1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Kirkwood EK, Khan J, Hasan MM, Iqbal A, Tahsina T, Huda T, Hoddinott JF, Laba TL, Muthayya S, Goodwin N, Islam M, Kingsley EA, Arifeen SE, Dibley MJ, Alam NA. Women's participation in household decision-making: Qualitative findings from the Shonjibon Trial in rural Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002907. [PMID: 38885288 PMCID: PMC11182512 DOI: 10.1371/journal.pgph.0002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
A key element of women's empowerment is the ability to participate in household decision-making. This study presents the qualitative results from the Shonjibon Cash and Counselling Trial baseline process evaluation with the aim of exploring the status of women's decision-making at the trial's outset and to facilitate the exploration of any changes in women's empowerment over the course of the trial. Between January and March 2021, we conducted forty-one in-depth interviews with pregnant women in rural Bangladesh. The research team translated, transcribed, coded, and discussed the interviews. We used thematic analysis to examine women's experience and perceptions on household decision-making. The key findings that emerged; women jointly participated in financial decision-making with their husbands; men made the final decision regarding seeking healthcare, and women solely made choices regarding infant and young child feeding. Our findings revealed that women felt that they needed to discuss their plans to go outside the house with their husbands, many perceived a lack of importance in the community towards women's participation in decision-making. This study documents current contextual information on the status of women's involvement in household decision-making and intrahousehold power dynamics at the start of the Shonjibon Cash and Counselling Trial.
Collapse
Affiliation(s)
- Elizabeth K. Kirkwood
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mohammad Mehedi Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Afrin Iqbal
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tanvir Huda
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Frederick Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Tracey Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Sumithra Muthayya
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The Sax Institute, Glebe, New South Wales, Australia
| | - Nicholas Goodwin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Shams E. Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Michael J. Dibley
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Neeloy Ashraful Alam
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Ameyaw EK, Amoah PA, Ezezika O. Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews. J Med Internet Res 2024; 26:e49510. [PMID: 38810250 PMCID: PMC11170050 DOI: 10.2196/49510] [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: 05/31/2023] [Revised: 10/29/2023] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. OBJECTIVE This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. METHODS We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. RESULTS A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). CONCLUSIONS The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. TRIAL REGISTRATION PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77.
Collapse
Affiliation(s)
- Edward Kwabena Ameyaw
- Institute of Policy Studies, Lingnan University, Hong Kong, China (Hong Kong)
- School of Graduate Studies, Lingnan University, Hong Kong, China (Hong Kong)
| | - Padmore Adusei Amoah
- Institute of Policy Studies, Lingnan University, Hong Kong, China (Hong Kong)
- School of Graduate Studies, Lingnan University, Hong Kong, China (Hong Kong)
- Department of Psychology, Lingnan University, Hong Kong, China (Hong Kong)
| | - Obidimma Ezezika
- Global Health & Innovation Lab, Faculty of Health Sciences, School of Health Studies, Western University, London, ON, Canada
| |
Collapse
|
4
|
Laws RA, Zheng M, Brown V, Lymer S, Campbell KJ, Russell CG, Taki S, Litterbach E, Ong KL, Denney-Wilson E. The impacts of an mHealth intervention targeting parents on health service usage and out-of-pocket costs in the first 9 months of life: The Growing healthy app. MATERNAL & CHILD NUTRITION 2024:e13662. [PMID: 38804571 DOI: 10.1111/mcn.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Mobile health (mHealth) interventions provide a low-cost, scalable approach to supporting parents with infant feeding advice with the potential to reduce health care visits and associated costs for infant feeding support. This Australian study examined the impact of the Growing healthy (GH) app on health service utilisation and out-of-pocket costs for families in the first 9 months of their infants life. A quasi-experimental study with a comparison group was conducted in 2015-2016 with an mHealth intervention group (GH app, n = 301) and a nonrandomized usual care group (n = 344). The GH app aimed to support parents of young infants with healthy infant feeding behaviours from birth to 9 months of age. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed surveys at baseline when infants were less than 3 months old (T1), at 6 months (T2) and 9 months (T3) of age. At T3, participants reported health services used and any out-of-pocket costs for advice on infant feeding, growth or activity. App users had lower odds (odds ratio: 0.38 95% confidence interval: 0.25, 0.59) of using one or more services and had lower number of visits to a general practitioner (1.0 vs. 1.5 visits, p = 0.003) and paediatrician (0.3 vs. 0.4 visits, p = 0.049) compared to the usual care group. There was no difference in out-of-pocket costs between groups. Provision of an evidenced-based infant feeding app may provide substantial savings to the health system and potentially to parents through fewer primary health care and paediatrician visits.
Collapse
Affiliation(s)
- Rachel A Laws
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Miaobing Zheng
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sharyn Lymer
- Biostatistics Consultant, Sydney, NSW, Australia
| | - Karen J Campbell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Catherine G Russell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eloise Litterbach
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, The Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- Department of Information Systems and Business Analytics, AISSC, RMIT University, Melbourne, VIC, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
5
|
Chaudry ZA, Naz T, Arshad I, Zahoor A, Javaid M, Sikander S. Innovative continuum of care to promote exclusive breast feeding in Pakistan: protocol of a pilot randomised controlled trial. BMJ Paediatr Open 2024; 8:e002562. [PMID: 38769049 PMCID: PMC11110549 DOI: 10.1136/bmjpo-2024-002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Breastmilk being the ideal nutrition from birth to 2 years and beyond has many health benefits for both newborn and mothers. This study will assess the feasibility and acceptability of a continuum of care programme, which is a health facility and community based till 6 months post partum to encourage ideal breastfeeding practices. METHODS AND ANALYSIS A pilot randomised control trial having two-parallel arms of intervention and control groups was conducted in gynaecology and obstetrics department of Aziz Bhatti Shaheed Teaching Hospital with a community outreach component of 6 months. 50 women between 28 and 32 weeks of gestation fulfilling inclusion criteria will be allocated in 1:1 randomly into intervention and control groups through computer-generated random number generator software. 25 participants in intervention group will receive counselling and training on breast feeding during antenatal visits along with a family member of support by a trained female doctor within the hospital, at birth by a trained nurse and at home for 6 months by a trained lady health worker. It will be supported by reading materials and videos through a mobile phone WhatsApp application. The 25 participants in control group will receive the support already provided within the hospital and at home. The primary outcomes feasibility and acceptability will be determined at 6 months post partum from participants and providers by a semistructured questionnaire. The secondary outcomes are rates of infant early initiation and exclusive breast feeding at 2 weeks, 1, 3 and 6 months, Infant Feeding Attitude at 1 month and Breastfeeding Self-Efficacy at 3 months. Quantitative and qualitative data will be analysed via SPSS software V.20 and thematic analysis, respectively. CONCLUSION This pilot randomised controlled trial (RCT) will guide the interventions for the definite RCT. ETHICS AND DISSEMINATION Approved by institutional ethical committee, informed consent from all participants and results will be disseminated in peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05951868.
Collapse
Affiliation(s)
- Zahid Azam Chaudry
- Department of Community Medicine & Public Health, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Tehmina Naz
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Iqra Arshad
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Aisha Zahoor
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Mahum Javaid
- UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Siham Sikander
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Mugyenyi GR, Byamugisha JK, Tumuhimbise W, Atukunda EC, Fajardo YT. Customization and acceptability of the WHO labor care guide to improve labor monitoring among health workers in Uganda. An iterative development, mixed method study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002780. [PMID: 38739560 PMCID: PMC11090317 DOI: 10.1371/journal.pgph.0002780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
Cognisant of persistently high maternal and perinatal mortality rates, WHO called for adoption and evaluation of new adaptable and context-specific solutions to improve labor monitoring and health outcomes. We aimed at customizing/refining the new WHO labour care guide (LCG) to suite health care provider needs (HCP) in monitoring labour in Uganda. We used mixed methods to customize/refine and pilot test the new WHO LCG using stakeholder perspectives. Between 1st July 2023 and 30th December 2023, we conducted; 1)30 stakeholder interviews to identify user needs/challenges that informed initial modifications of the WHO LCG; 2)15 HCP in-depth interviews to identify any further needs to modify the LCG; 3) Two focus group discussions and 4) Two exit expert panels to identify any further user needs to further refine proposed modifications into the final prototype. Questionnaires were administered to assess acceptability. We interviewed 125 stakeholders with median age of 36 years (IQR;26-48) exposed to the LCG for at least 12 months with 11.8(SD = 4.6) years of clinical practice. Simple useful modifications/customizations based on format, HCP's perceived function and role in improving decision making during monitoring labour included; 1) Customizing LCG by adding key socio-demographic data; 2) Adjusting observation ordering; 3) Modification of medication dosages and 4) Provision for recording key clinical notes/labour outcome data on reverse side of the same A4 paper. All HCPs found the modified WHO LCG useful, easy to use, appropriate, comprehensive, appealing and would recommend it to others for labour monitoring. It was implementable and majority took less than 2 minutes to completely record/fill observations on the LCG after each labour assessment. Active involvement of end-users improved inclusiveness, ownership, acceptability and uptake. The modified LCG prototype was found to be simple, appropriate and easy-to-use. Further research to evaluate large-scale use, feasibility and effectiveness is warranted.
Collapse
Affiliation(s)
- Godfrey R. Mugyenyi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Josaphat K. Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Wilson Tumuhimbise
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C. Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine T. Fajardo
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
8
|
Constantine A, Fantaye AW, Buh A, Obegu P, Fournier K, Kasonde M, Jacobs C, Clementina P, Gobina R, Kibu O, Foretia D, Nkangu M, Yaya S. Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol. PLoS One 2024; 19:e0295437. [PMID: 38446819 PMCID: PMC10917244 DOI: 10.1371/journal.pone.0295437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.
Collapse
Affiliation(s)
- Asahngwa Constantine
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Pamela Obegu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Fournier
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Ronald Gobina
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Odette Kibu
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Denis Foretia
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Miriam Nkangu
- Bruyere Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| |
Collapse
|
9
|
Singh K, Walters MR. Use of mHealth in promoting maternal and child health in "BIMARU" states of India "A health system strengthening strategy": Systematic literature review. PLOS DIGITAL HEALTH 2024; 3:e0000403. [PMID: 38306391 PMCID: PMC10836675 DOI: 10.1371/journal.pdig.0000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Low-middle income countries like India bear a heavier burden of maternal, childcare, and child mortality rates when compared with high-income countries, which highlights the disparity in global health. Numerous societal, geopolitical, economic, and institutional issues have been linked to this inequality. mHealth has the potential to ameliorate these challenges by providing health services and health-related information with the assistance of frontline workers in the provision of prepartum, delivery, and postnatal care to improve maternal and child health outcomes in hard-to-reach areas in low- and middle-income countries (LMICs). However, there is limited evidence to support how mHealth can strengthen maternal and child health in India. The scoping review guideline in the Cochrane Handbook was used to retrieve studies from 4 international databases: CINAHL, Embase, Medline Ovid, and PubMed. This search strategy used combined keywords (MeSH terms) related to maternal and child healthcare, mHealth, and BIMARU in conjunction with database-controlled vocabulary. Out of 278 records, 8 publications were included in the review. The included articles used mHealth for data collection, eLearning, communication, patient monitoring, or tracking to deliver maternal and neonatal care. The results of these papers reflected a favourable effect of mHealth on the target population and found that it altered their attitudes and behaviours about healthcare. Higher job satisfaction and self-efficiency were reported by mHealth user care providers. Multiple barriers to the acceptance of mHealth exist, but the majority of the evidence points towards the feasibility of the intervention in a clinical setting. The mHealth has positive potential for improving maternal and child health outcomes in low-resource settings in India's BIMARU states by strengthening the healthcare system. The results of the study could be used in the tailoring of an effective mHealth intervention and implementation strategy in a similar context. However, there is a need for economic evaluation in the future to bridge the knowledge gap regarding the cost-effectiveness of mHealth interventions.
Collapse
Affiliation(s)
- Khushbu Singh
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Matthew R Walters
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| |
Collapse
|
10
|
El Ayadi AM, Diamond-Smith NG, Duggal M, Singh P, Sharma P, Kaur J, Gopalakrishnan L, Gill N, Singh G, Ahuja A, Kumar V, Weil L, Bagga R. Preliminary impact of an mHealth education and social support intervention on maternal health knowledge and outcomes among postpartum mothers in Punjab, India. RESEARCH SQUARE 2023:rs.3.rs-3746241. [PMID: 38196635 PMCID: PMC10775402 DOI: 10.21203/rs.3.rs-3746241/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Significant disruptions in the perinatal continuum of care occur postpartum in India, despite it being a critical time to optimize maternal health and wellbeing. Group-oriented mHealth approaches may help mitigate the impact of limited access to care and the lack of social support that characterize this period. Our team developed and pilot tested a provider-moderated group intervention to increase education, communication with providers, to refer participants to in-person care, and to connect them with a virtual social support group of other mothers with similarly aged infants through weekly calls and text chat. Methods We analyzed the preliminary effectiveness of the pilot intervention on maternal health knowledge through 6 months postpartum among 135 participants in Punjab, India who responded to baseline and endline surveys. We described change in knowledge of maternal danger signs, birth preparedness, postpartum care use, postpartum physical and mental health, and family planning use over time between individuals in group call (synchronous), other intervention (asynchronous), and control groups. Results Participant knowledge regarding danger signs was low overall regarding pregnancy, childbirth and the postpartum period (mean range of 1.13 to 2.05 at baseline and 0.79 to 2.10 at endline). Group call participants had a significantly higher increase over time in knowledge of danger signs than other intervention and control group participants. Birth preparedness knowledge ranged from mean 0.89-1.20 at baseline to 1.31-2.07 at baseline, with group call participants having significantly greater increases in comparison to the control group. Group call participants had nearly three-fold increased odds of postpartum health check with a clinical provider than other intervention participants (OR 2.88, 95% CI 1.07-7.74). No differences were noted in postpartum depressive and anxiety symptoms. Conclusions Preliminary effectiveness results are promising, yet further robust testing of the MeSSSSage intervention effectiveness is needed. Further development of strategies to support health knowledge and behaviors and overcoming barriers to postpartum care access can improve maternal health among this population.
Collapse
Affiliation(s)
| | | | - Mona Duggal
- Postgraduate Institute of Medical Education & Research
| | | | | | - Jasmeet Kaur
- Indraprastha Institute of Information Technology Delhi
| | | | - Navneet Gill
- Postgraduate Institute of Medical Education & Research
| | - Garima Singh
- Postgraduate Institute of Medical Education & Research
| | - Alka Ahuja
- Postgraduate Institute of Medical Education & Research
| | | | | | - Rashmi Bagga
- Postgraduate Institute of Medical Education & Research
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Hartinger Pena SM, Mäusezahl D, Jäggi L, Aguilar L, Alvarado Llatance M, Castellanos A, Huaylinos Bustamante ML, Hinckley K, Charles McCoy D, Zhang C, Fink G. Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50371. [PMID: 38096020 PMCID: PMC10755649 DOI: 10.2196/50371] [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: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. OBJECTIVE The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. METHODS This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. RESULTS Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. CONCLUSIONS This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. TRIAL REGISTRATION ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50371.
Collapse
Affiliation(s)
- Stella Maria Hartinger Pena
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Lena Jäggi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonel Aguilar
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | | | | | | | - Kristen Hinckley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ce Zhang
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Noronha JA, Lewis MS, Phagdol T, Nayak BS, D A, Shetty J, N R, Nair S. Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e51792. [PMID: 38015596 DOI: 10.2196/51792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. OBJECTIVE This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? METHODS This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. RESULTS As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. CONCLUSIONS The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51792.
Collapse
Affiliation(s)
- Judith Angelitta Noronha
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Udupi, India
| | - Mitchelle S Lewis
- Department of Fundamentals of Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Tenzin Phagdol
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anupama D
- Department of Global Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Shetty
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ravishankar N
- Department of Biostatistics, Vallabhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Sreekumaran Nair
- Medical Biometrics & Informatics (Biostatistics), JIPMER, Pondicherry, India
| |
Collapse
|
15
|
Xu J, Akezhuoli H, Zhou M, Yao T, Lu J, Wang X, Zhou X. Development and evaluation of a culturally adapted digital-platform integrated multifaceted intervention to promote the utilization of maternal healthcare services: a single-arm pilot study. Int J Equity Health 2023; 22:217. [PMID: 37848902 PMCID: PMC10583400 DOI: 10.1186/s12939-023-02033-y] [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: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The utilization of hospital delivery and antenatal care (ANC) is essential for improving maternal and newborn outcomes. However, social and cultural barriers in underdeveloped rural areas hindered maternal care utilization. This study aims to design and evaluate the effectiveness of a culturally adapted digital-platform intervention to promote maternal care utilization among women in ethnic minority communities in China. METHODS From January 1st, 2020, to December 31st, 2021, all pregnant women in Mianshan town, Liangshan Autonomous Prefecture, were invited to participate in the intervention. The multifaceted intervention included participatory and cultural-tailored health education on a popular social media platform, transportation subsidies, and capacity building and economic incentives for healthcare providers. The effectiveness of the intervention was evaluated by comparing two groups: mothers who gave live birth before the intervention (January 1st to December 31st, 2019) and mothers whose entire pregnancy period was covered by the intervention. The primary outcomes were the rate of hospital delivery and ANC utilization. Data on pregnant women were retrospectively collected through telephone surveys and the maternal and newborn's health monitoring system. RESULTS A total of 237 intervention sample and 138 pre-intervention sample were included. The intervention group demonstrated significantly higher rates of hospital delivery (97.5% vs. 87.7%, p < 0.001), timely initiation of ANC (73.0% vs. 62.3%, p = 0.031), and timely completion of five-time ANC visits (37.1% vs.4.3%, p < 0.001) compared to the pre-intervention group. The intervention group was more likely to utilize hospital delivery (OR = 9.26, 95%CI [2.83-30.24], p < 0.001) and ANC, including timely initiation of ANC (OR = 2.18, 95%CI [1.31-3.62], p = 0.003), completion of five ANC visits (OR = 1.72, 95%CI [1.05-2.83], p = 0.032), and timely completion of five ANC visits (OR = 15.12, 95%CI [6.24-36.64], p < 0.001). CONCLUSIONS The culturally adapted digital-platform integrated multifaceted intervention effectively promoted the utilization of hospital delivery, timely initiation of ANC, and completion of ANC visits in the Yi ethnic community in China. This study provides valuable insights for future interventions targeting maternal healthcare services in underdeveloped ethnic minority communities worldwide. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2300073219. Registered 4 July 2023 - Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=199202 .
Collapse
Affiliation(s)
- Jiayao Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Hailati Akezhuoli
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Meng Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Tingting Yao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Lu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Xiaomin Wang
- School of Public Health, Hangzhou Normal University, No. 2318 Yuhangtang Road, Yuhang District, Hangzhou, 311121, China.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China.
- The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
16
|
Engel M, Brouwer MA, Jansen N, Leget C, Teunissen SCCM, Kars MC. The spiritual dimension of parenting a child with a life-limiting or life-threatening condition: A mixed-methods systematic review. Palliat Med 2023; 37:1303-1325. [PMID: 37461310 PMCID: PMC10548770 DOI: 10.1177/02692163231186173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Spirituality refers to the dynamic dimension of human life that relates to the way that persons experience meaning, purpose, and transcendence. The complex task of parenting a child with a life-limiting condition may raise existential questions, which are easily overlooked by healthcare professionals. AIM We explored how the spiritual dimension becomes manifest in parents of children in pediatric palliative care. DESIGN A mixed-methods systematic review was conducted, registered in Prospero (2021 CRD42021285318). DATA SOURCES PubMed, CINAHL, Embase, PsycInfo, and Cochrane were searched for articles published between January 1, 2015 and January 1, 2023. We included original empirical studies that reported on spirituality of parents of seriously ill children, from parents' perspectives. RESULTS Sixty-three studies were included: 22 North-American, 19 Asian, 13 European, 9 other. Studies varied in defining spirituality. We identified five different aspects of spirituality: religion, hope, parental identity, personal development, and feeling connected with others. All aspects could function as source of spirituality or cause of spiritual concern. Sources of spirituality helped parents to give meaning to their experiences and made them feel supported. However, parents also reported struggling with spiritual concerns. Several parents highlighted their need for professional support. CONCLUSIONS Although studies vary in defining spirituality, reports on spirituality focus on how parents connect to their faith, others, and themselves as parents. Healthcare professionals can support parents by paying attention to the spiritual process parents are going through. More research is needed into how healthcare professionals can support parents of seriously ill children in this process.
Collapse
Affiliation(s)
- Marijanne Engel
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije A Brouwer
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke Jansen
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia CCM Teunissen
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
17
|
Persis J, Kathirvel S, Chopra S, Singh A. Effectiveness of mHealth-based educational interventions to improve self-care during pregnancy: A pragmatic randomized controlled trial from northern India. Int J Gynaecol Obstet 2023; 163:177-185. [PMID: 37067037 DOI: 10.1002/ijgo.14792] [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: 06/30/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To assess and compare the effectiveness of mHealth-based educational interventions on improving pregnancy self-care knowledge, attitude, and practice (KAP) and the satisfaction in using the interventions. METHODS We conducted a three-group, pragmatic, randomized controlled trial (July 2019-June 2020) among pregnant women (aged 20-45 years, gestation <20 weeks, and no pre-existing diseases) attending the prenatal clinic of a tertiary care hospital in northern India. Participants were randomly assigned to three arms (Group 1, specially developed mobile application; Group 2, Whatsapp, and Group 3, Control-Standard of care) using block randomization. Blinding was not performed. The educational intervention (for Groups 1 and 2) included general details about pregnancy, self-care preventive practices, and self-management of minor illnesses during pregnancy. The control group received routine instructions delivered by the doctors as part of the standard of care. After 3 months, the post-intervention KAP assessment and satisfaction with interventions/care received were carried out. RESULTS Of the 150 pregnant women who participated (50 per group), 70 (46.6%) were graduates and 66 (44.0%) were primigravidas. Mean age was 28 years. Pregnant women in Groups 1 and 2 showed a statistically significant (P < 0.001) improvement in KAP on pregnancy self-care compared with the control group post-intervention. However, the same was insignificant (P > 0.05) between Groups 1 and 2. Participant satisfaction with the intervention was significantly high among Group 2 compared with the control group (P < 0.001). CONCLUSION mHealth-based delivery of self-care education effectively improved KAP among pregnant women. The effectiveness of mHealth-based intervention must be assessed in primary healthcare settings before scaling up. DETAILS OF TRIAL REGISTRATION Registered with Clinical Trial Registry India-CTRI/2019/10/021794 registered on October 29, 2019 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=37444&EncHid=&userName=CTRI/2019/10/021794).
Collapse
Affiliation(s)
- Jenefa Persis
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Community Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Uttar Pradesh, Bareilly, India
| |
Collapse
|
18
|
Engel M, Kars MC, Teunissen SCCM, van der Heide A. Effective communication in palliative care from the perspectives of patients and relatives: A systematic review. Palliat Support Care 2023; 21:890-913. [PMID: 37646464 DOI: 10.1017/s1478951523001165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVES In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals. METHODS A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021. RESULTS In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting. SIGNIFICANCE OF RESULTS Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.
Collapse
Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijke C Kars
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Cox V, Sharma P, Verma GS, Gill N, Diamond-Smith NG, Duggal M, Kumar V, Bagga R, Kaur J, Singh P, El Ayadi AM. User Acceptability and Perceived Impact of a Mobile Interactive Education and Support Group Intervention to Improve Postnatal Health Care in Northern India: A Qualitative Study. RESEARCH SQUARE 2023:rs.3.rs-3320095. [PMID: 37790487 PMCID: PMC10543439 DOI: 10.21203/rs.3.rs-3320095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Postnatal care, crucial for preventing and assessing complications after birth, remains low in India. An interactive mHealth community-based postnatal intervention was implemented to promote healthy maternal behaviors through knowledge and social support in rural Northern India. However, there is limited information on how virtual health interventions in resource-constrained settings are perceived by the users and which elements influence their engagement and sustained participation. Objective We explored the user perceptions of acceptability and impact of a virtual interactive maternal and child health intervention pilot tested in Punjab State, India, including their perspectives on barriers and facilitators to engage with this intervention. Methods This qualitative study was embedded within extensive mixed-method research, and oriented by the Realist Evaluation approach. Sixteen participants were recruited from the parent study. They were identified by purposive sampling to cover diverse levels of attendance and engagement with the intervention. In-depth interviews were conducted by phone. Following translation, a framework analysis was completed to search for the main themes. Feedback was requested from intervention moderators during the process to prioritize local interpretation. Results Study participants reported overall satisfaction with the intervention. The mothers appreciated the educational material provided and the communication with other participants and health professionals. Across context, intervention, and actor domains, the barriers most commented on were network and connectivity challenges, lack of time due to household responsibilities, and feeling uncomfortable sharing personal experiences. Family buy-in and support were fundamental for overcoming the high domestic workload and baby care. Another facilitator mentioned was moderators' guidance on using the different intervention modalities. Regarding perceived impact, participants shared that MeSSSSage increased their capability and motivation to breastfeed, seek care as needed, and use contraception according to their preferences. Finally, participants suggested adding more topics to the educational content and adjusting the dynamics within the group calls to improve the intervention. Conclusions This study identifies the high acceptability and perceived impact of a novel postnatal care program in a rural setting, including the users' perceived barriers to engaging with the intervention and possible solutions to overcome them. These findings enable refinement of the ongoing intervention, providing a more robust framing for its scalability and long-term sustainability. On a larger scale, conclusions from this research provide new insights and encouragement to global stakeholders who aspire to improve maternal and neonatal outcomes in low-income and middle-income countries through mHealth.
Collapse
Affiliation(s)
| | | | | | - Navneet Gill
- Postgraduate Institute of Medical Education & Research
| | | | - Mona Duggal
- Postgraduate Institute of Medical Education & Research
| | | | - Rashmi Bagga
- Postgraduate Institute of Medical Education & Research
| | - Jasmeet Kaur
- Indraprastha Institute of Information Technology Delhi
| | | | | |
Collapse
|
20
|
Mzembe T, Chikwapulo V, Kamninga TM, Vellemu R, Mohamed S, Nthakomwa L, Chifungo C, Wazny K, Musau K, Abdullahi L, Peterson M, Madise N, Chipeta MG. Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews. BMC Public Health 2023; 23:1734. [PMID: 37674154 PMCID: PMC10481488 DOI: 10.1186/s12889-023-16558-y] [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: 02/10/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Maternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but their uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality in LMICs. METHODS We searched Medline PubMed and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review. RESULTS We retrieved 4,022 articles. After removing duplicates and screening, we included 14 systematic reviews. Male-partner interventions were effective in increasing skilled birth attendance (SBA) postnatal visits and maternal antiretroviral (ART) uptake for HIV-positive pregnant women. However, there was no evidence of their effectiveness on increased early ANC initiation or adequate ANC visits. Mobile health interventions were effective in increasing adequate ANC visits, SBA, facility-based service utilisation, early ANC initiation, and adherence to nutritional supplements. Incentive-based interventions, particularly financial incentives, were effective in increasing the number of ANC visits but not postnatal visits. Facility-based interventions were effective in increasing postnatal visits, maternal ART initiation and uptake, immunisation uptake and follow-up ANC visits. None of the reviews assessed their impact on SBA or adequate ANC visits. Community-based interventions were effective in increasing SBA, ANC service utilisation, ART initiation and uptake, and nutritional supplements and immunisation uptake. CONCLUSION Our findings show that the different interventions effectively improved different outcomes on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further.
Collapse
Affiliation(s)
- Themba Mzembe
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi.
| | | | | | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Sahra Mohamed
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | | | | | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Leila Abdullahi
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | | |
Collapse
|
21
|
Alfian SD, Insani WN, Puspitasari IM, Wawruch M, Abdulah R. Effectiveness and Process Evaluation of Using Digital Health Technologies in Pharmaceutical Care in Low- and Middle-Income Countries: A Systematic Review of Quantitative and Qualitative Studies. Telemed J E Health 2023; 29:1289-1303. [PMID: 36749170 DOI: 10.1089/tmj.2022.0406] [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] [Indexed: 02/08/2023] Open
Abstract
Introduction: Digital health technology (DHT) has the potential to enhance remote health care delivery. However, little is known about the effectiveness of DHTs and factors that contribute to the limited uptake of DHTs in low- and middle-income countries (LMICs). Therefore, the objective of this study was to systematically review the effectiveness and evaluation process concerning the use of DHTs in pharmaceutical care in LMICs. Methods: A literature search on PubMed and Embase was conducted to identify experimental, descriptive, qualitative, and mixed-method studies that focused on the use of DHTs in pharmaceutical care as the main intervention, reported on the effects and/or the process of the DHT intervention, were performed by pharmacists, were conducted in LMICs, and had been published in English. Two reviewers independently conducted the study selection process. A qualitative narrative review of the effectiveness of using DHTs was conducted evaluating the population, intervention, comparators, and outcomes. We summarized the content and identified themes of the evaluation process under two categories-challenges and opportunities. Results: The search produced 589 studies, of which 16 met the eligibility criteria. The most common type of DHT was mobile health application (mHealth app; n = 8), followed by mobile phone call (n = 6) and mobile video call (n = 2). Eight studies assessed the effectiveness of using DHTs in pharmaceutical care. mHealth app, mobile phone call, mobile video call, text messages, home telemonitoring, and internet-based drug information centers improved some health-related outcomes. Two of these eight studies, however, did not find significant effects of a phone call or an mHealth app on certain health-related outcomes. Of the seven quantitative studies conducting a process evaluation, all showed that patients were satisfied with the use of DHTs in pharmaceutical care provided by pharmacists. Of the two mixed-methods and one qualitative study assessing the process evaluation concerning DHT usage, three distinct themes of challenges (patient-, DHT-, and health care system-related challenges) and opportunities (patient-, DHT-, and pharmacist-related opportunities) were identified. Conclusions: DHT is a promising approach in pharmaceutical care toward improving health-related outcomes in LMICs, despite the variable intervention effects. The challenges and opportunities identified are important considerations when developing and implementing DHTs in pharmaceutical care in LMICs.
Collapse
Affiliation(s)
- Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Widya N Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| |
Collapse
|
22
|
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.
Collapse
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;
| |
Collapse
|
23
|
Choudhury A, Shahsavar Y, Sarkar K, Choudhury MM, Nimbarte AD. Exploring Perceptions and Needs of Mobile Health Interventions for Nutrition, Anemia, and Preeclampsia among Pregnant Women in Underprivileged Indian Communities: A Cross-Sectional Survey. Nutrients 2023; 15:3699. [PMID: 37686731 PMCID: PMC10490056 DOI: 10.3390/nu15173699] [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: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
According to the National Family Health Survey of 2021, about 57% of women aged 15-49 in India currently suffer from anemia, marking a significant increase from the 53% recorded in 2016. Similarly, a study conducted in southern India reported a 32.60% prevalence of preeclampsia. Several community-based initiatives have been launched in India to address these public health challenges. However, these interventions have yet to achieve the desired results. Could the challenges faced by traditional healthcare interventions be overcome through a technological leap? This study assesses pregnant mothers' perceptions regarding mobile health interventions for managing anemia and preeclampsia. Additionally, the study captures their health awareness and knowledge. We conducted a survey with 131 pregnant mothers in three underserved villages in Jharkhand, India. Statistical analysis was conducted using the SEMinR package in R (Version 2023.06.0), utilizing the non-parametric partial least squares-structural equation modeling. We found that every household had at least one smartphone, with the respondents being the primary users. The main uses of smartphones were for calling, messaging, and social media. A total of 61% of respondents showed interest in a nutrition and pregnancy app, while 23.66% were uncertain. Regarding nutritional knowledge during pregnancy, 68.7% reported having some knowledge, but only 11.45% claimed comprehensive knowledge. There was a considerable knowledge gap regarding the critical nutrients needed during pregnancy and the foods recommended for a healthy pregnancy diet. Awareness of pregnancy-related conditions such as anemia and preeclampsia was low, with most respondents unsure of these conditions' primary causes, impacts, and symptoms. This study serves as a critical step towards leveraging technology to enhance public health outcomes in low-resource settings. With the accessibility of mobile devices and an apparent willingness to utilize mHealth apps, compounded by the pressing need for improved maternal health, the impetus for action is indisputable. It is incumbent upon us to seize this opportunity, ensuring that the potential of technology is fully realized and not squandered, thus circumventing the risk of a burgeoning digital divide.
Collapse
Affiliation(s)
- Avishek Choudhury
- Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA; (Y.S.)
| | - Yeganeh Shahsavar
- Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA; (Y.S.)
| | | | - Murari Mohan Choudhury
- Network for Enterprise Enhancement and Development Support (NEEDS), Deoghar 814143, India
| | - Ashish D. Nimbarte
- Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA; (Y.S.)
| |
Collapse
|
24
|
Obegu P, Nkangu M, Ngo NV, Wanda F, Kasonde M, Kibu OD, Abong N, Ndiforchu V, Fantaye AW, Buh A, Gobina RM, Foretia DA, Fobellah N, Yaya S. Community participation for reproductive, maternal, newborn and child health: insights from the design and implementation of the BornFyne-prenatal management system digital platform in Cameroon. Front Digit Health 2023; 5:1218641. [PMID: 37664872 PMCID: PMC10470631 DOI: 10.3389/fdgth.2023.1218641] [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: 05/07/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Across communities in low-middle income countries, digital health is currently revolutionizing the delivery of health services, particularly in the field of reproductive, maternal, newborn, and child health (RMNCH) services. While studies have shown the effectiveness of mHealth in delivering RMNCH services, there is little information about factors that enhance mHealth services utilization in low-cost settings including stakeholders' level of influence on the implementation of digital health intervention in sub-Saharan Africa. This paper seeks to describe important lessons on the levels of stakeholders' direct or indirect influence on the design and implementation of the BornFyne-PNMS digital health platform to support RMNCH services. Methods A participatory research (PR) design approach was employed to explore stakeholders' perspectives of a new initiative, through direct engagement of local priorities and perspectives. The process of introducing the digital application called the BornFyne-PNMS for district health delivery system and the community, and integrating it within the district health delivery system was guided by research-to-action, consistent with the PR approach. To explore stakeholders' perspectives through a PR approach, we conducted a series of stakeholder meetings fashioned after focus group discussions. Results Issues around male involvement in the program, sensitization and equity concerns arose. Emergent challenges and proposed strategies for implementation from diverse stakeholders evidently enriched the design and implementation process of the project intervention. Stakeholder meetings informed the addition of variables on the mobile application that were otherwise initially omitted, which will further enhance the RMNCH electronic data collection for health information systems strengthening in Cameroon. Discussion This study charts a direction that is critical in digital health delivery of RMNCH in a rural and low-income community and describes the important iterative stakeholder input throughout the study. The strategy of stakeholders' involvement in the BornFyne PNMS implementation charts a direction for ownership and sustainability in the strengthening of Cameroon's health information system.
Collapse
Affiliation(s)
- Pamela Obegu
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Miriam Nkangu
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ngo Valery Ngo
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Franck Wanda
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Mwenya Kasonde
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Odette D. Kibu
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Nelly Abong
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | | | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ronald M. Gobina
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Denis A. Foretia
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nkengafack Fobellah
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
25
|
Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review. EClinicalMedicine 2023; 62:102133. [PMID: 37593225 PMCID: PMC10430180 DOI: 10.1016/j.eclinm.2023.102133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability is essential as it could potentially reduce research waste from replication of inadequately implemented and unacceptable interventions. We conducted a systematic review to investigate these aspects of community-based interventions for preventing stillbirths in SSA. Methods In this systematic review, eight databases (MEDLINE(OvidSP), Embase (OvidSP), Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index (Web of Science Core Collection), CINAHL (EBSCOhost) and Global Index Medicus) and four grey literature sources were searched from January 1, 2000 to July 7, 2023 for relevant quantitative and qualitative studies from SSA (PROSPERO-CRD42021296623). Following deduplication, abstract screening and full-text review, studies were included if the interventions were community-based with or without a health facility component. The main outcomes were types of community-based interventions, completeness of intervention reporting using the TIDier (Template for Intervention Description and replication) checklist, and themes related to intervention acceptability identified using a theoretical framework. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. Findings Thirty-nine reports from thirty-four studies conducted in 18 SSA countries were eligible for inclusion. Four types of interventions were identified: nutritional, infection prevention, access to skilled childbirth attendants and health knowledge/behaviour of women. These interventions were implemented using nine strategies: mHealth (defined as the use of mobile and wireless technologies to support the achievement of health objectives), women's groups, community midwifery, home visits, mass media sensitisation, traditional birth attendant and community volunteer training, community mobilisation and transport vouchers. The completeness of reporting using the TIDier checklist varied across studies with a very low proportion of the included studies reporting the intervention intensity, dosing, tailoring and modification. The quality of the included studies were graded as poor (n = 6), fair (n = 14) and good (n = 18). Though interventions were acceptable, only 4 (out of 7) studies explored women's perceptions, mostly focusing on perceived intervention effects and how they felt, omitting key constructs like ethicality, opportunity cost and burden of participation. Interpretation Different community-based interventions have been tried and evaluated for stillbirth prevention in SSA. The reproducibility and implementation scale-up of these interventions may be limited by incomplete intervention descriptions in the published literature. To strengthen impact, it is crucial to holistically explore the acceptability of these interventions among women and their families. Funding Clarendon/Balliol/NDPH DPhil scholarship for UGA. MN is funded by a Medical Research Council Transition Support Award (MR/W029294/1).
Collapse
Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- London Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
26
|
Pajalic Z, Rauckiene A, Savosnick G, Bartels I, Calleja-Agius J, Saplacan D, Jónsdóttir SS, Asadi-Azarbaijani B. Digital solutions to follow up on discharged new parents-A systematic literature review. PLOS DIGITAL HEALTH 2023; 2:e0000317. [PMID: 37611020 PMCID: PMC10446181 DOI: 10.1371/journal.pdig.0000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
New parents and their newborns are followed up after discharge either through home visits from midwives/nurses or using information and communication technology. This follow-up focuses on individual needs related to breastfeeding and infant feeding, practical advice on caring for babies, supporting and strengthening the new mother's knowledge and self-confidence concerning child development and parenting skills, and supporting the relationship between parents and baby. This systematic review aims to integrate available research results that describe new parents' experiences when health and care providers used telemedicine as a platform for follow-up after discharge from the childbirth department. This literature review was conducted following the PRISMA statement and was prospectively registered in PROSPERO CRD42021236912. The studies were identified through the following databases: AMED, Academic, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Cochrane database, and CINAHL. Results from these studies were compiled using thematic analysis. A total of 886 studies were identified. Screening resulted in eight studies that met the inclusion criteria. Thematic analysis produced the following themes: a) Flexibility and convenience of digital support, b) Digital literacy, c) Parents feeling safe with digital support, and d) Adequate substitute for physical meetings. New parents who live in a home environment with a relaxed atmosphere and around-the-clock digital support experience a sense of control, security, full attention, and encouragement. Digital follow up at home has proven effective because it can meet the support needs of new parents when necessary.
Collapse
Affiliation(s)
- Zada Pajalic
- Faculty of Health Sciences, VID Specialized University, Oslo Norway
| | - Alona Rauckiene
- Department of Health Research and Innovation Science Centre, Klaipeda University, Klaipeda Lithuania
| | - Grethe Savosnick
- Faculty of Health Sciences, VID Specialized University, Oslo Norway
| | | | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Valletta Malta
| | - Diana Saplacan
- Department of Informatics, University of Oslo, Oslo Norway
| | | | | |
Collapse
|
27
|
Kermani F, Kahouei M, Valinejadi A, Sadeghi M, Momeni M, Pahlevanynejad S. Outcome's Classification in Mobile Applications Tailored to Parents of Premature Infants: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1642-1655. [PMID: 37744544 PMCID: PMC10512150 DOI: 10.18502/ijph.v52i8.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/20/2022] [Indexed: 09/26/2023]
Abstract
Background Integration of healthcare services for preterm neonates at home and hospital by mobile technology is an economical and convenient intervention, which is being increasingly applied worldwide. We aimed to classify the outcomes of mobile applications tailored to parents of premature infants. Methods This systematic review was conducted by searching the six main databases until May 2021. Mobile applications tailored to parents of premature infants and the reported outcomes of this technology were identified and classified. Quality of screened articles checked by MMAT tool. Results Overall, 10703 articles were retrieved, and after eliminating the duplicated articles, 9 articles were reviewed ultimately. Identified outcomes were categorized into three groups parental, application, and neonatal outcomes. In the parental outcomes, maternal stress/stress coping, parenting self-efficacy, satisfaction, anxiety, partnership advocacy/improved parent-infant relationship, feeling of being safe, reassurance and confidence, increase awareness, as well as discharge preparedness, were identified. In the application outcomes, application usage, ease of use/user-friendly, and usability of the designed application were placed. Finally, the neonatal outcomes include health and clinical items. Conclusion Mobile applications can be useful in prematurity for educating pregnant mothers, managing stress and anxiety, supporting families, and preparing for discharge. Moreover, due to the coronavirus condition, providing remote services for parents is an appropriate solution to reduce the in-person visits to neonatal care centers. Development of tailored apps can promote the neonates' health and reduce their parents' stress.
Collapse
Affiliation(s)
- Farzaneh Kermani
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Mehdi Kahouei
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Valinejadi
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Malihe Sadeghi
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Marjan Momeni
- School of Rehabilitation, Semnan University of Medical Sciences, Semnan, Iran
| | - Shahrbanoo Pahlevanynejad
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| |
Collapse
|
28
|
Mildon A, Lopez de Romaña D, Jefferds MED, Rogers LM, Golan JM, Arabi M. Integrating and coordinating programs for the management of anemia across the life course. Ann N Y Acad Sci 2023; 1525:160-172. [PMID: 37194608 PMCID: PMC10918752 DOI: 10.1111/nyas.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Anemia is a major global public health concern with a complex etiology. The main determinants are nutritional factors, infection and inflammation, inherited blood disorders, and women's reproductive biology, but the relative role of each varies between settings. Effective anemia programming, therefore, requires evidence-based, data-driven, contextualized multisectoral strategies, with coordinated implementation. Priority population groups are preschool children, adolescent girls, and pregnant and nonpregnant women of reproductive age. Opportunities for comprehensive anemia programming include: (i) bundling interventions through shared delivery platforms, including antenatal care, community-based platforms, schools, and workplaces; (ii) integrating delivery platforms to extend reach; (iii) integrating anemia and malaria programs in endemic areas; and (iv) integrating anemia programming across the life course. Major barriers to effective anemia programming include weak delivery systems, lack of data or poor use of data, lack of financial and human resources, and poor coordination. Systems strengthening and implementation research approaches are needed to address critical gaps, explore promising platforms, and identify solutions to persistent barriers to high intervention coverage. Immediate priorities are to close the gap between access to service delivery platforms and coverage of anemia interventions, reduce subnational coverage disparities, and improve the collection and use of data to inform anemia strategies and programming.
Collapse
Affiliation(s)
| | | | | | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | | |
Collapse
|
29
|
Thapaliya B, Yadav SK, Bhattarai S, Giri S, Sapkota S, Arjyal A, Harris-Fry H, Saville N, Hillman S, Baral S, Morrison J. Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic. PLoS One 2023; 18:e0284796. [PMID: 37093841 PMCID: PMC10124848 DOI: 10.1371/journal.pone.0284796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Naomi Saville
- UCL Institute for Global Health 30 Guilford Street, London, United Kingdom
| | - Sara Hillman
- UCL Institute for Women’s Health Room 237c Medical School Building, London, United Kingdom
| | | | - Joanna Morrison
- UCL Institute for Global Health 30 Guilford Street, London, United Kingdom
| |
Collapse
|
30
|
Atukunda EC, Siedner MJ, Obua C, Musiimenta A, Ware NC, Mugisha S, Najjuma JN, Mugyenyi GR, Matthews LT. Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized Controlled Trial. JMIR Form Res 2023; 7:e36619. [PMID: 36862461 PMCID: PMC10020914 DOI: 10.2196/36619] [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: 01/19/2022] [Revised: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND SMS text messaging and other mobile health (mHealth) interventions may improve knowledge transfer, strengthen access to social support (SS), and promote positive health behaviors among women in the perinatal period. However, few mHealth apps have been taken to scale in sub-Saharan Africa. OBJECTIVE We evaluated the feasibility, acceptability, and preliminary efficacy of a novel, mHealth-based, and patient-centered messaging app designed using behavioral science frameworks to promote maternity service use among pregnant women in Uganda. METHODS We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in Southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC; control), scheduled SMS text or audio messages from a novel messaging prototype (scheduled messaging [SM]), and SM plus SMS text messaging reminders to 2 participant-identified social supporters (SS). Participants completed face-to-face surveys at enrollment and in the postpartum period. The primary outcomes were feasibility and acceptability of the messaging prototype. Other outcomes included ANC attendance, skilled delivery, and SS. We conducted qualitative exit interviews with 15 women from each intervention arm to explore the intervention mechanisms. Quantitative and qualitative data were analyzed using STATA and NVivo, respectively. RESULTS More than 85% and 75% of participants received ≥85% of the intended SMS text messages or voice calls, respectively. More than 85% of the intended messages were received within 1 hour of the expected time; 18% (7/40) of women experienced network issues for both intervention groups. Over 90% (36/40) of the intervention participants found this app useful, easy to use, engaging, and compatible and strongly recommended it to others; 70% (28/40), 78% (31/40), and 98% (39/40; P=.04) of women in the control, SM, and SS arms, respectively, had a skilled delivery. Half (20/40), 83% (33/40), and all (40/40; P=.001) of the women in the control, SM, and SS arms attended ≥4 ANC visits, respectively. Women in the SS arm reported the highest support (median 3.4, IQR 2.8-3.6; P=.02); <20% (8/40; P=.002) missed any scheduled ANC visit owing to lack of transportation. Qualitative data showed that women liked the app; they were able to comprehend ANC and skilled delivery benefits and easily share and discuss tailored information with their significant others, who in turn committed to providing them the needed support to prepare and seek help. CONCLUSIONS We demonstrated that developing a novel patient-centered and tailored messaging app that leverages SS networks and relationships is a feasible, acceptable, and useful approach to communicate important targeted health-related information and support pregnant women in rural Southwestern Uganda to use available maternity care services. Further evaluation of maternal-fetal outcomes and integration of this intervention into routine care is needed. TRIAL REGISTRATION ClinicalTrials.gov NCT04313348; https://clinicaltrials.gov/ct2/show/NCT04313348.
Collapse
Affiliation(s)
| | - Mark J Siedner
- Department of Medicine and Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Samuel Mugisha
- Mbarara University of Science and Technology, Mbarara, Uganda.,Innovation Streams Limited (iStreams) Uganda, Mbarara, Uganda
| | | | | | - Lynn T Matthews
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
31
|
Carvalho LLD, Teixeira JMDS, Unger RJG, Motti VG, Lovisi GM, Grincenkov FRDS. Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:149-158. [PMID: 37105199 PMCID: PMC10139771 DOI: 10.1055/s-0043-1768458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. METHODS This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. RESULTS The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. CONCLUSION There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.
Collapse
Affiliation(s)
| | | | | | - Vivian Genaro Motti
- George Mason University, Information Sciences and Technology, Fairfax, VA, United States
| | | | | |
Collapse
|
32
|
Systematic review on the cost and cost-effectiveness of mHealth interventions supporting women during pregnancy. Women Birth 2023; 36:3-10. [PMID: 35339412 DOI: 10.1016/j.wombi.2022.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The increased integration of digital health into maternity care-alongside growing use of, and access to, personal digital technology among pregnant women-warrants an investigation of the cost-effectiveness of mHealth interventions used by women during pregnancy and the methodological quality of the cost-effectiveness studies. METHODS A systematic search was conducted to identify peer-reviewed studies published in the last ten years (2011-2021) reporting on the costs or cost-effectiveness of mHealth interventions used by women during pregnancy. Available data related to program costs, total incremental costs and incremental cost-effectiveness ratios (ICERs) were reported in 2020 United States Dollars. The quality of cost-effectiveness studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). FINDINGS Nine articles reporting on eight studies met the inclusion criteria. Direct intervention costs ranged from $7.04 to $86 per woman, total program costs ranged from $241,341 to $331,136 and total incremental costs ranged from -$21.16 to $1.12 million per woman. The following ICERs were reported: $2168 per DALY averted, $203.44 per woman ceasing smoking, and $3475 per QALY gained. The full economic evaluation studies (n = 4) were moderate to high in quality and all reported the mHealth intervention as cost-effective. Other studies (n = 4) were low to moderate in quality and reported low costs or cost savings associated with the implementation of the mHealth intervention. CONCLUSIONS FOR PRACTICE Preliminary evidence suggests mHealth interventions may be cost-effective and "low-cost" but more evidence is needed to ascertain the cost-effectiveness of mHealth interventions regarding positive maternal and child health outcomes and longer-term health service utilisation.
Collapse
|
33
|
Peiris DR, Wijesinghe MSD, Gunawardana BMI, Weerasinghe WMPC, Rajapaksha RMNU, Rathnayake KM, Ranathunga N, Kalupahana S, Supun YA, Deshpande S, Ahmed F. Mobile Phone-Based Nutrition Education Targeting Pregnant and Nursing Mothers in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2324. [PMID: 36767691 PMCID: PMC9916292 DOI: 10.3390/ijerph20032324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION A woman's nutrition during pregnancy and nursing affects the mother and the growing child. Similarly, the first two years of a child's life are critical to their growth and development and are facilitated by optimum nutrition. Women's nutrition-related knowledge, attitudes, and practices influence household food and nutrition security. Mobile health (mHealth) is a potentially effective health intervention in pandemic situations when physical gatherings are restricted. OBJECTIVES To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas. METHOD This intervention was evaluated using a before and after within-subjects design. The intervention included 19 messages over four weeks sent via mobile phone, covering nutrition themes such as pregnancy care, infant and young child-feeding, diet, family care for mother and child, and cash management. The intervention was evaluated based on a quantitative survey using a structured interviewer-administered questionnaire and qualitative interviews using a semi-structured questionnaire. The study population was pregnant and nursing mothers. The objective of the qualitative interviews was to identify how respondents used messages and how satisfied they were with the project. The outcome measures were awareness/knowledge, attitudes, social norms, self-efficacy, behaviour intentions, and practices of pregnant and nursing mothers. Trained enumerators collected data using a mobile phone. RESULTS A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = -18.70, p < 0.01) and attitudes (t = -2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers' practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses. CONCLUSION AND RECOMMENDATIONS The mobile intervention improved participants' knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.
Collapse
Affiliation(s)
| | | | | | | | | | - Kumari M. Rathnayake
- Department of Applied Nutrition, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura 60170, Sri Lanka
| | - Nayomi Ranathunga
- Department of Physiology, Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya 60200, Sri Lanka
| | | | | | - Sameer Deshpande
- Social Marketing @ Griffith, Griffith University, Nathan 4111, Australia
| | - Faruk Ahmed
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast 4222, Australia
| |
Collapse
|
34
|
Horwood C, Luthuli S, Mapumulo S, Haskins L, Jensen C, Pansegrouw D, McKerrow N. Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses' experiences of using an electronic clinical decision support system (CDSS) in South Africa. BMC Health Serv Res 2023; 23:30. [PMID: 36639801 PMCID: PMC9840278 DOI: 10.1186/s12913-022-09001-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa. METHODS We undertook a mixed methods study to prospectively explore experiences of implementation from the perspective of newly-trained eIMCI practitioners. eIMCI uptake was monitored throughout implementation. In-depth interviews (IDIs) were conducted with selected participants before and after training, after mentoring, and after 6 months implementation. Participants were then invited to participate in focus group discussions (FGDs) to provide further insights into barriers to eIMCI implementation. RESULTS We conducted 36 IDIs with 9 participants between October 2020 and May 2021, and three FGDs with 11 participants in October 2021. Most participants spoke positively about eIMCI reporting that it was well received in the clinics, was simple to use, and improved the quality of clinical assessments. However, uptake of eIMCI across participating clinics was poor. Challenges reported included lack of computer skills which made simple tasks, like logging in or entering patient details, time consuming. Technical support was provided, but was time consuming to access so that eIMCI was sometimes unavailable. Other challenges included heavy workloads, and the perception that eIMCI took longer and disrupted participant's work. Poor alignment between recording requirements of eIMCI and other clinic programmes increased participant's administrative workload. All these factors were a disincentive to eIMCI uptake, frequently leading participants to revert to paper IMCI which was quicker and where they felt more confident. CONCLUSION Despite the potential of CDSSs to increase adherence to guidelines and improve clinical management and prescribing practices in resource constrained settings where clinical support is scarce, they have not been widely implemented. Careful attention should be paid to the work environment, work flow and skills of health workers prior to implementation, and ongoing health system support is required if health workers are to adopt these approaches (350).
Collapse
Affiliation(s)
- Christiane Horwood
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Silondile Luthuli
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sphindile Mapumulo
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Cecilie Jensen
- grid.463338.90000 0001 2157 3236Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa
| | - Deidre Pansegrouw
- KwaZulu-Natal Department of Health, Ilembe District, KwaDukuza, South Africa
| | - Neil McKerrow
- KwaZulu-Natal Department of Health, Paediatrics and Child Health, Pietermaritzburg, South Africa ,grid.7836.a0000 0004 1937 1151Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa ,grid.16463.360000 0001 0723 4123Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
35
|
Sze YY, Berendes S, Russel S, Bellam L, Smith C, Cameron S, Free CJ. A systematic review of randomised controlled trials of the effects of digital health interventions on postpartum contraception use. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:50-59. [PMID: 36307185 DOI: 10.1136/bmjsrh-2022-201468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Digital health interventions (DHI) have been used to enhance the uptake of postpartum contraception and reduce unmet contraception needs. We conducted a systematic review of the effectiveness of DHI on postpartum contraceptive use and repeated pregnancy. METHOD We searched MEDLINE, Embase, Global Health, CINAHL and Cochrane CENTRAL (January 1990-July 2020). Randomised controlled trials (RCTs) of DHI promoting contraception among pregnant or postpartum women were included. Two researchers screened articles and extracted data. We assessed the risk of bias, certainty of evidence (CoE) and conducted meta-analyses following Cochrane guidance. RESULTS Twelve trials with 5527 women were included. Interventions were delivered by video (four trials), mobile phone counselling (three trials), short message services (SMS) (four trials) and computer (one trial). During pregnancy or the postpartum period, mobile phone counselling had an uncertain effect on the use of postpartum contraception (risk ratio (RR) 1.37, 95% CI 0.82 to 2.29, very low CoE); video-based education may moderately improve contraception use (RR 1.48, 95% CI 1.01 to 2.17, low CoE); while SMS education probably modestly increased contraception use (RR 1.12, 95% CI 1.01 to 1.23, moderate CoE). Mobile phone counselling probably increased long-acting reversible contraception (LARC) use (RR 4.23, 95% CI 3.01 to 5.93, moderate CoE). Both mobile phone counselling (RR 0.27, 95% CI 0.01 to 5.77, very low CoE) and videos (RR 1.25, 95% CI 0.24 to 6.53, very low CoE) had uncertain effects on repeated pregnancy. CONCLUSIONS During pregnancy or in the postpartum period, videos may moderately increase postpartum contraception use and SMS probably modestly increase postpartum contraception use. The effects of DHI on repeated pregnancy are uncertain. Further well-conducted RCTs of DHI would strengthen the evidence of effects on contraception use and pregnancy.
Collapse
Affiliation(s)
- Yik Yan Sze
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Medicine, University of Hong Kong Faculty of Medicine, Hong Kong
| | - Sima Berendes
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Russel
- Medical Student, Manchester University, North Manchester, Indiana, USA
| | - Laura Bellam
- Medical Student, Manchester University, North Manchester, Indiana, USA
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sharon Cameron
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Caroline J Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
36
|
Skeen S, Marlow M, du Toit S, Melendez-Torres GJ, Mudekunye L, Mapalala E, Ngoma K, Ntanda BM, Maketha M, Grieve C, Hartmann L, Gordon S, Tomlinson M. Using WhatsApp support groups to promote responsive caregiving, caregiver mental health and child development in the COVID-19 era: A randomised controlled trial of a fully digital parenting intervention. Digit Health 2023; 9:20552076231203893. [PMID: 37928327 PMCID: PMC10624105 DOI: 10.1177/20552076231203893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Digital interventions hold important potential for supporting parents when face-to-face interventions are unavailable. We assessed the feasibility and effectiveness of a digital parenting intervention in Zambia and Tanzania. Methods Using a randomised controlled trial, we evaluated the Sharing Stories digital parenting intervention for caregivers of children aged 9-32 months with access to a smartphone in their household. Caregivers were stratified based on child age and randomly assigned to the intervention or waitlist control arm. The intervention was delivered via facilitated WhatsApp groups over 6 weeks to promote caregiver wellbeing and responsive caregiving through shared reading activities. Primary outcomes were caregiver-reported responsive caregiving, child language and socio-emotional development. Secondary outcomes were caregiver mental health and parental stress. Masked assessors conducted assessments at baseline and immediate follow-up. Results Between October 2020 and March 2021, we randomly assigned 494 caregiver-child dyads to the intervention (n = 248) or waitlist control (n = 246) arm. Caregivers in the intervention group reported more responsive caregiving (OR = 2.55, 95% CI: 1.15-5.66, p = 0.02), time reading or looking at books (β = 0.45, p = 0.04) and telling stories (β = 0.72, p = 0.002). Intervention caregivers reported significantly lower symptoms of depression (β = -0.64, p = 0.05) and anxiety (β = -0.65, p = 0.02). Child development and parental stress did not differ significantly between groups. Conclusions Digital parenting interventions using WhatsApp can effectively promote responsive caregiving and caregiver mental health in low-resource settings, with great potential for scalability. Trial registration ISRCTN database, ISRCTN77689525.
Collapse
Affiliation(s)
- Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Marguerite Marlow
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
| | - Stefani du Toit
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - GJ Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Lynette Mudekunye
- Regional Psychosocial Support Initiative (REPSSI) Regional, Randburg, South Africa
| | - Edwick Mapalala
- Regional Psychosocial Support Initiative (REPSSI), Dar es Salaam, Tanzania
| | - Kelvin Ngoma
- Regional Psychosocial Support Initiative (REPSSI), Lusaka, Zambia
| | | | - Moroesi Maketha
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
| | - Caitlin Grieve
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
| | - Laura Hartmann
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
| | - Sarah Gordon
- Department of Global Health, Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Tygerberg, South Africa
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
37
|
Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
Collapse
Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| |
Collapse
|
38
|
Murray JB, Sharp A, Munro S, Janssen PA. Expectant parents’ preferences for teaching by texting: a development and usability study of SmartMom (Preprint). JMIR Form Res 2022; 7:e44661. [PMID: 37071451 PMCID: PMC10155084 DOI: 10.2196/44661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/28/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. OBJECTIVE We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. METHODS This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. RESULTS We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that "having reliable information is the most important thing" (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality ("It was nice to have that [information] fed to you"; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom's opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. CONCLUSIONS The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology-based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.
Collapse
Affiliation(s)
- Jennifer B Murray
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Sharp
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Patricia A Janssen
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
39
|
Lenel F, Priebe J, Satriawan E, Syamsulhakim E. Can mHealth campaigns improve CCT outcomes? Experimental evidence from sms-nudges in Indonesia. JOURNAL OF HEALTH ECONOMICS 2022; 86:102687. [PMID: 36242788 DOI: 10.1016/j.jhealeco.2022.102687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Employing a clustered RCT this paper examines the short-term impact of a 12-month mHealth BCC campaign on health practices & outcomes among CCT beneficiaries in Indonesia. Our analysis reveals that the intervention led to substantial improvements in maternal health behavior (postnatal care, child vaccinations, hygiene practices) & outcomes (anemia rates). Adopting a heterogeneous treatment effect framework, we further show that improvements in maternal hygiene practices and anemia rates are closely linked to health knowledge gained by mothers through the sms campaign. In contrast, we provide suggestive evidence that improvements in other health indicators are more likely to be related to the reminder and nudge components of the intervention.
Collapse
Affiliation(s)
| | - Jan Priebe
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Straße 74, 20359 Hamburg, Germany.
| | | | | |
Collapse
|
40
|
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] [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.
Collapse
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
| |
Collapse
|
41
|
Dieteren C, Sarkar S, Saharan S, Bonfrer I. Effects of a smartphone application on maternal health knowledge and dietary diversity among pregnant women in India: a randomized single center pilot study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.39604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background India contributes to one-fifth of infant and maternal deaths globally. Healthy lifestyles during pregnancy combined with good quality health care can help to avoid many maternal and neonatal deaths. Access to appropriate information is important for developing or maintaining a healthy lifestyle. The increased coverage of smartphones across low- and middle-income countries (LMICs) has given rise to smartphone apps supporting healthy pregnancies. The objective of this study is to evaluate the effects of the smartphone application Together For Her on maternal health knowledge and dietary diversity among pregnant Indian women. Methods We ran a randomised single-centre pilot study in a private hospital in Maharashtra, India. We randomly selected pregnant women at ≤20 weeks of gestation who were invited to download the application, in addition to regular antenatal care. The control group only received regular antenatal care. Knowledge about a healthy lifestyle during pregnancy, self-reported dietary diversity and individual characteristics were collected via telephone interviews at baseline (T0), midline (T0 + 4 weeks) and endline (T0 + 12 weeks). Results Complete data were collected for 179 respondents (intervention:94; control:85). Respondents in the intervention group showed larger increases in their knowledge over the 12-week study period, with an overall knowledge increase of 13.4 percentage points (P<0.001). The largest effects were found in the modules anaemia, breastfeeding and skin-to-skin contact. Self-reported diversity in nutritional intake also improved significantly more in the intervention group than in the control group. Conclusions Smartphone applications can effectively supplement antenatal care by increasing women’s knowledge about a healthy lifestyle during pregnancy, which is likely to reduce the risk of adverse maternal health outcomes. Future research includes the roll-out of a larger multi-centre RCT to assess the effect of the smartphone application on health outcomes.
Collapse
|
42
|
Olajubu AO, Fajemilehin BR, Olajubu TO. Mothers’ experiences with mHealth intervention for postnatal care utilisation in Nigeria: a qualitative study. BMC Pregnancy Childbirth 2022; 22:843. [PMCID: PMC9670477 DOI: 10.1186/s12884-022-05177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
The postnatal period implies a crucial and delicate time for both the mother and the newborn. There is a growing body of evidence that is increasingly pointing to mHealth interventions as a potential tool for improved utilisation of maternal and child health services, including postnatal care. This can promote the health of mother and baby during this delicate period. However, the success of the interventions must be explored to validate their usefulness and reliability. Hence, this study explored the experiences of postpartum women on the usefulness of the mHealth intervention (postnatal care assistant) they received.
Methods
Twenty women, who were involved in mHealth intervention were interviewed using a semi-structured interview guide. They were recruited from the intervention group of a quasi-experimental study that evaluated the effect of a mHealth intervention on the uptake of postnatal care services. Thematic analysis of data was done using NVivo software version 10.
Results
Five major themes emerged from data shared by the participants. They are general feelings about the messages, benefits derived from the messages about pregnancy and hospital delivery, increased knowledge about baby care, facilitation of PNC utilisation and involvement of significant others in decision making. They affirmed that the information and reminder messages gave them the impetus to utilise postnatal care services.
Conclusion
Mothers reported that mHealth intervention provided immense support and assistance during pregnancy and the reminder messages encouraged them to utilise postnatal care services. This study suggests that improved education and reminder messages via mobile phones are needed during pregnancy and after childbirth to promote mother and child health through the utilization of postnatal care services, and efforts to put this approach to action should be pursued.
Collapse
|
43
|
Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol 2022; 46:151630. [PMID: 35725655 DOI: 10.1016/j.semperi.2022.151630] [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: 11/26/2022]
Abstract
The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.
Collapse
Affiliation(s)
- Vivek V Shukla
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Susan Niermeyer
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Ruth Guinsburg
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
| |
Collapse
|
44
|
Osanyin GE, Bankethomas A, Oluwole EO, Odeseye AK, Afolabi BB. Effects of a mHealth voice messaging intervention on antenatal care utilisation at primary care level in Lagos, Nigeria: a cluster randomised trial. J Public Health Afr 2022; 13:2222. [PMID: 36277941 PMCID: PMC9585595 DOI: 10.4081/jphia.2022.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nigeria has one of the lowest antenatal care (ANC) utilization rates compared to other low- and middle-income nations. In order to ensure a positive pregnant experience, the World Health Organization recommends at least eight ANC visits during pregnancy. This study intends to examine the impact of a mobile phone-based voice message intervention on ANC use in Lagos, Nigeria. Methods In this cluster-randomized experiment, primary healthcare centres were divided into five intervention and five control groups using multistage simple random sampling. The intervention consisted of a weekly voice message transmitted through mobile phone from the time of recruitment in the first trimester until two weeks postpartum. Attending at least eight ANC visits before birth was the primary outcome. STATA v17.0 was used to conduct descriptive and bivariate analyses as well as multivariate linear models to calculate crude risk ratios. Results 458 women participated. All intervention group women (269 women, or 58.7% of the sample) received the text message. These ladies were mostly married, Christian, had several children, and had completed high school. Women who received the intervention were more likely to attend eight ANC visits. Conclusion A voice message-based intervention can boost ANC utilization, according to the conclusion. This contributes to the existing body of information about the influence of mHealth treatments on maternal health outcomes and serves as a useful tool for ensuring that no woman is left behind.
Collapse
|
45
|
Bossman E, Johansen MA, Zanaboni P. mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review. Front Glob Womens Health 2022; 3:942146. [PMID: 36090599 PMCID: PMC9453039 DOI: 10.3389/fgwh.2022.942146] [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: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Reducing maternal mortality, neonatal mortality and under 5-year mortality are important targets addressed by the United Nations' Sustainable Development Goals. Despite studies reported an improvement in maternal and child health indicators, the progress achieved is not uniform across regions. Due to the increasing availability of mobile phones in low and middle-income countries, mHealth could impact considerably on reducing maternal and child mortality and maximizing women's access to quality care, from the antenatal stage to the post-natal period. Methods A systematic literature review of mHealth interventions aimed at reducing maternal and child mortality in Sub-Saharan Africa and Southern Asia. Primary outcomes were maternal mortality, neonatal mortality, and under-five mortality. Secondary outcomes were skilled birth attendance, antenatal care (ANC) and post-natal care (PNC) attendance, and vaccination/immunization coverage. We searched for articles published from January 2010 to December 2020 in Embase, Medline and Web of Science. Quantitative comparative studies were included. The protocol was developed according to the PRISMA Checklist and published in PROSPERO [CRD42019109434]. The Quality Assessment Tool for Quantitative Studies was used to assess the quality of the eligible studies. Results 23 studies were included in the review, 16 undertaken in Sub-Saharan Africa and 7 in Southern Asia. Most studies used SMS or voice message reminders for education purposes. Only two studies reported outcomes on neonatal mortality, with positive results. None of the studies reported results on maternal mortality or under-five mortality. Outcomes on skilled birth attendance, ANC attendance, PNC attendance, and vaccination coverage were reported in six, six, five, and eleven studies, respectively. Most of these studies showed a positive impact of mHealth interventions on the secondary outcomes. Conclusion Simple mHealth educational interventions based on SMS and voice message reminders are effective at supporting behavior change of pregnant women and training of health workers, thus improving ANC and PNC attendance, vaccination coverage and skilled birth attendance. Higher quality studies addressing the role of mHealth in reducing maternal and child mortality in resource-limited settings are needed, especially in Southern Asia. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019109434, identifier CRD42019109434.
Collapse
Affiliation(s)
- Elvis Bossman
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monika A. Johansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Zanaboni
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
- *Correspondence: Paolo Zanaboni
| |
Collapse
|
46
|
Ouédraogo S, Accrombessi M, Ouattara A, Massougbodji A, Dabira ED, Sarigda M, Diallo I, Zida A, Nicolas M, Ouédraogo L, Cot M, Sondo B. Impact of mobile phone intervention on intermittent preventive treatment of malaria during pregnancy in Burkina Faso : A pragmatic randomized trial. Rev Epidemiol Sante Publique 2022; 70:209-214. [PMID: 35989210 DOI: 10.1016/j.respe.2022.07.002] [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: 07/23/2021] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) coverage remains far below the desirable goal of at least three doses before delivery. This study evaluates an innovative intervention using mobile phones as a means of increasing coverage for the third dose of IPTp-SP. METHODS This study in Burkina Faso was designed as an open-label, pragmatic, two-arm, randomised trial. Pregnant women who attended antenatal clinic (ANC) visits were included at their first ANC visit and followed until delivery. The intervention was built around the use of mobile phones as means ensuring direct tracking of pregnant women. RESULTS Two hundred and forty-eight (248) pregnant women were included in the study. The proportion of women who received at least three doses of IPTp-SP was 54.6 %. In the intervention group, 54.1 % of women received at least three doses of IPTp-SP versus 55.1 % in the control group, a non-significant difference (adjusted odds ratio "aOR", 0.86 ; 95 % confidence interval "95 % CI", 0.49-1.51). Women in the intervention group were more likely to carry out their ANC visits in a timely manner than those in the control group (aOR, 3.21 ; 95 % CI, 1.91-5.39). CONCLUSION While mobile phone intervention did not increase the proportion of women receiving three doses of IPTp-SP, it did help to increase the proportion of timely ANC visits. TRIAL REGISTRATION PACTR202106905150440.
Collapse
Affiliation(s)
- Smaïla Ouédraogo
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
| | - Manfred Accrombessi
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Adama Ouattara
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | | | - Edgard D Dabira
- Medical Research Council at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Maurice Sarigda
- Programme d'appui au développement sanitaire (PADS), Ministère de la santé, Ouagadougou, Burkina Faso
| | - Ismaël Diallo
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Zida
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Méda Nicolas
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | | | - Michel Cot
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Blaise Sondo
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| |
Collapse
|
47
|
Rahman MO, Yamaji N, Sasayama K, Yoneoka D, Ota E. Technology-based innovative healthcare solutions for improving maternal and child health outcomes in low- and middle-income countries: A network meta-analysis protocol. Nurs Open 2022; 10:367-376. [PMID: 35978460 PMCID: PMC9748107 DOI: 10.1002/nop2.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/29/2022] [Accepted: 07/29/2022] [Indexed: 01/04/2023] Open
Abstract
AIM The aims of the study were to synthesize the role of technology-based healthcare interventions (TBIs) and to identify the most effective interventions for the best functional maternal and child health (MCH) outcomes among low-risk pregnant women in low- and middle-income countries (LMICs). DESIGN A systematic review and network meta-analysis (NMA). METHODS We will perform a comprehensive search in electronic databases and other resources to identify relevant randomized controlled trials. Two reviewers will independently perform study selection, data extraction and quality assessment. Our primary outcomes include proportion of recommended antenatal care visits, skilled delivery care, postnatal care visits and exclusive breastfeeding practices. We will use pairwise random-effects meta-analysis and NMAs to estimate direct, indirect and relative effects using the relevant intervention classifications for each outcome separately. We plan to assess hierarchy of interventions, statistical inconsistency and certainty of evidence. RESULTS This review will compare the effectiveness of different form of TBIs on a comprehensive range of MCH outcomes and will provide the outcome-specific reliable evidence of the most effective interventions on improving MCH in LMICs. The review findings will guide researchers, stakeholders or policymakers on the potential use of TBIs in the given contexts that could achieve the best functional MCH outcomes in LMICs.
Collapse
Affiliation(s)
- Md. Obaidur Rahman
- Department of Global Health Nursing, Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan,Center for Surveillance, Immunization, and Epidemiologic ResearchNational Institute of Infectious DiseasesTokyoJapan,Center for Evidence‐Based Medicine and Clinical ResearchDhakaBangladesh
| | - Noyuri Yamaji
- Department of Global Health Nursing, Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan
| | - Kiriko Sasayama
- Department of Global Health Nursing, Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic ResearchNational Institute of Infectious DiseasesTokyoJapan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan,Tokyo Foundation for Policy ResearchTokyoJapan
| |
Collapse
|
48
|
Chua JYX, Shorey S. Effectiveness of mobile application-based perinatal interventions in improving parenting outcomes: A systematic review. Midwifery 2022; 114:103457. [PMID: 35985142 PMCID: PMC9364944 DOI: 10.1016/j.midw.2022.103457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
Objective Parents face many challenges during the perinatal period and are at risk for mental health issues, especially during the current coronavirus (COVID-19) pandemic. Mobile application-based interventions can help parents to improve their psychosocial well-being in a convenient and accessible manner. This review aims to examine the effectiveness of mobile application-based perinatal interventions in improving parenting self-efficacy, anxiety, and depression (primary outcomes), as well as stress, social support, and parent-child bonding (secondary outcomes) among parents. Methods Seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Thesis and Dissertations) were searched from their respective inception dates until August 2021. The Cochrane Risk of Bias-2 tool was used to conduct quality appraisals. Results were narratively synthesized due to the high heterogeneity of intervention and participant types. Findings A total of 6164 articles were retrieved from the seven electronic databases and citation searching. After excluding duplicate records and irrelevant titles/abstracts, 105 full texts were examined. Full-text screening excluded another 93 articles, leaving 12 included studies in this review. All studies were rated as having some concerns or a high overall risk of bias. Mobile application-based interventions were found to be feasible and promising in improving parents’ overall well-being post-intervention during the perinatal period. Further research would be needed to determine their long-term effects. Key conclusions and implications for practice Parental well-being was shown to improve using the following intervention components: educational resources on perinatal and infant care, psychotherapy, and support from peers and healthcare professionals. Hence, future interventions could aim to include these components and evaluate all inter-related parenting outcomes (parenting self-efficacy, stress, anxiety, depression, social support, and parent-child bonding). Parents could be provided with experiential learning exposure by using computer animations and virtual reality. Future research could be conducted on more fathers and parents from varied geographical regions.
Collapse
Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive 117597, Singapore.
| |
Collapse
|
49
|
Tenner AG, Greenberg AL, Nicholaus P, Rose CC, Addo N, Shari CR, Friedman A, George UN, Losak MJ, Mfinanga JA, Sawe HR. Mobile application adjunct to the WHO basic emergency care course: a mixed methods study. BMJ Open 2022; 12:e056763. [PMID: 35798522 PMCID: PMC9263902 DOI: 10.1136/bmjopen-2021-056763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The WHO developed a 5-day basic emergency care (BEC) course using the traditional lecture format. However, adult learning theory suggests that lecture-based courses alone may not promote long-term knowledge retention. We assessed whether a mobile application adjunct (BEC app) can have positive impact on knowledge acquisition and retention compared with the BEC course alone and evaluated perceptions, acceptability and barriers to adoption of such a tool. DESIGN Mixed-methods prospective cohort study. PARTICIPANTS Adult healthcare workers in six health facilities in Tanzania who enrolled in the BEC course and were divided into the control arm (BEC course) or the intervention arm (BEC course plus BEC app). MAIN OUTCOME MEASURES Changes in knowledge assessment scores, self-efficacy and perceptions of BEC app. RESULTS 92 enrolees, 46 (50%) in each arm, completed the BEC course. 71 (77%) returned for the 4-month follow-up. Mean test scores were not different between the two arms at any time period. Both arms had significantly improved test scores from enrolment (prior to distribution of materials) to day 1 of the BEC course and from day 1 of BEC course to immediately after BEC course completion. The drop-off in mean scores from immediately after BEC course completion to 4 months after course completion was not significant for either arm. No differences were observed between the two arms for any self-efficacy question at any time point. Focus groups revealed five major themes related to BEC app adoption: educational utility, clinical utility, user experience, barriers to access and barriers to use. CONCLUSION The BEC app was well received, but no differences in knowledge retention and self-efficacy were observed between the two arms and only a very small number of participants reported using the app. Technologic-based, linguistic-based and content-based barriers likely limited its impact.
Collapse
Affiliation(s)
- Andrea G Tenner
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Anya L Greenberg
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paulina Nicholaus
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Christian C Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Newton Addo
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Catherine Reuben Shari
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Alexandra Friedman
- Department of Emergency Medicine, Highland Hospital, Oakland, California, USA
| | - Upendo N George
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Michael J Losak
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Juma A Mfinanga
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| |
Collapse
|
50
|
Patil SR, Nimmagadda S, Gopalakrishnan L, Avula R, Bajaj S, Diamond-Smith N, Paul A, Fernald L, Menon P, Walker D. Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India. BMJ Glob Health 2022; 6:bmjgh-2021-007298. [PMID: 35835476 PMCID: PMC9296874 DOI: 10.1136/bmjgh-2021-007298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months. Methods We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages. Results Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices. Conclusion The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers. Trial registration number ISRCTN83902145.
Collapse
Affiliation(s)
- Sumeet R Patil
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
| | - Sneha Nimmagadda
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | | | - Rasmi Avula
- International Food Policy Research Institute, New Delhi, India
| | - Sumati Bajaj
- International Food Policy Research Institute, New Delhi, India
| | - Nadia Diamond-Smith
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Anshuman Paul
- Center for Causal Research and Evaluations, NEERMAN, Mumbai, India
| | - Lia Fernald
- Community Health Sciences, School of Public Health, UC Berkeley, Berkeley, CA, USA
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | - Dilys Walker
- Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|