tanzania
| | - Theresia Masoi
- Department of Obstetrics and Gynecology, University of Dodoma, Dodoma 41218, Tanzania
| | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | | | - Paola Borella
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy
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13
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Saunders JE, Bessen S, Magro I, Cowan D, Quiroz MG, Mojica-Alvarez K, Penalba D, Reike C, Niemczak CE, Fellows A, Buckey JC. Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren. J Glob Health 2022; 12:04060. [PMID: 35938885 PMCID: PMC9359107 DOI: 10.7189/jogh.12.04060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sarah Bessen
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Isabelle Magro
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Devin Cowan
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Marvin Gonzalez Quiroz
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
- Centre for Nephrology, University College London, London, UK
| | | | - Donoso Penalba
- Department of Public Health at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Christopher E Niemczak
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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14
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Krishnamoorthy Y, Rehman T. Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey. Fam Pract 2022; 39:603-609. [PMID: 34564727 DOI: 10.1093/fampra/cmab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. METHODS Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). RESULTS In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. CONCLUSION Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Rathi S, Chakrabarti AS, Chatterjee C, Hegde A. Pandemics and technology engagement: New evidence from m-Health intervention during COVID-19 in India. REVIEW OF DEVELOPMENT ECONOMICS 2022; 26:RODE12909. [PMID: 35942311 PMCID: PMC9350278 DOI: 10.1111/rode.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Information provision for social welfare via cheap technological media is now a widely available tool used by policymakers. Often, however, an ample supply of information does not translate into high consumption of information due to various frictions in demand, possibly stemming from the pecuniary and non-pecuniary cost of engagement, along with institutional factors. We test this hypothesis in the Indian context using a unique data set comprising 2 million call records of enrolled users of ARMMAN, a Mumbai-based nongovernmental organization that sends timely informational calls to mobile phones of less-privileged pregnant women. The strict lockdown induced by COVID-19 in India was an unexpected shock on engagement with m-Health technology, in terms of both reductions in market wages and increased time availability at home. Using a difference-in-differences design on unique calls tracked at the user-time level with fine-grained time-stamps on calls, we find that during the lockdown period, the call durations increased by 1.53 percentage points. However, technology engagement behavior exhibited demographic heterogeneity increasing relatively after the lockdown for women who had to borrow the phones vis-à-vis phone owners, for those enrolled in direct outreach programs vis-à-vis self-registered women, and for those who belonged to the low-income group vis-à-vis high-income group. These findings are robust with coarsened exact matching and with a placebo test for a 2017-2018 sample. Our results have policy implications around demand-side frictions for technology engagement in developing economies and maternal health.
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Affiliation(s)
- Sawan Rathi
- Indian Institute of Management AhmedabadGujaratIndia
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16
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Keddy KH, Saha S, Kariuki S, Kalule JB, Qamar FN, Haq Z, Okeke IN. Using big data and mobile health to manage diarrhoeal disease in children in low-income and middle-income countries: societal barriers and ethical implications. THE LANCET INFECTIOUS DISEASES 2022; 22:e130-e142. [DOI: 10.1016/s1473-3099(21)00585-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
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17
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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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18
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Ariyani NW, Wirawan IMA, Pinatih GNI, Kusuma AANJ. The effect of an application-based educational intervention with a social cognitive theory model on pregnant women in Denpasar, Bali, Indonesia: a randomized controlled trial. Osong Public Health Res Perspect 2022; 13:153-161. [PMID: 35538687 PMCID: PMC9091633 DOI: 10.24171/j.phrp.2021.0209] [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: 07/09/2021] [Accepted: 03/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to elucidate the effect of application-based antenatal education based on social cognitive theory (SCT) on Health Promoting Lifestyle Profile II (HPLP II) scores, compliance with iron tablet consumption, and readiness for childbirth and complications among pregnant women in Denpasar, Bali, Indonesia. Methods This randomized controlled trial included 71 pregnant women in the treatment group and 74 pregnant women in the control group. The treatment group application-based antenatal education based on SCT, while the control group attended a conventional pregnancy class. Iron tablet consumption was verified by counting the remaining iron tablets. Information on participants’ lifestyles was collected using the HPLP II questionnaire with the help of an assistant. The collected data were statistically analyzed using IBM SPSS ver. 24.0. Results The antenatal education intervention effectively increased the HPLP II score by 0.32 points (2.62±0.331 before the intervention and 2.94±0.273 after). Meanwhile, the control group had a 0.13-point increase (p=0.001), from 2.67±0.336 to 2.80±0.275. There was no significant difference in iron tablet consumption (p=0.333) or readiness for delivery and complications (p=0.557) between the treatment and control groups. Conclusion Application-based antenatal education with SCT effectively increased the HPLP II scores of pregnant women in Denpasar, Bali. Although there was no significant difference in iron tablet consumption or readiness for delivery and complications, the values increased to a greater extent in the treatment group than in the control group. This education model is more suited to urban pregnant women who employed and have good internet access.
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19
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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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20
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Sebayang SK, Has EMM, Hadisuyatmana S, Efendi F, Astutik E, Kuswanto H. Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data. Matern Child Health J 2022; 26:545-555. [PMID: 35013886 PMCID: PMC8747864 DOI: 10.1007/s10995-021-03324-y] [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] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Objective The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women’s empowerment indicators to provide evidence for the need for policy change. Methods Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women’s empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women’s empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design. Results The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women’s knowledge level were associated with any PNC, but the association between women’s knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women’s knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant’s gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant’s size at birth. Conclusions for Practice PNC coverage after discharge in Indonesia needs improvement. Women’s empowerment indicators need to be addressed in improving PNC coverage. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03324-y.
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Affiliation(s)
- Susy K Sebayang
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia. .,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Jl. Wijaya Kusuma No. 113, Banyuwangi, East Java, 68425, Indonesia.
| | - Eka M M Has
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group of Community Health, Surabaya, Indonesia
| | - Erni Astutik
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia.,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember (ITS), Kampus ITS Sukolilo, Surabaya, Indonesia
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Constant D, Lopes S, Grossman D. Could routine pregnancy self-testing facilitate earlier recognition of unintended pregnancy? A feasibility study among South African women. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e60-e66. [PMID: 33972398 DOI: 10.1136/bmjsrh-2020-201017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION We explored whether routine pregnancy self-testing is feasible and acceptable to women at risk of late recognition of pregnancy as a strategy to facilitate early entry into either antenatal or abortion care. METHODS A feasibility study among South African sexually active women not desiring pregnancy within 1 year, and not using long-acting or injectable contraceptives. At recruitment, we provided five free urine pregnancy tests for self-testing on the first day of each of the next 3 months. We sent monthly text reminders to use the tests with requests for no-cost text replies. Our main outcome was the proportion of participants self-testing within 5 days of the text reminder over three consecutive months. Other outcomes were ease of use of tests, preference for self-testing versus clinic testing, acceptability of routine self-testing (all binary responses followed by open response options) and response to text messages (four-point Likert scale). RESULTS We followed up 71/76 (93%) participants. Two confirmed new pregnancies at the first scheduled test and completed exit interviews, and 64/69 (93%) self-reported completing all three monthly tests. Self-testing was easy to do (66/71, 93%); advantages were convenience (21/71, 30%) and privacy (18/71, 25%), while the main disadvantage was no nurse present to advise (17/71, 24%). Most would recommend monthly testing (70/71, 99%). Text reminders were generally not bothersome (57/71, 80%); 35/69 (51%) participants replied with test results over all three months. CONCLUSION Providing free pregnancy tests to women at risk of late recognition of pregnancy is feasible to strengthen early confirmation of pregnancy status.
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Affiliation(s)
- Deborah Constant
- Women's Health Research Unit, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sofia Lopes
- Women's Health Research Unit, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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Guthrie BL, Tsegaye AT, Rankin KC, Walson JL, Alemie GA. Partnering faith leaders with community health workers increases utilization of antenatal care and facility delivery services in Ethiopia: A cluster randomized trial. J Glob Health 2021; 11:04063. [PMID: 34737863 PMCID: PMC8564884 DOI: 10.7189/jogh.11.04063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia and other countries continue to experience high rates of maternal mortality and neonatal deaths. Interventions are needed to increase utilization of antenatal care (ANC) and facility delivery services to improve outcomes. Methods A cluster-randomized trial was conducted in the Amhara Region of Ethiopia, with 6 communities randomly assigned to receive the intervention and 12 communities monitored as controls. Intervention teams provided outreach to pregnant women and their families. Registry data were used to measure utilization of services provided at health centers in intervention and control communities.The intervention consisted of trained pairs of community health workers and Ethiopian Orthodox priests who worked together to promote health messages around safe delivery. The pairs visited pregnant women and their families in their homes to provide counseling, discuss concerns, and answer questions about ANC and facility deliveries. Intervention impact was measured using facility-level data on monthly number of ANC visits and facility deliveries at the health centers that served the intervention and control communities. Intervention effect was measured using difference-in-difference analyses estimated by generalized estimating equation models. Results During the 12-month intervention period, intervention facilities (n = 6) recorded 14% more ANC1 visits (relative risk RR = 1.14; 95% confidence interval (CI) = 1.09-1.19; P < 0.001) and 26% more ANC4 visits (RR = 1.26; 95%CI = 1.18, 1.34; P < 0.001) compared to control health centers (n = 12). The intervention health centers experienced a 10% increase in facility deliveries over what would have been expected had the intervention not occurred (RR = 1.10; 95% CI = 1.05-1.16; P < 0.001). Conclusions Promotion of safe delivery through home visits by community health workers paired with Ethiopian Orthodox priests increased utilization of ANC and facility delivery services. This approach could leverage the influential role of faith leaders and increase the impact of community health workers in Ethiopia. Trial registration NCT04039932.
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Affiliation(s)
- Brandon L Guthrie
- Departments of Global Health and Epidemiology, University of Washington, Seattle, WAUSA
| | - Adino T Tsegaye
- Department of Epidemiology & Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Katherine C Rankin
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Judd L Walson
- Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Getahun A Alemie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Scott K, Shinde A, Ummer O, Yadav S, Sharma M, Purty N, Jairath A, Chamberlain S, LeFevre AE. Freedom within a cage: how patriarchal gender norms limit women's use of mobile phones in rural central India. BMJ Glob Health 2021; 6:bmjgh-2021-005596. [PMID: 34551901 PMCID: PMC8461288 DOI: 10.1136/bmjgh-2021-005596] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction India has one of the highest gender gaps in mobile phone access in the world. As employment opportunities, health messaging (mHealth), access to government entitlements, banking, civic participation and social engagement increasingly take place in the digital sphere, this gender gap risks further exacerbating women’s disadvantage in Indian society. This study identifies the factors driving women’s unequal use of phones in rural Madhya Pradesh, India. Methods We interviewed mothers of 1-year-old children (n=29) who reported that they had at least some access to a mobile phone. Whenever possible, we also spoke to their husbands (n=23) and extended family members (n=34) through interviews or family group discussions about the use of phones in their households, as well as their perspectives on gender and phone use more broadly. Our analysis involved comparing wife–husband pairs to assess differences in phone access and use, and thematic coding on the determinants of women’s phone use using an iteratively developed conceptual framework. Results While respondents reported that women could use the phone without needing permission, this apparent ‘freedom’ existed in a context that severely constrained women’s actual use, most directly through: (1) narrow expectations and desires around how women would use phones, (2) women’s dependence on men for phone ownership and lower proximity to phones, (3) the poorer functionality of women’s phones; (4) women’s limited digital skills, and (5) time allocation constraints, wherein women had less leisure time and were subject to social norms that discouraged using a phone for leisure. Conclusion Our framework, presenting the distal and proximate determinants of women’s phone use, enables more nuanced understanding of India’s digital divide. Addressing these determinants is vital to shift from re-entrenching unequal gender relations to transforming them through digital technology.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aashaka Shinde
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- BBC Media Action, New Delhi, Delhi, India.,Oxford Policy Management, New Delhi, Delhi, India
| | | | | | - Nikita Purty
- Oxford Policy Management, New Delhi, Delhi, India
| | | | | | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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24
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Hicks JP, Allsop MJ, Akaba GO, Yalma RM, Dirisu O, Okusanya B, Tukur J, Okunade K, Akeju D, Ajepe A, Okuzu O, Mirzoev T, Ebenso B. Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study. JMIR Mhealth Uhealth 2021; 9:e24182. [PMID: 34528891 PMCID: PMC8485189 DOI: 10.2196/24182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/12/2020] [Accepted: 08/01/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. OBJECTIVE This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. METHODS A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention's acceptability and usability in the work environment. RESULTS In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. CONCLUSIONS This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs' workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. TRIAL REGISTRATION ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372.
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Affiliation(s)
- Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Godwin O Akaba
- Department of Obstetrics and Gynaecology, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Ramsey M Yalma
- Department of Community Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | | | - Babasola Okusanya
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Kehinde Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - David Akeju
- Department of Sociology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Okey Okuzu
- Instrat Global Health Solutions, Abuja, Nigeria
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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25
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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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Giebel GD, Speckemeier C, Abels C, Börchers K, Wasem J, Blase N, Neusser S. Problems and Barriers related to the Use of Digital Health Applications: A Scoping Review Protocol (Preprint). JMIR Res Protoc 2021; 11:e32702. [PMID: 35451979 PMCID: PMC9073601 DOI: 10.2196/32702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/19/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The use of mobile health (mHealth) apps is increasing rapidly worldwide. More and more institutions and organizations develop regulations and guidelines to enable an evidence-based and safe use. In Germany, mHealth apps fulfilling predefined criteria (Digitale Gesundheitsanwendungen [DiGA]) can be prescribed and are reimbursable by the German statutory health insurance scheme. Due to the increasing distribution of DiGA, problems and barriers should receive special attention. Objective This study aims to identify the relevant problems and barriers related to the use of mHealth apps fulfilling the criteria of DiGA. Methods This scoping review will follow published methodological frameworks and the PRISMA-Scr (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) criteria. Electronic databases (MEDLINE, EMBASE, PsycINFO, and JMIR), reference lists of relevant articles, and grey literature sources will be searched. Two reviewers will assess the eligibility of the articles by a two-stage (title and abstract as well as full text) screening process. Only problems and barriers related to mHealth apps fulfilling the criteria of DiGA are included for this research. The identified studies will be categorized and analyzed with MAXQDA. Results This scoping review gives an overview of the available evidence and identifies research gaps regarding problems and barriers related to DiGA. The results are planned to be submitted to an indexed, peer-reviewed journal in the first quarter of 2022. Conclusions This is the first review to identify the problems and barriers related to the use of mHealth apps fulfilling the German definition of DiGA. Nevertheless, the findings can be applied to other contexts and health care systems as well. International Registered Report Identifier (IRRID) DERR1-10.2196/32702
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Affiliation(s)
- Godwin Denk Giebel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
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Li Q, Xue W, Gong W, Quan X, Li Q, Xiao L, Xu DR, Caine ED, Poleshuck EL. Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study. BMC Health Serv Res 2021; 21:739. [PMID: 34311719 PMCID: PMC8311906 DOI: 10.1186/s12913-021-06752-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization. METHODS We recruited 13 women ages 18-35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants' age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis. RESULTS Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while "doing the month", the perceived gap between the ideal of "perfect moms" and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages. CONCLUSION The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.
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Affiliation(s)
- Qiao Li
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Wenqing Xue
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
- Department of Psychiatry, University of Rochester, Rochester, NY, 14642, USA.
- Institute and of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Xin Quan
- Department of Family Therapy, Nova Southeastern University, Fort Lauderdale, USA
| | - Quanlei Li
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - Lina Xiao
- East China Institute of Social Development, East China University of Science and Technology, Shanghai, China
| | - Dong Roman Xu
- ACACIA Lab for Health Systems Strengthening, Institute for Global Health and School of Health Management, Southern Medical University, Guangzhou, China
| | - Eric D Caine
- Department of Psychiatry, University of Rochester, Rochester, NY, 14642, USA
| | - Ellen L Poleshuck
- Departments of Psychiatry and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Mekonnen ZA, Gelaye KA, Were M, Tilahun B. Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia. JMIR Mhealth Uhealth 2021; 9:e27603. [PMID: 34128813 PMCID: PMC8277338 DOI: 10.2196/27603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message-based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. OBJECTIVE This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. METHODS A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. RESULTS A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. CONCLUSIONS Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, United States
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Mourtada R, Bashour H, Houben F. A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: low cost interventions are needed to address disparities in antenatal care. Contracept Reprod Med 2021; 6:17. [PMID: 34059151 PMCID: PMC8167987 DOI: 10.1186/s40834-021-00156-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/04/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Syria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women's socio-demographic characteristics. This study compares two governorates: Latakia, where uptake of ANC was high and Aleppo, where uptake of ANC was low to highlight the barriers to women's adequate uptake of ANC that existed in Syria pre-conflict. METHODS This qualitative study carried out 30 semi-structured interviews with (18-45-year-old) pregnant women from Aleppo and Latakia (recruited purposively from different types of health facilities in rural and urban areas), and 15 observation sessions at health facilities. Transcripts and fieldnotes were analyzed using the Framework Method with attention to the dimensions of availability, accessibility and acceptability of services. RESULTS Inadequate uptake of ANC in Aleppo included not attending ANC, seeking care with providers who are not trained to provide ANC or discontinuing care. Three themes explained the regional disparities in the uptake of ANC in Aleppo and Latakia: women's assessment of their health status and reasoning of causes of ill health in pregnancy; women's evaluation of the risks of seeking ANC; and women's appraisal of the value of different types of service providers. Poor experiences at public health facilities were reported by women in Aleppo but not by women in Latakia. Evaluations of ANC services were connected with the availability, accessibility (geographical and financial) and acceptability of ANC services, however, women's views were shaped by the knowledge and prevailing opinions in their families and community. CONCLUSIONS Findings are utilized to discuss low-cost interventions addressing the disparities in ANC uptake. Interventions should aim to enable vulnerable women to make informed decisions focusing on regions of low uptake. Women's groups that foster education and empowerment, which have been effective in other low resource settings, could be of value in Syria. Increased use of mobile phones and social media platforms suggests mobile health technologies (mHealth) may present efficient platforms to deliver these interventions.
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Affiliation(s)
- Rima Mourtada
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.
- Faculty of Health Sciences, American University of Beirut, Bliss Street, Beirut, Lebanon.
| | - Hyam Bashour
- Faculty of Medicine, University of Damascus, Damascus, Syria
| | - Fiona Houben
- Faculty of Health and Wellbeing, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1QU, UK
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Campbell BR, Choi K, Neils MG, Canan C, Moll A, Dillingham R, Shenoi SV. Mobile Device Usage by Gender Among High-Risk HIV Individuals in a Rural, Resource-Limited Setting. Telemed J E Health 2021; 27:615-624. [PMID: 32835638 PMCID: PMC8215405 DOI: 10.1089/tmj.2020.0218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mobile health (mHealth) is a promising tool to deliver healthcare interventions to underserved populations. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV in the middle-income country. Methods: We surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship, and employment status, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes. Results: Although only 10% of the 788 individuals surveyed used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, employed, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young, female, and employed. Participants reporting condomless sex or lack of circumcision were significantly less likely to have private data access or to purchase data. Conclusions: mHealth interventions should be feasible in rural KwaZulu-Natal, though differ by gender. As women are more likely to own smartphones, smartphone-based mHealth interventions specifically geared to prevent the acquisition of or to support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of nonsmartphone short message service and be attuned to mobile data limitations-especially when targeting men.
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Affiliation(s)
- Breanna R. Campbell
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Koeun Choi
- Section of Infection Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Megan Gray Neils
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Chelsea Canan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Anthony Moll
- Antiretroviral Program, Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Address correspondence to: Rebecca Dillingham, MD, MPH, Department of Medicine, UVA School of Medicine, P.O. Box 801379, Charlottesville, VA 22908, USA
| | - Sheela V. Shenoi
- Section of Infection Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Internet use by pregnant women seeking childbirth information. J Gynecol Obstet Hum Reprod 2021; 50:102144. [PMID: 33848646 DOI: 10.1016/j.jogoh.2021.102144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND During pregnancy period, women's information needs increases. Receiving information during this period affects the birth and postpartum period. OBJECTIVE The aim of this study was to determine the use of the internet to receiving childbirth information by pregnant women. METHODS The study was a descriptive study. Data were collected using an Information Form. The sample consisted of 162 pregnant women. RESULTS The 92.4% of women used the internet as a source of information about childbirth. Blogs or web pages were the most frequently used internet sources with 85.8% usage, followed by mobile applications with 75.6%, and social media with 58.1%. Most of the women found the information they received from the internet partially useful and reliable. 24.3% of the women stated that receiving information on internet decreased their fears and 14.8% that it increased their fears. CONCLUSIONS Most women used the internet as primary information source. Health professionals should orient people to reliable sources.
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Nguyen PH, Khương LQ, Pramanik P, Billah SM, Menon P, Piwoz E, Leslie HH. Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys. BMJ Open 2021; 11:e040109. [PMID: 33472778 PMCID: PMC7818835 DOI: 10.1136/bmjopen-2020-040109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh. METHODS We used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles. RESULTS Contact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14-17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp). CONCLUSION Nutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | | | - Priyanjana Pramanik
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Sk Masum Billah
- Maternal and Child Health Division, ICDDRB, Dhaka, Dhaka District, Bangladesh
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Ellen Piwoz
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Hannah H Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Bonciani M, De Rosis S, Vainieri M. Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma. JMIR Res Protoc 2021; 10:e19073. [PMID: 33464218 PMCID: PMC7854034 DOI: 10.2196/19073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Mobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy). Objective The protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway. Methods A pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results Following study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway. Conclusions The study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application. International Registered Report Identifier (IRRID) DERR1-10.2196/19073
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Affiliation(s)
- Manila Bonciani
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
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Ward VC, Raheel H, Weng Y, Mehta KM, Dutt P, Mitra R, Sastry P, Godfrey A, Shannon M, Chamberlain S, Kaimal R, Carmichael SL, Bentley J, Abdalla S, Pepper KT, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Nanda P, Tarigopula UK, Atmavilas Y, Bhattacharya D, Darmstadt GL. Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ward VC, Raheel H, Weng Y, Mehta KM, Dutt P, Mitra R, Sastry P, Godfrey A, Shannon M, Chamberlain S, Kaimal R, Carmichael SL, Bentley J, Abdalla S, Pepper KT, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Nanda P, Tarigopula UK, Atmavilas Y, Bhattacharya D, Darmstadt GL. Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India. J Glob Health 2020; 10:021005. [PMID: 33425329 PMCID: PMC7758913 DOI: 10.7189/jogh.10.021005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Mobile health (mHealth) tools have potential for improving the reach and quality of health information and services through community health workers in low- and middle-income countries. This study evaluates the impact of an mHealth tool implemented at scale as part of the statewide reproductive,maternal, newborn and child health and nutrition (RMNCHN) program in Bihar, India. Methods Three survey-based data sets were analysed to compare the health-related knowledge, attitudes and behaviours amongst childbearing women exposed to the Mobile Kunji and Dr. Anita mHealth tools during their visits with frontline workers compared with those who were unexposed. Results An evaluation by Mathematica (2014) revealed that exposure to Mobile Kunji and Dr. Anita recordings were associated with significantly higher odds of consuming iron-folic acid tablets (odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.8-3.1) as well as taking a set of three measures for delivery preparedness (OR = 2.8, 95% CI = 1.9-4.2) and appropriate infant complementary feeding (OR = 1.9, 95% CI = 1.0-3.5). CARE India’s Community-based Household Surveys (2012-2017) demonstrated significant improvements in early breastfeeding (OR = 1.64, 95% CI = 1.5-1.78) and exclusive breastfeeding (OR = 1.46, 95% CI = 1.33-1.62) in addition to birth preparedness practices. BBC Media Action’s Usage & Engagement Survey (2014) demonstrated a positive association between exposure to Mobile Kunji and Dr. Anita and exclusive breastfeeding (58% exposed vs 43% unexposed, P < 0.01) as well as maternal respondents’ trust in their frontline worker. Conclusions Significant improvements in RMNCHN-related knowledge and behaviours were observed for Bihari women who were exposed to Mobile Kunji and Dr. Anita. This analysis is unique in its rigorous evaluation across multiple data sets of mHealth interventions implemented at scale. These results can help inform global understanding of how best to use mHealth tools, for whom, and in what contexts. Study registration ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Victoria C Ward
- 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
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kala M 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
| | | | | | | | | | | | | | - Rajani Kaimal
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | | | - Dana Rotz
- Mathematica, Princeton, New Jersey, USA
| | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | | | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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Coleman J, Black V, Thorson AE, Eriksen J. Evaluating the effect of maternal mHealth text messages on uptake of maternal and child health care services in South Africa: a multicentre cohort intervention study. Reprod Health 2020; 17:160. [PMID: 33081795 PMCID: PMC7576764 DOI: 10.1186/s12978-020-01017-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background There are high expectations that mobile health (mHealth) strategies will increase uptake of health care services, especially in resource strained settings. Our study aimed to evaluate effects of an mHealth intervention on uptake of maternal health services. Methods This was an intervention cohort study conducted at six public antenatal and postnatal care clinics in inner-city Johannesburg, South Africa. The intervention consisted of twice-weekly informative and pregnancy stage-based maternal health information text messages sent to women during pregnancy until their child was one year of age. The intervention arm of 87 mother-infant pairs was compared to a control arm of 90 pairs. Univariate and multivariate analyses were used to compare the probability of the outcome between the two groups. Results Intervention participants had higher odds of attending all government-recommended antenatal and postnatal visits, all recommended first year vaccinations (OR: 3.2, 95% CI 1.63–6.31) and had higher odds of attending at least the recommended four antenatal visits (OR: 3.21, 95% CI 1.73–5.98). Conclusion We show an improvement in achieving complete maternal-infant continuum of care, providing evidence of a positive impact of informative maternal mHealth messages sent to pregnant women and new mothers. Trial registration ISRCTN, ISRCTN41772986. Registered 13 February 2019—Retrospectively registered, https://www.isrctn.com/ISRCTN41772986
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Affiliation(s)
- Jesse Coleman
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2000, South Africa.,Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Vivian Black
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2000, South Africa.,Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein, , Johannesburg, 2000, South Africa
| | - Anna Ekéus Thorson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Laboratory Medicine, Karolinska Institutet, C1 68, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
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Hirai M, Morris J, Luoto J, Ouda R, Atieno N, Quick R. The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study. BMC Pregnancy Childbirth 2020; 20:453. [PMID: 32770963 PMCID: PMC7414717 DOI: 10.1186/s12884-020-03130-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products. Methods To explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences. Results FGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education. Conclusions Future interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.
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Affiliation(s)
- Mitsuaki Hirai
- Division of Global Health Protection, Office of the Director, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Jamae Morris
- Department of African American Studies, Georgia State University, 33 Gilmer Street SE, Atlanta, GA, 30303, USA
| | - Jill Luoto
- RAND Corporation, Santa Monica, CA, 90407, USA
| | - Rosebel Ouda
- Safe Water and AIDS Project, P.O Box 3323, Kisumu, 40100, Kenya
| | - Nancy Atieno
- Safe Water and AIDS Project, P.O Box 3323, Kisumu, 40100, Kenya
| | - Robert Quick
- National Center for Emerging and Zoonotic Infectious Diseases, Office of Infectious Diseases Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
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Singh JK, Acharya D, Paudel R, Gautam S, Adhikari M, Kushwaha SP, Park JH, Yoo SJ, Lee K. Effects of Female Community Health Volunteer Capacity Building and Text Messaging Intervention on Gestational Weight Gain and Hemoglobin Change Among Pregnant Women in Southern Nepal: A Cluster Randomized Controlled Trial. Front Public Health 2020; 8:312. [PMID: 32766199 PMCID: PMC7379845 DOI: 10.3389/fpubh.2020.00312] [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] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Public health interventions such as text messaging are commonly evaluated in high-income countries and that the evaluation reports of the effectiveness of community health volunteers in low-income countries like Nepal is scarce. This study aimed to determine whether female community health volunteer (FCHV) capacity building and text messaging to expectant mother increases gestational weights and hemoglobin levels of pregnant women living in southern Nepal. Methods: A cluster randomized control trial was carried out in 52 clusters of 6 Village Development Committees in southern Nepal between July 2015 and March 2016. A total of 413 pregnant mothers of gestation age between 13 and 28 weeks (214 in the intervention group and 199 in the control group) were included in the analysis. Intervention consisted of FCHV capacity building followed by regular supervision and monitoring and mobile phone text messaging to expectant mothers. Regression analysis, controlled for confounders, was conducted to assess gestational weight gains and changes in hemoglobin levels. Results: At the end of the pregnancy, the mean weight gain difference between the intervention and control groups was 1.1 kg (95% CI: 1.0, 1.9). Rates of weight increases in the intervention and control groups were 0.504 kg/week (95% CI: 0.371, 0.528), and 0.399 kg/week (95% CI: 0.362, 0.465), respectively. Similarly, the mean inter group difference in hemoglobin levels was 0.11 gm/dl (95% CI: 0.09, 0.15), and rates of hemoglobin increases (gm/dl/week) in the intervention and control groups were 0.02 gm/dl (95% CI: 0.01, 0.09) and 0.004 gm/dl (95% CI: 0.02, 0.12), respectively. Conclusions: The study shows that FCHV capacity building and mobile text messaging have a positive effect on the gestational weights and hemoglobin levels of expectant mothers. Our findings suggest that mobile text messaging coupled with FCHV capacity building services should be supported and would usefully expand in resource poor settings. Trial registration: ISRCTN60684155.
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Affiliation(s)
- Jitendra Kumar Singh
- Department of Community Medicine, Janaki Medical College, Tribhuvan University, Janakpur, Nepal
| | - Dilaram Acharya
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju-si, South Korea.,Department of Community Medicine, Devdaha Medical College and Research Institute, Kathmandu University, Dhulikhel, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Salila Gautam
- Department of Public Health, Sanjeevani College of Medical Sciences, Biratnagar, Nepal
| | | | | | - Ji-Hyuk Park
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju-si, South Korea
| | - Seok-Ju Yoo
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju-si, South Korea
| | - Kwan Lee
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju-si, South Korea
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Feroz AS, Ali NA, Saleem S. Assessing mobile phone access, usage, and willingness among women to receive voice message-based mobile health intervention to improve antenatal care attendance in district Thatta, Sindh, Pakistan. Reprod Health 2020; 17:104. [PMID: 32631370 PMCID: PMC7336476 DOI: 10.1186/s12978-020-00956-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who were not able to seek the recommended antenatal visits. In Thatta district, the maternal mortality ratio is estimated at 313/100,000 live births. Various studies reported that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services. However, the feasibility and effectiveness of mobile health interventions to increase uptake of preventive maternal healthcare services among pregnant women in different settings may be different due to differing patient demographics, cultural diversity, environmental and behavioral factors, availability and accessibility to mobile phones, and budgetary constraints. Prior to implementing a similar intervention in Thatta District, it is crucially important to assess the mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance. Methods A cross-sectional quantitative study will be used to assess mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance in district Thatta. The study will be conducted in Thatta district of Sindh province. Married women of reproductive age (MWRA), who are residing in selected villages of Mirpur Sakro and willing to participate will be included in the study. Multistage sampling technique will be used to recruit the 415 study participants. A structured questionnaire has been designed on Epicollect to collect data from 415 women. Data will be analyzed using IBM SPSS Statistics version 23, with a level of significance as < 0.05. Discussion This research project will provide invaluable information on the current access, usage of mobile phones among women of district Thatta and their willingness to receive voice messages to improve the antenatal care services. The study will also highlight demographic, sociocultural and economic factors associated with women willingness and readiness to receive voice messages regarding antenatal care.
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Affiliation(s)
- Anam Shahil Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Naureen Akber Ali
- School of Nursing and Midwifery, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Balzarini F, Frascella B, Oradini-Alacreu A, Gaetti G, Lopalco PL, Edelstein M, Azzopardi-Muscat N, Signorelli C, Odone A. Does the use of personal electronic health records increase vaccine uptake? A systematic review. Vaccine 2020; 38:5966-5978. [PMID: 32620374 DOI: 10.1016/j.vaccine.2020.05.083] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on the impact of their use is scant. With PEHRs being more and more marketed as easily implementable and cost-effective instruments to provide people with direct control on their health, the question on whether their use might be associated with the priority to improve vaccine coverage arises. METHODS We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on PEHR effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention (standard care, no access to PEHR), ii) PEHR access only vs access to PEHR with additional features (e.g. health education materials, active reminders). RESULTS Of 3114 identified citations, 8 studies were included, the majority published in the US and before 2015; 62% were randomized trials, the rest having an observational study design. Evidence suggests a moderate positive impact of PEHR access in increasing vaccine uptake, with data available for influenza and pneumococcal vaccines, diabetic patients and childhood immunization. Pooled data report the addition of digital communication features, i.e. the delivery of educational messages, reminders and availability of scheduling features might increase vaccine uptake, as compared to PEHR access alone. However, evidence is not conclusive. CONCLUSION While immunization programs are struggling to achieve optimal coverage targets, it seems the potential of PEHRSs supporting informed adherence to vaccines recommendations is neither fully exploited nor explored. Which factors mediate the association between PEHRs access and vaccine uptake? Which PEHRs' design and functional components can maximize their impact? On which target populations? Which PEHR models works better for high-risk populations? Our findings can only partially answer those questions and further experimental research is needed.
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Affiliation(s)
| | | | | | - Giovanni Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research, New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Michael Edelstein
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK; European Public Health Association Section on Infectious Diseases Control
| | - Natasha Azzopardi-Muscat
- Director Country Health Policies and Systems World Health Organisation, Regional Office for Europe, Copenhagen, Denmark
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, Milan, Italy; European Public Health Association Section on Infectious Diseases Control.
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Coleman J, Eriksen J, Black V, Thorson A, Hatcher A. The Mobile Alliance for Maternal Action Text Message-Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study. JMIR Hum Factors 2020; 7:e14078. [PMID: 32459628 PMCID: PMC7367535 DOI: 10.2196/14078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program. Objective The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback. Methods Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback. Results The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family. Conclusions These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system.
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Affiliation(s)
- Jesse Coleman
- Wits Reproductive Health & HIV Institute, School of Medicine, University of Witwatersrand, Johannesburg, South Africa.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Vivian Black
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Thorson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abigail Hatcher
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Almohanna AA, Win KT, Meedya S. Effectiveness of Internet-Based Electronic Technology Interventions on Breastfeeding Outcomes: Systematic Review. J Med Internet Res 2020; 22:e17361. [PMID: 32469315 PMCID: PMC7293063 DOI: 10.2196/17361] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/05/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Supporting women to initiate and continue breastfeeding is a global challenge. A range of breastfeeding interventions employing electronic technologies (e-technologies) are being developed, which offer different delivery modes and features over the internet; however, the impact of internet-based e-technologies on breastfeeding outcomes remains unclear. OBJECTIVE This study aimed to identify the characteristics of current internet-based breastfeeding interventions employing e-technologies and investigate the effects of internet-based e-technologies on breastfeeding outcomes. METHODS A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following databases: Scopus, Web of Science, the Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, the Association for Computing Machinery, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore. RESULTS This systematic review included 16 studies published between 2007 and 2018, with 4018 women in 8 countries. The characteristics of the interventions were grouped based on (1) mode of delivery (web-based, mobile phone apps, and computer kiosk), (2) purpose of the interventions (education and support), and (3) key strategies (monitoring and breastfeeding tracking, personalization, online discussion forum, web-based consultation, and breastfeeding station locators). Combining educational activities with web-based personalized support through discussion forums appeared to be the most effective way to improve breastfeeding outcomes and long-term exclusive breastfeeding rates. Monitoring and breastfeeding trackers appeared to be the least effective ways. CONCLUSIONS This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women. Future internet-based breastfeeding interventions employing e-technologies might consider improving interaction with mothers and personalizing the content of the proposed interventions.
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Affiliation(s)
- Alaa Ali Almohanna
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Khin Than Win
- School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Shahla Meedya
- School of Nursing, University of Wollongong, Wollongong, Australia
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Esopo K, Derby L, Haushofer J. Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: a systematic review. BMC Pregnancy Childbirth 2020; 20:316. [PMID: 32448165 PMCID: PMC7245828 DOI: 10.1186/s12884-020-02992-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa tend to have low adherence to antenatal and postnatal care regimens, contributing to high infant and child mortality rates. Despite low adherence figures and the high returns from attending antenatal and postnatal care visits, research on interventions to improve adherence is in its infancy. Our aim was to determine the effectiveness of existing interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa. METHODS Full text, peer-reviewed articles, published in English and listed in PubMed or PsycINFO through January 2018 were identified in a systematic review. Studies were restricted to randomized controlled trials only and had to assess intervention impact on antenatal and postnatal care adherence, operationalized as the frequency of visits attended. Two reviewers independently screened papers for inclusion and evaluated the risk of systematic error in each study using the Cochrane risk of bias tool. Any discrepancies were reconciled by a third independent reviewer. RESULTS The initial search generated 186 articles, of which, five met our inclusion criteria. Due to the small sample size and methodological variation across studies, a pooled effect size estimate could not be obtained. Therefore, effects on antenatal and postnatal care adherence were examined and reported at the individual study level. None of the interventions were directly aimed at improving adherence, but two of the five, both behavioral interventions, demonstrated effectiveness in increasing antenatal care (rate ratio 5.86, 95% CI 2.6-13.0, p<0.0001) and postnatal care adherence (31.3%, 95% CI 15.4-47.2, p=0.0009), respectively. Three home visit interventions had no effect on antenatal care adherence. Although the risk of bias was unclear or high in some cases, it remained low in most categories across studies. CONCLUSIONS Results point to a large gap in the literature on interventions to address antenatal and postnatal care adherence in sub-Saharan Africa. Interventions drawing upon the executive function literature and the promising results of the behavioral interventions reviewed here are urgently needed to address these gaps. TRIAL REGISTRATION The review was prospectively registered with PROSPERO, id number https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=88152, on February 7, 2018.
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Affiliation(s)
- Kristina Esopo
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, 93106 CA USA
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 630 West 168th Street, New York, 10032 NY USA
| | - Johannes Haushofer
- Department of Psychology, Princeton University, 427 Peretsman-Scully Hall, Princeton, 08544 NJ USA
- Woodrow Wilson School for Public and International Affairs & Department of Economics, Princeton University, Princeton, 08544 NJ USA
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Vasudevan L, Ostermann J, Moses SM, Ngadaya E, Mfinanga SG. Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey. JMIR Mhealth Uhealth 2020; 8:e17122. [PMID: 32267240 PMCID: PMC7177426 DOI: 10.2196/17122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results Of 406 women, only 3 had never used a phone. Most women (>98%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States.,Duke Global Health Institute, Duke University, Durham, NC, United States.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
| | - Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States.,Department of Health Services, Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
| | - Sara Marwerwe Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania.,Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania.,School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
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Bonifácio LP, Franzon ACA, Zaratini FS, Vicentine FB, Barbosa-Júnior F, Braga GC, Sanchez JAC, Oliveira-Ciabati L, Andrade MS, Fernandes M, Fabio SV, Duarte G, Pileggi VN, Souza JP, Vieira EM. PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial. Reprod Health 2020; 17:45. [PMID: 32252789 PMCID: PMC7132868 DOI: 10.1186/s12978-020-0859-6] [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] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. Methods A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. Conclusion The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men’s involvement in prenatal, labour and postpartum care of their partners. Trial registration Clinical trial registry: RBR-54zf73, U1111–1163-7761.
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Affiliation(s)
- Lívia Pimenta Bonifácio
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | - Ana Carolina Arruda Franzon
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiani Spessoto Zaratini
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Bergamini Vicentine
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Francisco Barbosa-Júnior
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Jazmin Andrea Cifuentes Sanchez
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lívia Oliveira-Ciabati
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Magna Santos Andrade
- Department of Education, College of Nursing, State University of Bahia (UNEB), Senhor do Bonfim, Bahia, Brazil
| | - Mariana Fernandes
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Suzi Volpato Fabio
- Women Health Programme, Ribeirao Preto Health Department, Ribeirao Preto, São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Vicky Nogueira Pileggi
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Elisabeth Meloni Vieira
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Lee S, Begley CE, Morgan R, Chan W, Kim SY. Addition of mHealth (mobile health) for family planning support in Kenya: disparities in access to mobile phones and associations with contraceptive knowledge and use. Int Health 2020; 11:463-471. [PMID: 30576546 DOI: 10.1093/inthealth/ihy092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently mobile health (mHealth) has been implemented in Kenya to support family planning. Our objectives were to investigate disparities in mobile phone ownership and to examine the associations between exposure to family planning messages through mHealth (stand-alone or combined with other channels such as public forums, informational materials, health workers, social media and political/religious/community leaders' advocacy) and contraceptive knowledge and use. METHODS Logistic and Poisson regression models were used to analyze the 2014 Kenya Demographic and Health Survey. RESULTS Among 31 059 women, 86.7% had mobile phones and were more likely to have received higher education, have children ≤5 y of age and tended to be wealthier or married. Among 7397 women who were sexually active, owned a mobile phone and received family planning messages through at least one channel, 89.8% had no exposure to mHealth. mHealth alone was limited in improving contraceptive knowledge and use but led to intended outcomes when used together with four other channels compared with other channels only (knowledge: incidence rate ratio 1.084 [95% confidence interval {CI} 1.063-1.106]; use: odds ratio 1.429 [95% CI 1.026-1.989]). CONCLUSIONS Socio-economic disparities existed in mobile phone ownership, and mHealth alone did not improve contraceptive knowledge and use among Kenyan women. However, mHealth still has potential for family planning when used with existing channels.
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Affiliation(s)
- Seohyun Lee
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles E Begley
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sun-Young Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Atti Le giornate della ricerca scientificae delle esperienze professionali dei giovani: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI) Roma 20-21 dicembre 2019. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 60:E1-E85. [PMID: 32258536 PMCID: PMC7105054 DOI: 10.15167/2421-4248/jpmh2019.60.4s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Frascella B, Oradini-Alacreu A, Balzarini F, Signorelli C, Lopalco PL, Odone A. Effectiveness of email-based reminders to increase vaccine uptake: a systematic review. Vaccine 2020; 38:433-443. [DOI: 10.1016/j.vaccine.2019.10.089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023]
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Tripathi V, Arnoff E, Bellows B, Sripad P. Use of interactive voice response technology to address barriers to fistula care in Nigeria and Uganda. Mhealth 2020; 6:12. [PMID: 32270004 PMCID: PMC7136652 DOI: 10.21037/mhealth.2019.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The use of digital health technologies has expanded across low-resource settings, including in programs seeking to improve maternal health care seeking and service usage. However, there has been limited use of these technologies for screening and referral within maternal health, and many interventions have relied on SMS tools, which may have limited impact in settings with low female literacy. Digital health technologies have the potential to increase access to care for chronic maternal morbidities, such as obstetric fistula, and for women facing stigma, geographic isolation, and other sociocultural barriers to care seeking. This study documented the process of developing and implementing an innovative fistula screening and referral hotline using interactive voice response (IVR) technology, and described the service usage results and stakeholder perspectives associated with the hotline. METHODS The IVR hotline was introduced within the context of a broader Fistula Treatment Barriers Reduction Intervention implemented by the USAID-funded Fistula Care Plus project in Ebonyi and Katsina states in Nigeria and Kalungu district in Uganda. The intervention used three communication pathways to disseminate fistula information and conduct fistula screening: trained community agents, trained primary health care providers, and the IVR hotline paired with mass media messaging. All positively-screened women were eligible to receive vouchers for free transportation to an accredited fistula treatment center. Quantitative and qualitative data on intervention implementation and use across all three communication pathways were gathered during intervention implementation, at baseline, midline, and endline; as well as through ongoing program monitoring. This study presents findings specifically on service usage and stakeholder perspectives related to the IVR hotline. RESULTS Over a period of ten to twelve months of implementation, depending on the intervention area, a total of 566 women completed the IVR hotline screening process. Across the areas, 415 (73%) hotline callers screened positive for fistula symptoms. Hotline users and implementation partners reported positive impressions of the hotline, particularly the ability to preserve anonymity in seeking information and referral for fistula symptoms. Challenges to hotline use included limited mobile phone ownership and poor cellular network connectivity, affecting operability by women and community agents. CONCLUSIONS Implementation of the fistula screening hotline suggests that IVR-based interventions may be useful in expanding access to health services for stigmatized conditions, particularly in settings where literacy is limited. In the current context, such IVR tools require pairing with community and health system partners to complete referral and support clients. Further program experience and evaluation research is required to understand the options for integrating the IVR hotline or other interventions similarly using mobile technologies for screening and referral into broader digital health platforms that are sustained by national health systems or commercial business models.
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Affiliation(s)
| | - Elly Arnoff
- Fistula Care Plus Project, EngenderHealth, Washington, DC, USA
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