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Solorzano-Barrera C, Rodriguez-Patarroyo M, Tórres-Quintero A, Guzman-Tordecilla DN, Franco-Rodriguez AN, Maniar V, Shrestha P, Vecino-Ortiz AI, Pariyo GW, Gibson DG, Ali J. Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study. Glob Health Action 2024; 17:2297886. [PMID: 38205794 PMCID: PMC10786427 DOI: 10.1080/16549716.2023.2297886] [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: 08/02/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group. OBJECTIVE To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia. METHODS An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants. RESULTS The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement. CONCLUSIONS These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.
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Affiliation(s)
| | | | | | - Deivis Nicolas Guzman-Tordecilla
- Institute of Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Vidhi Maniar
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrés I. Vecino-Ortiz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W. Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Valerio MGP, Laher B, Phuka J, Lichand G, Paolotti D, Leal Neto O. Participatory Disease Surveillance for the Early Detection of Cholera-Like Diarrheal Disease Outbreaks in Rural Villages in Malawi: Prospective Cohort Study. JMIR Public Health Surveill 2024; 10:e49539. [PMID: 39012690 DOI: 10.2196/49539] [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: 06/01/2023] [Revised: 02/16/2024] [Accepted: 05/16/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Cholera-like diarrheal disease (CLDD) outbreaks are complex and influenced by environmental factors, socioeconomic conditions, and population dynamics, leading to limitations in traditional surveillance methods. In Malawi, cholera is considered an endemic disease. Its epidemiological profile is characterized by seasonal patterns, often coinciding with the rainy season when contamination of water sources is more likely. However, the outbreak that began in March 2022 has extended to the dry season, with deaths reported in all 29 districts. It is considered the worst outbreak in the past 10 years. OBJECTIVE This study aims to evaluate the feasibility and outcomes of participatory surveillance (PS) using interactive voice response (IVR) technology for the early detection of CLDD outbreaks in Malawi. METHODS This longitudinal cohort study followed 740 households in rural settings in Malawi for 24 weeks. The survey tool was designed to have 10 symptom questions collected every week. The proxies' rationale was related to exanthematic, ictero-hemorragica for endemic diseases or events, diarrhea and respiratory/targeting acute diseases or events, and diarrhea and respiratory/targeting seasonal diseases or events. This work will focus only on the CLDD as a proxy for gastroenteritis and cholera. In this study, CLDD was defined as cases where reports indicated diarrhea combined with either fever or vomiting/nausea. RESULTS During the study period, our data comprised 16,280 observations, with an average weekly participation rate of 35%. Maganga TA had the highest average of completed calls, at 144.83 (SD 10.587), while Ndindi TA had an average of 123.66 (SD 13.176) completed calls. Our findings demonstrate that this method might be effective in identifying CLDD with a notable and consistent signal captured over time (R2=0.681404). Participation rates were slightly higher at the beginning of the study and decreased over time, thanks to the sensitization activities rolled out at the CBCCs level. In terms of the attack rates for CLDD, we observed similar rates between Maganga TA and Ndindi TA, at 16% and 15%, respectively. CONCLUSIONS PS has proven to be valuable for the early detection of epidemics. IVR technology is a promising approach for disease surveillance in rural villages in Africa, where access to health care and traditional disease surveillance methods may be limited. This study highlights the feasibility and potential of IVR technology for the timely and comprehensive reporting of disease incidence, symptoms, and behaviors in resource-limited settings.
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Affiliation(s)
| | - Beverly Laher
- Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - John Phuka
- Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Guilherme Lichand
- Graduate School of Education, Stanford University, Stanford, CA, United States
| | | | - Onicio Leal Neto
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Ravalihasy A, Faye A, Diallo AI, Gaye I, Ridde V. A social acceptability scale: Validation in the context of government measures to curb the COVID-19 pandemic in Senegal. Ann Epidemiol 2024; 94:49-63. [PMID: 38641214 DOI: 10.1016/j.annepidem.2024.04.004] [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: 06/19/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION In March 2020, the government of Senegal introduced a curfew, a ban on travel between regions, the closure of markets, and a ban on attending places of worship to contain the spread of the COVID-19 pandemic. As part of research into the response to COVID-19, we developed a scale to measure the social acceptability of these measures. METHODS We used Sekhon's theoretical framework of acceptability (TFA) to formulate the content of the scale items. We assessed the homogeneity of the scale using Cronbach's Alpha and average interitem correlations. We measured the dimensional properties of the scale using rating scale models. We tested the sensitivity of the scale to sociodemographic characteristics using mixed linear regressions and rating scale models. RESULTS The final scale consisted of seven items corresponding to the constructs of acceptability. Analysis performed on data from 813 individuals showed that the scale has satisfactory statistical properties (Cronbach's α > 0.8, Loevinger's coefficient>0.3, intraclass correlation>0.4). CONCLUSION This scale was one of the first to test the TFA. The small number of items was advantageous for use under challenging data collection contexts. Measuring the acceptability of public health interventions with this tool can help in their design and implementation.
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Affiliation(s)
| | - Adama Faye
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Amadou Ibra Diallo
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Ibrahima Gaye
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Valéry Ridde
- Ceped (IRD-Université Paris Cité-Inserm ERL 1244), Paris France; Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
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Umar N, Hill Z, Schellenberg J, Sambo NU, Shuaibu A, Aliyu AM, Kulani KK, Abdullahi MU, Usman A, Mohammed H, Adamu H, Ibrahim M, Mohammed A, Abdulhamid A, Muhammed Z, Alfayo A, Marchant T. Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment. BMJ Glob Health 2023; 8:e013498. [PMID: 38148109 PMCID: PMC10753731 DOI: 10.1136/bmjgh-2023-013498] [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] [Received: 07/23/2023] [Accepted: 11/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has accelerated the use of mobile phones to provide primary health care services and maintain continuity of care. This study aims to understand rural women's preferences for telephone call engagement with primary health care providers in Nigeria. METHODS A discrete choice experiment was conducted alongside an action research project that empowered primary health care workers to develop and implement a telephone call intervention to assess and enhance experiences with facility childbirth care. Between January and March 2022, 30 providers from 10 primary health care facilities implemented the choice experiment among rural women who had institutional childbirth to elicit service user preferences for telephone call engagement. The women were asked to express their preferred scenario for telephone call engagement with their primary health care providers. Generalised linear mixed models were used to estimate women's preferences. RESULTS Data for 460 women were available for the discrete choice experiment. The study showed that rural women have preferences for telephone call engagement with primary health care providers. Specifically, women preferred engaging with female to male callers (β=1.665 (95% CI 1.41, 1.93), SE=0.13, p<0.001), preferred call duration under 15 min (β=1.287 (95% CI 0.61, 1.96), SE=0.34, p<0.001) and preferred being notified before the telephone engagement (warm calling) (β=1.828 (95% CI 1.10, 2.56), SE=0.37, p<0.001). Phone credit incentive was also a statistically significant predictor of women's preferences for engagement. However, neither the availability of scheduling options, the period of the day or the day of the week predicts women's preferences. CONCLUSIONS The study highlights the importance of understanding rural women's preferences for telephone call engagement with healthcare providers in low-income and middle-income countries. These findings can inform the development of mobile phone-based interventions and improve acceptability and broader adoption.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Abdulrahman Shuaibu
- Office of the Executive Secretary, State Primary Health Care Development Agency, Gombe, Nigeria
| | | | | | | | - Ahmed Usman
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hafsat Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hajara Adamu
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Maryam Ibrahim
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adamu Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adama Abdulhamid
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Zainab Muhammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Afodiya Alfayo
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Sánchez-Páez DA, Masquelier B, Menashe-Oren A, Baruwa OJ, Reniers G. Measuring under-5 mortality and fertility through mobile phone surveys: an assessment of selection bias in 34 low-income and middle-income countries. BMJ Open 2023; 13:e071791. [PMID: 37977863 PMCID: PMC10693685 DOI: 10.1136/bmjopen-2023-071791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to assess sample selection bias in mobile phone survey estimates of fertility and under-5 mortality. DESIGN With data from the Demographic and Health Surveys, we use logistic regressions to identify sociodemographic correlates of mobile phone ownership and access, and Poisson regressions to estimate the association between mobile phone ownership (or access) and fertility and under-5 mortality estimates. We evaluate the potential reasons why estimates by mobile phone ownership differ using a set of behavioural characteristics. SETTING 34 low-income and middle-income countries, mostly in sub-Saharan Africa. PARTICIPANTS 534 536 women between the ages of 15 and 49. OUTCOME MEASURES Under-5 mortality rate (U5MR) and total fertility rate (TFR). RESULTS Mobile phone ownership ranges from 23.6% in Burundi to 96.7% in Armenia. The median TFR ratio and U5MR ratio between the non-owners and the owners of a mobile phone are 1.48 and 1.29, respectively. Fertility and mortality rates would be biased downwards if estimates are only based on women who own or have access to mobile phones. Estimates of U5MR can be adjusted through poststratification using age, educational level, area of residence, wealth and marital status as weights. However, estimates of TFR remain biased even after adjusting for these covariates. This difference is associated with behavioural factors (eg, contraceptive use) that are not captured by the poststratification variables, but for which there are also differences between mobile phone owners and non-owners. CONCLUSIONS Mobile phone surveys need to collect data on sociodemographic background characteristics to be able to weight and adjust mortality estimates ex post facto. Fertility estimates from mobile phone surveys will be biased unless further research uncovers the mechanisms driving the bias.
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Affiliation(s)
- David A Sánchez-Páez
- Department of Economics, Universidad de Valladolid, Valladolid, Spain
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Bruno Masquelier
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ashira Menashe-Oren
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ololade Julius Baruwa
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Georges Reniers
- Population Studies Group, London School of Hygiene and Tropical Medicine, London, UK
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Aruldas K, Ramesh RM, Oswald WE, Janagaraj V, Titus A, Johnson J, Saxena M, Israel GJ, Halliday K, Walson JL, Means AR, Ajjampur SSR. Remote evaluation of STH program coverage: Experiences from the DeWorm3 study, India. PLoS Negl Trop Dis 2023; 17:e0011748. [PMID: 37971962 PMCID: PMC10653432 DOI: 10.1371/journal.pntd.0011748] [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: 05/06/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The DeWorm3 trial is a multi-country study testing the feasibility of interrupting transmission of soil-transmitted helminths by community-wide mass drug administration (cMDA). Treatment coverage during cMDA delivery was validated by in-person coverage evaluation surveys (CES) after each round of treatment. A mobile phone-based CES was carried out in India when access to households was restricted during the COVID-19 lockdown. METHODS Two focus group discussions were conducted with the survey implementers to document their experiences of conducting phone-based CES via mobile-phone voice calls. PRINCIPAL FINDINGS In the phone-based CES, only 56% of sampled households were reached compared to 89% during the in-person CES (89%). This was due to phone numbers being wrongly recorded, or calls being unanswered leading to a higher number of households that had to be sampled in order to achieve the sample size of 2,000 households in phone-based CES compared in-person CES (3,600 and 2,352 respectively). Although the phone-based CES took less time to complete than in person coverage evaluations, the surveyors highlighted the lack of gender representation among phone survey participants as it was mostly men who answered calls and were then interviewed. The surveyors also mentioned that eliciting responses to open-ended questions and confirming treatment compliance from every member of the household was challenging during phone based CES. These observations were confirmed by analysing the survey participation data which showed women's participation in CES was significantly lower in phone-based CES (66%) compared to in-person CES (94%) (Z = -22.38; p<0.01) and that a significantly higher proportion of households provided proxy responses in phone-based CES (51%) compared to in-person CES (21%) (Z = 20.23; p<0.01). CONCLUSIONS The phone-based CES may be a viable option to evaluate treatment coverage but issues such as participation bias, gender inclusion, and quality of responses will need to be addressed to optimize this methodology.
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Affiliation(s)
- Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Rohan Michael Ramesh
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - William E. Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health Division, International Development Group, Research Triangle Institute International, Research Triangle Park, North Carolina, United States of America
| | - Venkateshprabhu Janagaraj
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Malvika Saxena
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Gideon John Israel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Katherine Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Judd L. Walson
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
| | - Arianna Rubin Means
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
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Ramesh RM, Oswald WE, Israel GJ, Aruldas K, Galagan S, Legge H, Puthupalayam Kaliappan S, Walson J, Halliday KE, Ajjampur SSR. Representativeness of a mobile phone-based coverage evaluation survey following mass drug administration for soil-transmitted helminths: a comparison of participation between two cross-sectional surveys. BMJ Open 2023; 13:e070077. [PMID: 37899143 PMCID: PMC10619066 DOI: 10.1136/bmjopen-2022-070077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES With increasing mobile phone subscriptions, phone-based surveys are gaining popularity with public health programmes. Despite advantages, systematic exclusion of participants may limit representativeness. Similar to control programmes for neglected tropical diseases (NTDs), the DeWorm3 trial of biannual community-wide mass drug administration (MDA) for elimination of soil-transmitted helminth infection used in-person coverage evaluation surveys to measure the proportion of the at-risk population treated during MDA. Due to lockdown during the COVID-19 pandemic, a phone-based coverage evaluation survey was necessary, providing an opportunity for the current study to compare representativeness and implementation (including non-response) of these two survey modes. DESIGN Comparison of two cross-sectional surveys. SETTING The DeWorm3 trial site in Tamil Nadu, India, includes Timiri, a rural subsite, and Jawadhu Hills, a hilly, hard-to-reach subsite inhabited predominantly by a tribal population. PARTICIPANTS In the phone-based and in-person coverage evaluation surveys, all individuals residing in 2000 randomly selected households (50 in each of the 40 trial clusters) were eligible to participate. Here, we characterise household participation. RESULTS Of 2000 households, 1780 (89.0%) participated during the in-person survey. Of 2000 households selected for the phone survey, 346 (17.3%) could not be contacted as they had not provided a telephone number during the census and 1144 (57.2%) participated. Smaller households, households with lower socioeconomic status and those with older, women or less educated household-heads were under-represented in the phone-based survey compared with censused households. Regression analysis revealed non-response in the phone-based survey was higher among households from the poorest socioeconomic quintile (prevalence ratio (PR) 2.3, 95% CI 2.0 to 2.7) and lower when heads of households had completed secondary school or higher education (PR 0.7, 95% CI 0.6 to 0.8). CONCLUSIONS Our findings suggest phone-based surveys under-represent households likely to be at higher risk of NTDs and in-person surveys are more appropriate for measuring MDA coverage within programmatic settings. TRIAL REGISTRATION NUMBER NCT03014167.
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Affiliation(s)
- Rohan Michael Ramesh
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - William E Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Global Health Division, International Development Group, RTI International, Research Triangle Park, NC, USA
| | - Gideon John Israel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hugo Legge
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Katherine E Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Ross E, Al Ozairi E, Al Qabandi N, Jamison R. Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study. JMIR Form Res 2023; 7:e45977. [PMID: 37843911 PMCID: PMC10616742 DOI: 10.2196/45977] [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: 01/24/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND We evaluated the outcomes of a pilot SMS text messaging-based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait. OBJECTIVE The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns. METHODS SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding. RESULTS A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign. CONCLUSIONS SMS text messaging-based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots.
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Affiliation(s)
- Edgar Ross
- Atrius Healthcare, Harvard Medical School, Burlington, MA, United States
| | | | | | - Robert Jamison
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Kibria GMA, Ahmed S, Khan IA, Fernández-Niño JA, Vecino-Ortiz A, Ali J, Pariyo G, Kaufman M, Sen A, Basu S, Gibson D. Developing digital tools for health surveys in low- and middle-income countries: Comparing findings of two mobile phone surveys with a nationally representative in-person survey in Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002053. [PMID: 37498841 PMCID: PMC10374008 DOI: 10.1371/journal.pgph.0002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS) could complement in-person surveys in LMICs. We compared the representativeness and prevalence estimates of two MPS (i.e., interactive voice response (IVR) and computer-assisted telephone interview (CATI)) with a nationally representative household survey in Bangladesh-the STEPwise approach to NCD risk factor surveillance (STEPs) 2018. This cross-sectional study included 18-69-year-old respondents. CATI and IVR recruitments were done by random digit dialing, while STEPs used multistage cluster sampling design. The prevalence of NCD risk factors related to tobacco, alcohol, diet, and hypertension was reported and compared by prevalence differences (PD) and prevalence ratios (PR). We included 2355 (57% males), 1942 (62% males), and 8185 (47% males) respondents in the CATI, IVR, and STEPs, respectively. CATI (28%) and IVR (52%) had a higher proportion of secondary/above-educated people than STEPs (13%). Most prevalence estimates differed by survey mode; however, CATI estimates were closer to STEPs than IVR. For instance, in CATI, IVR, and STEPs, respectively, the prevalence was 21.4%, 17.9%, and 23.5% for current smoking; and 1.6%, 2.2%, and 1.5% for alcohol drinking in past month. Compared to STEPs, the PD ranged from '-56.6% to 0.4%' in CATI and '-41.0% to 8.4%' in IVR; the PR ranged from '0.3 to 1.1' in CATI and '0.3 to 1.6' in IVR. There were some differences and some similarities in NCD indicators produced by MPS and STEPs with differences likely due to differences in socioeconomic characteristics between survey participants.
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Affiliation(s)
- Gulam Muhammaed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Iqbal Ansary Khan
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Julián A Fernández-Niño
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Andres Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States of America
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Michelle Kaufman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Aninda Sen
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Sunada Basu
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Dustin Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Guzman-Tordecilla DN, Vecino-Ortiz AI, Torres-Quintero A, Solorzano-Barrera C, Ali J, Peñaloza-Quintero RE, Ahmed S, Pariyo GW, Maniar V, Gibson DG. Examination of the demographic representativeness of a cross-sectional mobile phone survey in collecting health data in Colombia using random digit dialling. BMJ Open 2023; 13:e073647. [PMID: 37328185 PMCID: PMC10277114 DOI: 10.1136/bmjopen-2023-073647] [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] [Received: 03/18/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES As mobile phone ownership becomes more widespread in low-income and middle-income countries, mobile phone surveys (MPSs) present an opportunity to collect data on health more cost-effectively. However, selectivity and coverage biases in MPS are concerns, and there is limited information about the population-level representativeness of these surveys compared with household surveys. This study aims at comparing the sociodemographic characteristics of the respondents of an MPS on non-communicable disease risk factors to a household survey in Colombia. DESIGN Cross-sectional study. We used a random digit dialling method to select the samples for calling mobile phone numbers. The survey was conducted using two modalities: computer-assisted telephone interviews (CATIs) and interactive voice response (IVR). The participants were assigned randomly to one of the survey modalities based on a targeted sampling quota stratified by age and sex. The Quality-of-Life Survey (ECV), a nationally representative survey conducted in the same year of the MPS, was used as a reference to compare the sample distributions by sociodemographic characteristics of the MPS data. Univariate and bivariate analyses were performed to evaluate the population representativeness between the ECV and the MPSs. SETTING The study was conducted in Colombia in 2021. PARTICIPANTS Population at least 18 years old with a mobile phone. RESULTS We completed 1926 and 2983 interviews for CATI and IVR, respectively. We found that the MPS data have a similar (within 10% points) age-sex data distribution compared with the ECV dataset for some subpopulations, mainly for young populations, people with none/primary and secondary education levels, and people who live in urban and rural areas. CONCLUSIONS This study shows that MPS could collect similar data to household surveys in terms of age, sex, high school education level and geographical area for some population categories. Strategies are needed to improve representativeness of the under-represented groups.
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Affiliation(s)
- Deivis Nicolas Guzman-Tordecilla
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute of Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Andres I Vecino-Ortiz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Saifuddin Ahmed
- Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vidhi Maniar
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Labrique A, Nagarajan M, Kibria GMA, Vecino-Ortiz A, Pariyo GW, Ali J, Kaufman MR, Gibson D. Improving success of non-communicable diseases mobile phone surveys: Results of two randomized trials testing interviewer gender and message valence in Bangladesh and Uganda. PLoS One 2023; 18:e0285155. [PMID: 37224125 DOI: 10.1371/journal.pone.0285155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation rates of IVR surveys in two LMICs, Bangladesh and Uganda. METHODS We conducted two randomized, controlled micro-trials using fully-automated random digit dialing to test the impact of (1) the gender of the speaker recording the survey (i.e., survey voice); and (2) the valence of the invitation to participate in the survey (i.e., survey introduction) on response and cooperation rates. Participants indicated their consent by using the keypad of cellphones. Four study arms were compared: (1) male and informational (MI); (2) female and information (FI); (3) male and motivational (MM); and (4) female and motivational (FM). RESULTS Bangladesh and Uganda had 1705 and 1732 complete surveys, respectively. In both countries, a majority of the respondents were males, young adults (i.e., 18-29-year-olds), urban residents, and had O-level/above education level. In Bangladesh, the contact rate was higher in FI (48.9%), MM (50.0%), and FM (55.2%) groups than in MI (43.0%); the response rate was higher in FI (32.3%) and FM (33.1%) but not in MM (27.2%) and MI (27.1%). Some differences in cooperation and refusal rates were also observed. In Uganda, MM (65.4%) and FM (67.9%) had higher contact rates than MI (60.8%). The response rate was only higher in MI (52.5%) compared to MI (45.9%). Refusal and cooperation rates were similar. In Bangladesh, after pooling by introductions, female arms had higher contact (52.1% vs 46.5%), response (32.7% vs 27.1%), and cooperation (47.8% vs 40.4%) rates than male arms. Pooling by gender showed higher contact (52.3% vs 45.6%) and refusal (22.5% vs 16.3%) rates but lower cooperation rate (40.0% vs 48.2%) in motivational arms than informational arms. In Uganda, pooling intros did not show any difference in survey rates by gender; however, pooling by intros showed higher contact (66.5% vs 61.5%) and response (50.0% vs 45.2%) rates in motivational arms than informational arms. CONCLUSION Overall, we found higher survey rates among female voice and motivational introduction arms compared to male voice and informational introduction arm in Bangladesh. However, Uganda had higher rates for motivational intro arms only compared to informational arms. Gender and valence must be considered for successful IVR surveys. TRIAL REGISTRATION Name of the registry: ClinicalTrials.gov. Trial registration number: NCT03772431. Date of registration: 12/11/2018, Retrospectively Registered. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03772431?term=03772431&cond=Non-Communicable+Disease&draw=2&rank=1. Protocol Availability: https://www.researchprotocols.org/2017/5/e81.
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Affiliation(s)
- Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Madhuram Nagarajan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | - Andres Vecino-Ortiz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - George W Pariyo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Michelle R Kaufman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Dustin Gibson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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12
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Arita S, Ba MF, Traoré Z, Bonnet E, Faye A, Ridde V. Use of interviewer-administered telephone surveys during infectious disease outbreaks, epidemics and pandemics: a scoping review. BMJ Glob Health 2023; 8:bmjgh-2022-011109. [PMID: 37137536 PMCID: PMC10163463 DOI: 10.1136/bmjgh-2022-011109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/11/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION During the COVID-19 crisis, researchers had to collect data remotely. Telephone surveys and interviews can quickly gather data from a distance without heavy expense. Although interviewer-administered telephone surveys (IATS) can accommodate the needs of international public health research, the literature on their use during infectious disease outbreaks is scarce. This scoping review aimed to map the characteristics of IATS during infectious disease outbreaks. METHODS IATS conducted principally during infectious disease outbreaks and answered by informants at least 18 years old were searched from PubMed and EBSCO. There was a manual addition of relevant documents identified during an initial search. Overall trends were reported using different groupings, including WHO regions, and study details were compared before and during the COVID-19 pandemic. RESULTS 70 IATS published between 2003 and 2022 were identified. 57.1% were conducted during the COVID-19 pandemic. Among 30 IATS conducted before the COVID-19 pandemic in the world, only 3.3% were carried out in low-income and middle-income countries (LMICs). This percentage of studies in LMICs out of all the IATS rose to 32.5% during the pandemic. The share of qualitative studies grew from 6.7% before the COVID-19 outbreak to 32.5% during the outbreak. IATS performed during the COVID-19 pandemic focused on more diverse, specific population groups, such as patients and healthcare professionals. Mobile phones are increasingly used for IATS over time. CONCLUSION IATS are used globally with high frequency in the Western Pacific Region and high-income countries. Technical and financial challenges continue to exist, and assessments of inclusiveness and representativeness should be carefully conducted. A lack of details related to methods was observed, and this scoping review urges researchers using this data collection method in the future to specify how they executed IATS for better use and more efficient deployment.
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Affiliation(s)
- Sayaka Arita
- École des Hautes Études en Santé Publique, Saint-Denis, France
| | - Mouhamadou Faly Ba
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal
| | | | - Emmanuel Bonnet
- UMR 215 PRODIG, Institut de Recherche pour le Développement, Aubervilliers, France
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Valéry Ridde
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal
- UMR 196 CEPED, Université Paris Cité, Institut de Recherche pour le Développement, Paris, France
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Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, Xepapadaki P. Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders. JAMA Netw Open 2023; 6:e2313120. [PMID: 37171821 PMCID: PMC10182430 DOI: 10.1001/jamanetworkopen.2023.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority. Objective To assess actual and perceived optimal childhood asthma monitoring practices used globally. Design, Setting, and Participants This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies. Main Outcomes and Measures Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains. Results A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest. Conclusions and Relevance These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- North West Lung Centre, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Antoine Deschildre
- Center for Infection and Immunity of Lille, Institut Pasteur de Lille, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Lille, Lille, France
| | - Wanda Phipatanakul
- Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Gary Wong
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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Umar N, Hill Z, Schellenberg J, Tuncalp Ö, Muzigaba M, Sambo NU, Shuaibu A, Marchant T. Women's perceptions of telephone interviews about their experiences with childbirth care in Nigeria: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001833. [PMID: 37075047 PMCID: PMC10115259 DOI: 10.1371/journal.pgph.0001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023]
Abstract
Our objective is to investigate women's perceptions of phone interviews about their experiences with facility childbirth care. The study was conducted between October 2020 and January 2021, in Gombe State, Nigeria. Participants were women aged 15-49 years, who delivered in ten study Primary Health Care centres, provided phone numbers, and consented to a follow-up telephone interview about their childbirth experience. The phone interviews took place 14 months after the delivery and consisted of a quantitative survey about women's experiences of facility childbirth followed by a set of structured qualitative questions about their experiences with the phone survey. Three months later 20 women were selected, based on their demographic characteristics, for a further in-depth qualitative phone interview to explore the answers to the structured qualitative questions in more depth. The qualitative interviews were analysed using a thematic approach. We found that most of the women appreciated being called to discuss their childbirth experiences as it made them feel privileged and valued, they were motivated to participate as they viewed the topic as relevant and thought that their interview could lead to improvements in care. They found the interview procedures easy and perceived that the call offered privacy. Poor network connectivity and not owning the phone they were using presented challenges to some women. Women felt more able to re-arrange interview times on the phone compared to a face-to-face interview, they valued the increased autonomy as they were often busy with household chores and could rearrange to a more convenient time. Views about interviewer gender diverged, but most participants preferred a female interviewer. The preferred interview length was a maximum of 30 minutes, though some women said duration was irrelevant if the subject of discussion was important. In conclusion, women had positive views about phone interviews on experiences with facility childbirth care.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Özge Tuncalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Abdulrahman Shuaibu
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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15
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Worges M, Kamala B, Yukich J, Chacky F, Lazaro S, Dismas C, Aroun S, Ibrahim R, Khamis M, Gitanya MP, Mwingizi D, Metcalfe H, Bantanuka W, Deku S, Dadi D, Serbantez N, Loll D, Koenker H. Estimation of bed net coverage indicators in Tanzania using mobile phone surveys: a comparison of sampling approaches. Malar J 2022; 21:379. [PMID: 36496423 PMCID: PMC9735037 DOI: 10.1186/s12936-022-04408-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Threats to maintaining high population access with effective bed nets persist due to errors in quantification, bed net wear and tear, and inefficiencies in distribution activities. Monitoring bed net coverage is therefore critical, but usually occurs every 2-3 years through expensive, large-scale household surveys. Mobile phone-based survey methodologies are emerging as an alternative to household surveys and can provide rapid estimates of coverage, however, little research on varied sampling approaches has been conducted in sub-Saharan Africa. METHODS A nationally and regionally representative cross-sectional mobile phone survey was conducted in early 2021 in Tanzania with focus on bed net ownership and access. Half the target sample was contacted through a random digit dial methodology (n = 3500) and the remaining half was reached through a voluntary opt-in respondent pool (n = 3500). Both sampling approaches used an interactive voice response survey. Standard RBM-MERG bed net indicators and AAPOR call metrics were calculated. In addition, the results of the two sampling approaches were compared. RESULTS Population access (i.e., the percent of the population that could sleep under a bed net, assuming one bed net per two people) varied from a regionally adjusted low of 48.1% (Katavi) to a high of 65.5% (Dodoma). The adjusted percent of households that had a least one bed net ranged from 54.8% (Pemba) to 75.5% (Dodoma); the adjusted percent of households with at least one bed net per 2 de facto household population ranged from 35.9% (Manyara) to 55.7% (Dodoma). The estimates produced by both sampling approaches were generally similar, differing by only a few percentage points. An analysis of differences between estimates generated from the two sampling approaches showed minimal bias when considering variation across the indicator for households with at least one bed net per two de facto household population. CONCLUSION The results generated by this survey show that overall bed net access in the country appears to be lower than target thresholds. The results suggest that bed net distribution is needed in large sections of the country to ensure that coverage levels remain high enough to sustain protection against malaria for the population.
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Affiliation(s)
- Matt Worges
- USAID Tanzania Vector Control Activity, Tropical Health, New Orleans, LA USA
| | - Benjamin Kamala
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programs, Dar Es Salaam, Tanzania
| | - Joshua Yukich
- USAID Tanzania Vector Control Activity, Tropical Health, New Orleans, LA USA
| | - Frank Chacky
- Tanzania National Malaria Control Program, Dodoma, Tanzania
| | - Samwel Lazaro
- Tanzania National Malaria Control Program, Dodoma, Tanzania
| | - Charles Dismas
- Tanzania National Malaria Control Program, Dodoma, Tanzania
| | - Sijenun Aroun
- Tanzania National Malaria Control Program, Dodoma, Tanzania
| | - Raya Ibrahim
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | | | - Deodatus Mwingizi
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programs, Dar Es Salaam, Tanzania
| | | | | | | | - David Dadi
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programs, Dar Es Salaam, Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, Dar Es Salaam, Tanzania
| | - Dana Loll
- grid.21107.350000 0001 2171 9311USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programs, Baltimore, MD USA
| | - Hannah Koenker
- USAID Tanzania Vector Control Activity, Tropical Health, Baltimore, MD USA
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Allen LN, Mackinnon S, Gordon I, Blane D, Marques AP, Gichuhi S, Mwangi A, Burton MJ, Bolster N, Macleod D, Kim M, Ramke J, Bastawrous A. Performance and Resource Requirements of In-Person, Voice Call, and Automated Telephone-Based Socioeconomic Data Collection Modalities for Community-Based Health Programs: A Systematic Review. JAMA Netw Open 2022; 5:e2243883. [PMID: 36441550 PMCID: PMC9706363 DOI: 10.1001/jamanetworkopen.2022.43883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Gathering data on socioeconomic status (SES) is a prerequisite for health programs that aim to improve equity. There is a lack of evidence on which approaches offer the best combination of reliability, cost, and acceptability. OBJECTIVE To compare the performance of different approaches to gathering data on SES in community health programs. DATA SOURCES A search of the Cochrane Library, MEDLINE, Embase, Global Health, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and OpenGrey from 1999 to June 29, 2021, was conducted, with no language limits. Google Scholar was also searched and the reference lists of included articles were checked to identify further studies. The search was performed on June 29, 2021. STUDY SELECTION Any empirical study design was eligible if it compared 2 or more modalities to elicit SES data from the following 3 categories: in-person, voice call, or automated telephone-based systems. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. They also assessed the risk of bias using Cochrane tools and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Findings were synthesized thematically without meta-analysis. MAIN OUTCOMES AND MEASURES Response rate, equivalence, time, costs, and acceptability to patients and health care professionals. RESULTS The searches returned 3943 records. The 11 included studies reported data on 14 036 individuals from 7 countries, collecting data on 11 socioeconomic domains using 2 or more of the following modes: in-person surveys, computer-assisted telephone interviews (CATIs), and 2 types of automated data collection: interactive voice response calls (IVRs) and web surveys. Response rates were greater than 80% for all modes except IVRs. Equivalence was high across all modes (Cohen κ > 0.5). There were insufficient data to make robust time and cost comparisons. Patients reported high levels of acceptability providing data via IVRs, web surveys, and CATIs. CONCLUSIONS AND RELEVANCE Selecting an appropriate and cost-effective modality to elicit SES data is an important first step toward advancing equitable effective service coverage. This systematic review did not identify evidence that remote and automated data collection modes differed from human-led and in-person approaches in terms of reliability, cost, or acceptability.
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Affiliation(s)
- Luke N. Allen
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Iris Gordon
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Blane
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ana Patricia Marques
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Matthew J. Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nigel Bolster
- Peek Vision, Berkhamsted, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Macleod
- International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Min Kim
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Public knowledge, practices, and awareness of antibiotics and antibiotic resistance in Myanmar: The first national mobile phone panel survey. PLoS One 2022; 17:e0273380. [PMID: 35980986 PMCID: PMC9387831 DOI: 10.1371/journal.pone.0273380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022] Open
Abstract
In 2017, the Myanmar National Action Plan for Containment of Antimicrobial Resistance (AMR) (2017–2022) was endorsed by the Ministry of Health and Sports, Myanmar; one of its objectives was to increase public awareness of AMR to accelerate appropriate antibiotic use. This survey aimed to assess the public knowledge, practices and awareness concerning antibiotics and AMR awareness among adults in Myanmar. We conducted a nationwide cross-sectional mobile phone panel survey in January and February 2020. Participants were randomly selected from the mobile phone panel in each of three groups stratified by gender, age group, and residential area urbanity; they were interviewed using a structured questionnaire. Collected data were weighted based on the population of each stratum from the latest national census and analyzed using descriptive and inferential statistics. Two thousand and forty-five adults from 12 regions and states participated in this survey. Overall, 89.5% of participants had heard about antibiotics; however, only 0.9% provided correct answers to all five questions about antibiotics, whereas 9.7% provided all incorrect answers. More than half of participants (58.5%) purchased antibiotics without a prescription, mainly from medical stores or pharmacies (87.9%); this was more frequent in age group (18–29 years) and those in rural areas (p = 0.004 and p < 0.001, respectively). Only 56.3% were aware of antibiotic resistance and received their information from medical professionals (46.3%), family members or friends (38.9%), or the media (26.1%). Less than half (42.4%) knew that antibiotics were used in farm animals. Most did not know that using antibiotics in farm animals could develop resistance (73.2%) and is banned for the purposes of growth stimulation (64.1%). This survey identifies considerable gaps in the knowledge, practices, and awareness about antibiotics among the general population in Myanmar. Continuous public education and awareness campaigns must be urgently conducted to fulfill these gaps, which would aid in promoting antibiotic stewardship, leading to combating AMR in Myanmar.
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Chasukwa M, Choko AT, Muthema F, Nkhalamba MM, Saikolo J, Tlhajoane M, Reniers G, Dulani B, Helleringer S. Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000852. [PMID: 36962430 PMCID: PMC10021539 DOI: 10.1371/journal.pgph.0000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
Despite the urgent need for timely mortality data in low-income and lower-middle-income countries, mobile phone surveys rarely include questions about recent deaths. Such questions might a) be too sensitive, b) take too long to ask and/or c) generate unreliable data. We assessed the feasibility of mortality data collection using mobile phone surveys in Malawi. We conducted a non-inferiority trial among a random sample of mobile phone users. Participants were allocated to an interview about their recent economic activity or recent deaths in their family. In the group that was asked mortality-related questions, half of the respondents completed an abridged questionnaire, focused on information necessary to calculate recent mortality rates, whereas the other half completed an extended questionnaire that also included questions about symptoms and healthcare. The primary trial outcome was the cooperation rate, i.e., the number of completed interviews divided by the number of mobile subscribers invited to participate. Secondary outcomes included self-reports of negative feelings and stated intentions to participate in future interviews. We called more than 7,000 unique numbers and reached 3,054 mobile subscribers. In total, 1,683 mobile users were invited to participate. The difference in cooperation rates between those asked to complete a mortality-related interview and those asked to answer questions about economic activity was 0.9 percentage points (95% CI = -2.3, 4.1), which satisfied the non-inferiority criterion. The mortality questionnaire was non-inferior to the economic questionnaire on all secondary outcomes. Collecting mortality data required 2 to 4 additional minutes per reported death, depending on the inclusion of questions about symptoms and healthcare. More than half of recent deaths elicited during mobile phone interviews had not been registered with the National Registration Bureau. Including mortality-related questions in mobile phone surveys is feasible. It might help strengthen the surveillance of mortality in countries with deficient civil registration systems. Registration: AEA RCT Registry, #0008065 (14 September 2021).
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Affiliation(s)
- Michael Chasukwa
- Institute of Public Opinion and Research, Zomba, Malawi
- Department of Political and Administrative Studies, University of Malawi, Zomba, Malawi
| | - Augustine T. Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Funny Muthema
- Institute of Public Opinion and Research, Zomba, Malawi
| | | | - Jacob Saikolo
- Institute of Public Opinion and Research, Zomba, Malawi
| | - Malebogo Tlhajoane
- Program in Social Research and Public Policy, Division of Social Science, New York University, Abu Dhabi, United Arab Emirates
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Boniface Dulani
- Institute of Public Opinion and Research, Zomba, Malawi
- Department of Political and Administrative Studies, University of Malawi, Zomba, Malawi
| | - Stéphane Helleringer
- Program in Social Research and Public Policy, Division of Social Science, New York University, Abu Dhabi, United Arab Emirates
- Department of Sociology, New York University, New York, United States of America
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Munos MK, Maïga A, Sawadogo-Lewis T, Wilson E, Ako O, Mkuwa S, Ngalesoni F, Brenner JL, Matovelo D, Ouili I, Soura A, Bougma M, Sheffel A, Hobbs AJ, Walker N. The RADAR coverage tool: developing a toolkit for rigorous household surveys for reproductive, maternal, newborn, and child health & nutrition indicators. Glob Health Action 2022; 15:2006419. [PMID: 36098955 PMCID: PMC9481084 DOI: 10.1080/16549716.2021.2006419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Population-based intervention coverage data are used to inform the design of projects, programs, and policies and to evaluate their impact. In low- and middle-income countries (LMICs), household surveys are the primary source of coverage data. Many coverage surveys are implemented by organizations with limited experience or resources in population-based data collection. We developed a streamlined survey and set of supporting materials to facilitate rigorous survey design and implementation. The RADAR coverage survey tool aimed to 1) rigorously measure priority reproductive, maternal, newborn, child health & nutrition coverage indicators, and allow for equity and gender analyses; 2) use standard, valid questions, to the extent possible; 3) be as light as possible; 4) be flexible to address users’ needs; and 5) be compatible with the Lives Saved Tool for analysis of program impact. Early interactions with stakeholders also highlighted survey planning, implementation, and analysis as challenging areas. We therefore developed a suite of resources to support implementers in these areas. The toolkit was piloted by implementers in Tanzania and in Burkina Faso. Although the toolkit was successfully implemented in these settings and facilitated survey planning and implementation, we found that implementers must still have access to sufficient resources, time, and technical expertise in order to use the tool appropriately. This potentially limits the use of the tool to situations where high-quality surveys or evaluations have been prioritized and adequately resourced.
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Affiliation(s)
- Melinda K Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Onome Ako
- Amref Health Africa, Toronto, Canada
| | - Serafina Mkuwa
- Amref Health Africa in Tanzania, Dar Es Salaam, Tanzania
| | | | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Dismas Matovelo
- Catholic University of Health and Allied Sciences - Bugando, Mwanza, Tanzania
| | - Idrissa Ouili
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Abdramane Soura
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Moussa Bougma
- Institut Supérieur Des Sciences de La Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Gibson DG, Kibria GMA, Pariyo GW, Ahmed S, Ali J, Labrique AB, Khan IA, Rutebemberwa E, Flora MS, Hyder AA. Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36943. [PMID: 35532997 PMCID: PMC9127645 DOI: 10.2196/36943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146
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Affiliation(s)
| | | | | | - Saifuddin Ahmed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Elizeus Rutebemberwa
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adnan Ali Hyder
- Milken Institute School of Public Health, George Washington University, Washington DC, MD, United States
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21
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Umar N, Schellenberg J, Hill Z, Bhattacharya AA, Muzigaba M, Tunçalp Ö, Sambo NU, Shuaibu A, Marchant T. To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria. BMJ Glob Health 2022; 7:bmjgh-2021-008017. [PMID: 35296464 PMCID: PMC8928249 DOI: 10.1136/bmjgh-2021-008017] [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: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background To institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However, evidence on the validity of telephone interviews for this purpose is limited. Methods Eight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to follow-up telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including, agreement, sensitivity, specificity, area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews. Results Demographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators, agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis, but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators, agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis, and all had an AUC below 0.6. Conclusions The telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Women’s reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, Department of Epidemiology and Public Health, University College London Research, London, UK
| | - Antoinette Alas Bhattacharya
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneve, Switzerland
| | - Özge Tunçalp
- Sexual and Reproductive Health and Research, World Health Organizations, Geneva, Switzerland
| | | | - Abdulrahman Shuaibu
- Executive Office, State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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22
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Ng A, Mohan D, Shah N, Scott K, Ummer O, Chamberlain S, Bhatnagar A, Dhar D, Agarwal S, Ved R, LeFevre AE. Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: a feasibility study. BMJ Open 2022; 12:e056076. [PMID: 35273055 PMCID: PMC8915337 DOI: 10.1136/bmjopen-2021-056076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Efforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery. PARTICIPANTS Women 5-7 months pregnant with access to a phone. SETTING Four districts of Madhya Pradesh, India. DESIGN Cross-sectional surveys administered face-to-face and within 2 weeks, the same surveys were repeated among two random subsamples of the original sample: face-to-face (n=205) and caller-attended telephone interviews (n=375). Bivariate analyses, multivariable linear regression, and prevalence and bias-adjusted kappa scores are presented. RESULTS Knowledge scores were low across domains: 52% for maternal nutrition and pregnancy danger signs, 58% for family planning, 47% for essential newborn care, 56% infant and young child feeding, and 58% for infant and young child care. Higher knowledge (≥1 composite score) was associated with older age; higher levels of education and literacy; living in a nuclear family; primary health decision-making; greater attendance in antenatal care and satisfaction with accredited social health activist services. Survey questions had low inter-rater and intermodal reliability (kappa<0.70) with a few exceptions. Questions with the lowest reliability included true/false questions and those with unprompted, multiple response options. Reliability may have been hampered by the sensitivity of the content, lack of privacy, enumerators' and respondents' profile differences, rapport, social desirability bias, and/or enumerator's ability to adequately convey concepts or probe. CONCLUSIONS Phone surveys are a reliable modality for generating population-level estimates data about pregnant women's knowledge, however, should not be used for individual-level tracking. TRIAL REGISTRATION NUMBER NCT03576157.
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Affiliation(s)
- Angela Ng
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, Delhi, India
| | - Sara Chamberlain
- BBC Media Action, New Delhi, Delhi, India
- BBC Media Action, London, UK
| | - Aarushi Bhatnagar
- Health, Nutrition and Population, World Bank New Delhi Office, New Delhi, India
| | - Diva Dhar
- The Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
- The Bill and Melinda Gates Foundation, Delhi, India
| | - Amnesty Elizabeth LeFevre
- Division of Public Health and Family Medicine, University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
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23
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Silva TM, Estrela M, Roque V, Gomes ER, Figueiras A, Roque F, Herdeiro MT. Perceptions, knowledge and attitudes about COVID-19 vaccine hesitancy in older Portuguese adults. Age Ageing 2022; 51:6544240. [PMID: 35258520 PMCID: PMC8992312 DOI: 10.1093/ageing/afac013] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus 2019 (COVID-19) has become a public-health emergency of international concern. Most efforts to contain the spread and transmission of the virus rely on campaigns and interventions targeted to reduce Vaccine Hesitancy and Refusal (VHR). OBJECTIVE this study aims to assess the major factors associated with VHR in the older population in Portugal. METHODS a nation-wide cross-sectional study was conducted in the older Portuguese population (≥65 years old) through computer-assisted telephone interviewing. Logistic regression was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge and attitudes) and of the outcome (VHR). RESULTS the response rate was 60.1% (602/1,001). Perceptions, knowledge and attitudes were strongly associated with VHR probability. A 1-point Likert scale increase in concerns about the vaccines' efficacy and safety increased the risk of VHR by 1.96 (95% confidence interval [CI]: 1.40-6.28) and 3.13 (95%CI: 2.08-8.22), respectively. A reduction of VHR probability for 'reliability of the information released by social media' (OR = 0.34, 95%CI: 0.16-0.70) and for 'trust in national and international competent authorities' (OR = 0.34, 95%CI: 0.17-0.69) is also observed per 1-point increase. CONCLUSIONS as VHR seems to be strongly associated with perceptions, knowledge and attitudes, the design and promotion of vaccination campaigns/educational interventions specifically targeted at changing these potentially modifiable determinants may help to tackle COVID-19 VHR and achieve a wider vaccine coverage.
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Affiliation(s)
- Tânia Magalhães Silva
- iBiMED – Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Marta Estrela
- iBiMED – Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Vítor Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute (UDI-IPG), Guarda, Portugal
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal
| | - Adolfo Figueiras
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health - CIBERESP), Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute (UDI-IPG), Guarda, Portugal
- Health Sciences Research Center, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| | - Maria Teresa Herdeiro
- iBiMED – Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Leslie HH, Lee HY, Blouin B, García PJ, Kruk ME. Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey. BMJ Qual Saf 2022; 31:599-608. [PMID: 35121652 PMCID: PMC9304114 DOI: 10.1136/bmjqs-2021-014095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities. METHODS We analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS. RESULTS 13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures. CONCLUSION While satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.
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Affiliation(s)
- Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA.,Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Hwa-Young Lee
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Convergence Science Academy, Institute of Convergence Science (ICONS), Yonsei University, Seoul, South Korea
| | - Brittany Blouin
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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25
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Manners R, Adewopo J, Niyibituronsa M, Remans R, Ghosh A, Schut M, Egoeh SG, Kilwenge R, Fraenzel A. Leveraging Digital Tools and Crowdsourcing Approaches to Generate High-Frequency Data for Diet Quality Monitoring at Population Scale in Rwanda. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2021.804821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diet quality is a critical determinant of human health and increasingly serves as a key indicator for food system sustainability. However, data on diets are limited, scattered, often project-dependent, and current data collection systems do not support high-frequency or consistent data flows. We piloted in Rwanda a data collection system, powered by the principles of citizen science, to acquire high frequency data on diets. The system was deployed through an unstructured supplementary service data platform, where respondents were invited to answer questions regarding their dietary intake. By combining micro-incentives with a normative nudge, 9,726 responses have been crowdsourced over 8 weeks of data collection. The cost per respondent was < $1 (system set-up, maintenance, and a small payment to respondents), with interactions taking <15 min. Exploratory analyses show that >70% of respondents consume tubers and starchy vegetables, leafy vegetables, fruits, legumes, and wholegrains. Women consumed better quality diets than male respondents, revealing a sex-based disparity in diet quality. Similarly, younger respondents (age ≤ 24 years) consumed the lowest quality diets, which may pose significant risks to their health and mental well-being. Middle-income Rwandans were identified to have consumed the highest quality diets. Long-term tracking of diet quality metrics could help flag populations and locations with high probabilities of nutrition insecurity, in turn guiding relevant interventions to mitigate associated health and social risks.
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26
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Gupta S, Seth P, Abraham M, Pingali P. COVID-19 and women's nutrition security: panel data evidence from rural India. ECONOMIA POLITICA (BOLOGNA, ITALY) 2022; 39:157-184. [PMID: 35422584 PMCID: PMC8249434 DOI: 10.1007/s40888-021-00233-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/22/2021] [Indexed: 05/19/2023]
Abstract
In response to the COVID-19 pandemic, India implemented a stringent nationwide lockdown. Although food value chains and allied activities were exempted from the lockdown, there were widespread disruptions in food access and availability. Using two panel-datasets, we distinguish the pandemic's impact on non-staples versus staples in relation to household food availability and women's diet diversity at the national, state, and district levels in four economically backward districts of Uttar Pradesh (Maharajganj), Bihar (Munger), and Odisha (Kandhamal and Kalahandi). Both the primary and secondary data indicate a decline in household food expenditures and women's dietary diversity in May 2020 compared to May 2019, particularly for non-staples like meats, eggs, vegetables and fruits. This occurred despite special PDS, direct benefit transfer, and ration from aanganwadis rations reaching 80%, 50%, and 30% of surveyed households, respectively. While national and state-level expenditures recovered to the pre-lockdown levels by June 2020, the district-level expenditures did not recover. Our findings contribute to the growing body of evidence of women's disproportionate vulnerability to economic shocks, the impact of a staple grain focused safety net program, and restricted markets on the access and availability of diverse nutritious foods. This paper makes a case for policy reforms towards PDS diversification to include nutrition-rich foods and market reforms to remove supply-side bottlenecks and expansion of direct benefit transfers for healthy food access. We also highlight the importance of gender-responsive safety nets and their increased coverage for improving intrahousehold nutritional disadvantages.
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Affiliation(s)
- Soumya Gupta
- Tata-Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, USA
| | - Payal Seth
- Tata-Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, USA
| | - Mathew Abraham
- Tata-Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, USA
| | - Prabhu Pingali
- Tata-Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, USA
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27
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Berry I, Mangtani P, Rahman M, Khan IA, Sarkar S, Naureen T, Greer AL, Morris SK, Fisman DN, Flora MS. Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh. JMIR Public Health Surveill 2021; 7:e29020. [PMID: 34766914 PMCID: PMC8663489 DOI: 10.2196/29020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Population-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys. Objective This study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh. Methods A population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness. Results A total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2% (1047/2006) and a co-operation rate of 89.0% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile. Conclusions Probability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone–based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs.
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Affiliation(s)
- Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Punam Mangtani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sudipta Sarkar
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Tanzila Naureen
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Amy L Greer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Division of Infectious Disease and Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Hersh S, Nair D, Komaragiri PB, Adlakha RK. Patchy signals: capturing women's voices in mobile phone surveys of rural India. BMJ Glob Health 2021; 6:bmjgh-2021-005411. [PMID: 34475116 PMCID: PMC8413869 DOI: 10.1136/bmjgh-2021-005411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Phone surveys are a rapid and cost-effective way to collect primary data for research, monitoring and evaluation purposes. But for these data to be precise, reliable and unbiased, women’s perspectives must be accurately represented. Throughout 2020, we conducted seven household surveys in rural India to understand households’ experiences of the COVID-19 pandemic and contemporaneous relief programmes. Given social distancing protocols, we conducted these surveys over the phone, using household phone numbers collected during earlier, face-to-face research. Analysing metadata from these surveys (along with women’s responses to questions about phone use), we determine how gaps in phone access inhibit women’s representation in phone surveys. We find that the prevalence of male management of household phones significantly reduces access to female respondents. This is a problem for two reasons. Firstly, men are usually the first to pick up the phone: in two surveys in which we tracked the gender of the person who picked up, men picked up 63.2% and 71.1% of the time, respectively. Moreover, only a small minority of those we reached by phone were able and willing to pass the phone to a household member of the opposite gender, when prompted (with no statistically significant difference between pass rates for women and men). This low immediate pass rate, in combination with low female pickup, led to fewer women respondents. As such, we recommend that researchers dedicate time and resources to taking appointments and making call-backs to reach more women. We also show that the use of female enumerators improves households’ willingness to participate in women-centred surveys, and call for more investment into female enumerator teams.
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Affiliation(s)
- Skye Hersh
- ID Insight Private Limited, New Delhi, Delhi, India
| | - Divya Nair
- ID Insight Private Limited, New Delhi, Delhi, India
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Akhtar Z, Mah-E-Muneer S, Rashid MM, Ahmed MS, Islam MA, Chowdhury S, Khan Z, Hassan MZ, Islam K, Parveen S, Debnath N, Rahman M, Chowdhury F. Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh. Antibiotics (Basel) 2021; 10:1052. [PMID: 34572634 PMCID: PMC8469517 DOI: 10.3390/antibiotics10091052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
The general population has been excessively using antibiotics during the COVID-19 pandemic. Therefore, the use of antibiotics for any reported illnesses in the preceding four weeks and knowledge of antibiotics among the general population in the community were assessed for possible interventions. A mobile phone survey among a general population across eight administrative divisions of Bangladesh was conducted during January-March 2021. Reported illness episodes irrespective of COVID-19 in the preceding four weeks of the interview, use of antibiotics for the illnesses, and knowledge on antibiotics among the general population were recorded. Descriptive analyses were performed. We randomly interviewed 1854 participants, with a mean age of 28.5 years (range: 18-75 years); 60.6% were male. Among all participants, 86.3% (95% CI: 84.7-87.8) heard names of antibiotics, but only 12.1% reported unspecified harmful effects, and 3.5% reported antimicrobial resistance when antibiotics were taken without a physician's prescription. Among 257 (13.9%) participants, who consumed medicines for their recent illness episode, 32.7% (95% CI: 27.2-38.6) reported using antibiotics. Of those who could recall the names of antibiotics prescribed (n = 36), the most frequently used was azithromycin (22.2%) followed by cefixime (11.1%) and ciprofloxacin (5.6%). Our findings show an increased antibiotic use for illnesses reported in the preceding four weeks and an elevated knowledge at the community level during the COVID-19 pandemic compared with the pre-pandemic period.
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Affiliation(s)
- Zubair Akhtar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Syeda Mah-E-Muneer
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Md. Mahbubur Rashid
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Md. Shakil Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Md. Ariful Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Sukanta Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Zobaid Khan
- Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, First Floor, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh; (Z.K.); (K.I.); (N.D.)
| | - Md. Zakiul Hassan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Khaleda Islam
- Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, First Floor, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh; (Z.K.); (K.I.); (N.D.)
| | - Shahana Parveen
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
| | - Nitish Debnath
- Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, First Floor, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh; (Z.K.); (K.I.); (N.D.)
| | - Mahmudur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
- Global Health Development, EMPHNET, 69 Mohakhali, Dhaka 1212, Bangladesh
| | - Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (S.M.-E.-M.); (M.M.R.); (M.S.A.); (M.A.I.); (S.C.); (M.Z.H.); (S.P.); (M.R.); (F.C.)
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Nagpal K, Mathur MR, Biswas A, Fraker A. Who do phone surveys miss, and how to reduce exclusion: recommendations from phone surveys in nine Indian states. BMJ Glob Health 2021; 6:bmjgh-2021-005610. [PMID: 34380709 PMCID: PMC8359516 DOI: 10.1136/bmjgh-2021-005610] [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: 03/05/2021] [Accepted: 07/24/2021] [Indexed: 12/03/2022] Open
Abstract
Computer-assisted telephone interviews (CATI) through mobile phones are a low-cost, rapid and safe way to collect data. However, decisions for how such mobile phone surveys are designed and implemented, and their data analysed, can have implications for the sample reached, and in turn affect the generalisability of sample estimates. In this practice paper, we propose a framework for extending the use of CATI–mobile phone surveys in India, which can be applied broadly to future surveys conducted using this method. Across the stages of design, implementation and analysis, we outline challenges in ensuring that the data collected through such surveys are representative and provide recommendations for reducing non-coverage and non-response errors, thereby enabling practitioners in India to use CATI–mobile phone surveys to estimate population statistics with lower bias. We support our analysis by drawing on primary data that we collected in five mobile phone surveys across nine Indian states in 2020. Our recommendations can help practitioners in India improve the representativeness of data collected through mobile phone surveys and generate more accurate estimates.
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Affiliation(s)
- Karan Nagpal
- ID Insight India Private Limited, New Delhi, India
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31
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Greenleaf A, Mwima G, Lethoko M, Conkling M, Keefer G, Chang C, McLeod N, Maruyama H, Chen Q, Farley S, Low A. Participatory surveillance of COVID-19 in Lesotho via weekly calls: Protocol for cell phone data collection. JMIR Res Protoc 2021; 10:e31236. [PMID: 34351866 PMCID: PMC8478051 DOI: 10.2196/31236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone–based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. Objective We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. Methods We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. Results The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. Conclusions The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone–based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. International Registered Report Identifier (IRRID) DERR1-10.2196/31236
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Affiliation(s)
- Abigail Greenleaf
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
| | - Gerald Mwima
- ICAP at Columbia University - Lesotho, Mailman School of Public Health, Columbia University, Maseru, LS
| | - Molibeli Lethoko
- ICAP at Columbia University - Lesotho, Mailman School of Public Health, Columbia University, Maseru, LS
| | - Martha Conkling
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, US
| | - George Keefer
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
| | - Christiana Chang
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
| | - Natasha McLeod
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
| | - Haruka Maruyama
- ICAP at Columbia University - Tanzania, Mailman School of Public Health, Columbia University, Dar es Salaam, TZ
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, US
| | - Shannon Farley
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, US
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Ashigbie PG, Rockers PC, Laing RO, Cabral HJ, Onyango MA, Mboya J, Arends D, Wirtz VJ. Phone-based monitoring to evaluate health policy and program implementation in Kenya. Health Policy Plan 2021; 36:444-453. [PMID: 33724372 PMCID: PMC8128015 DOI: 10.1093/heapol/czab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/01/2022] Open
Abstract
Monitoring and evaluating policies and programs in low- and middle-income countries are often difficult because of the lack of routine data. High mobile phone ownership in these countries presents an opportunity for efficient data collection through telephone interviews. This study examined the feasibility of collecting data on medicines through telephone interviews in Kenya. Data on the availability and prices of medicines at 137 health facilities and 639 patients were collected in September 2016 via in-person interviews. Between December 2016 and December 2017, monthly telephone interviews were conducted with health facilities and patients. An unannounced in-person interview was conducted with respondents to validate the telephone interview within 24 h. A bottom-up itemization costing approach was used to estimate the costs of telephone and in-person data collection. In-depth interviews were conducted with data collectors and respondents to explore their perceptions on both modes of data collection. The level of agreement between data on medicines availability collected through phone and in-person interviews was strong at the health facility level [kappa = 0.90; confidence interval (CI) 0.88–0.92] and moderate at the household level (kappa = 0.50, CI 0.39–0.60). Price data from telephone and in-person interviews showed strong intra-class correlation at health facilities [intra-class correlation coefficient (ICC) = 0.96] and moderate intra-class correlation at households (ICC = 0.47). The cost per phone interview at health facilities and households were $19.73 and $16.86, respectively, compared to $186.20 for a baseline in-person interview. Participants considered telephone interviews to be more convenient. In countries with high cell phone penetration, telephone data collection should be considered in monitoring and evaluating public health programs especially at health facilities. Additional strategies may be needed to optimize this mode of data collection at the household level. Variations in cell phone ownership, telecommunication network and data collection costs across different settings may limit the generalizability of the findings from this study.
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Affiliation(s)
- Paul G Ashigbie
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Richard O Laing
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.,Faculty of Community Health Sciences, School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville 7535, Cape Town, Republic of South Africa
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Monica A Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - John Mboya
- Innovations for Poverty Action, Sandalwood Lane, Westlands, Nairobi, Kenya
| | - Daniella Arends
- Faculty of Sciences, Department of Pharmaceutical Sciences and School of Pharmacy, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
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Vecino-Ortiz AI, Nagarajan M, Katumba KR, Akhter S, Tweheyo R, Gibson DG, Ali J, Rutebemberwa E, Khan IA, Labrique A, Pariyo GW. A cost study for mobile phone health surveys using interactive voice response for assessing risk factors of noncommunicable diseases. Popul Health Metr 2021; 19:32. [PMID: 34183013 PMCID: PMC8240284 DOI: 10.1186/s12963-021-00258-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda. Methods This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years. Results We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations. Conclusion Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00258-z.
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Affiliation(s)
- Andres I Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA.
| | - Madhuram Nagarajan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | | | - Shamima Akhter
- Institute of Epidemiology, Disease control and Research, Dhaka, Bangladesh
| | - Raymond Tweheyo
- Makerere University School of Public Health, Kampala, Uganda
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | | | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease control and Research, Dhaka, Bangladesh
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
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LeFevre AE, Shah N, Bashingwa JJH, George AS, Mohan D. Does women's mobile phone ownership matter for health? Evidence from 15 countries. BMJ Glob Health 2021; 5:bmjgh-2020-002524. [PMID: 32424014 PMCID: PMC7245424 DOI: 10.1136/bmjgh-2020-002524] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/03/2022] Open
Abstract
Mobile phones have the potential to increase access to health information, improve patient-provider communication, and influence the content and quality of health services received. Evidence on the gender gap in ownership of mobile phones is limited, and efforts to link phone ownership among women to care-seeking and practices for reproductive maternal newborn and child health (RMNCH) have yet to be made. This analysis aims to assess household and women's access to phones and its effects on RMNCH health outcomes in 15 countries for which Demographic and Health Surveys data on phone ownership are available. Multilevel logistic regression models were used to explore factors associated with women's phone ownership, along with the association of phone ownership to a wide range of RMNCH indicators. Study findings suggest that (1) gender gaps in mobile phone ownership vary, but they can be substantial, with less than half of women owning mobile phones in several countries; (2) the gender gap in phone ownership is larger for rural and poorer women; (3) women's phone ownership is generally associated with better RMNCH indicators; (4) among women phone owners, utilisation of RMNCH care-seeking and practices differs based on their income status; and (5) more could be done to unleash the potential of mobile phones on women's health if data gaps and varied metrics are addressed. Findings reinforce the notion that without addressing the gender gap in phone ownership, digital health programmes may be at risk of worsening existing health inequities.
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Affiliation(s)
- Amnesty E LeFevre
- Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa .,International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Asha S George
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Diwakar Mohan
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hemler EC, Korte ML, Lankoande B, Millogo O, Assefa N, Chukwu A, Workneh F, Tinkasimile A, Lyatuu I, Soura A, Wang D, Madzorera I, Vuai S, Bärnighausen T, Sando MM, Killewo J, Oduola A, Sie A, Berhane Y, Fawzi WW. Design and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey. Am J Trop Med Hyg 2021; 105:310-322. [PMID: 34161299 PMCID: PMC8437175 DOI: 10.4269/ajtmh.20-1618] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/20/2021] [Indexed: 11/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development of evidence-based strategies to mitigate its direct and indirect health consequences. To address this need, the Africa Research, Implementation Science, and Education (ARISE) Network established a mobile survey platform in SSA to generate longitudinal data regarding knowledge, attitudes, and practices (KAP) related to COVID-19 prevention and management and to evaluate the impact of COVID-19 on health and socioeconomic domains. We conducted a baseline survey of 900 healthcare workers, 1,795 adolescents 10 to 19 years of age, and 1,797 adults 20 years or older at six urban and rural sites in Burkina Faso, Ethiopia, and Nigeria. Households were selected using sampling frames of existing Health and Demographic Surveillance Systems or national surveys when possible. Healthcare providers in urban areas were sampled using lists from professional associations. Data were collected through computer-assisted telephone interviews from July to November 2020. Consenting participants responded to surveys assessing KAP and the impact of the pandemic on nutrition, food security, healthcare access and utilization, lifestyle, and mental health. We found that mobile telephone surveys can be a rapid and reliable strategy for data collection during emergencies, but challenges exist with response rates. Maintaining accurate databases of telephone numbers and conducting brief baseline in-person visits can improve response rates. The challenges and lessons learned from this effort can inform future survey efforts during COVID-19 and other emergencies, as well as remote data collection in SSA in general.
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Affiliation(s)
- Elena C. Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Michelle L. Korte
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Isaac Lyatuu
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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36
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Rinawan FR, Susanti AI, Amelia I, Ardisasmita MN, Widarti, Dewi RK, Ferdian D, Purnama WG, Purbasari A. Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build "a bridge" from the community to the national scale. BMC Public Health 2021; 21:1024. [PMID: 34059029 PMCID: PMC8165997 DOI: 10.1186/s12889-021-11035-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. METHODS A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. RESULTS (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs' knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. CONCLUSIONS The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs' book. Hence, its implementation is promising for use at the national level.
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Affiliation(s)
- Fedri Ruluwedrata Rinawan
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia. .,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.
| | - Ari Indra Susanti
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Mother and Child Health Division, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Indah Amelia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Mulya Nurmansyah Ardisasmita
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Biostatistics and Epidemiology Division, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Widarti
- Midwifery Master Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Puskesmas Sungai Durian, Jl. MT Haryono Gg. Wiyata 2, Kelurahan Kapuas Kanan Hulu, Kecamatan Sintang, Kab. Sintang, West Kalimantan, 78614, Indonesia
| | - Rima Kusumah Dewi
- Midwifery Master Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Makassar Regional General Hospital, Jl. Perintis Kemerdekaan No.KM.14, Daya, Kec. Biringkanaya, Kota Makassar, South Sulawesi, 90243, Indonesia
| | - Dani Ferdian
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Wanda Gusdya Purnama
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No.193, Bandung, West Java, 40153, Indonesia
| | - Ayi Purbasari
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No.193, Bandung, West Java, 40153, Indonesia
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Hensen B, Mackworth-Young CRS, Simwinga M, Abdelmagid N, Banda J, Mavodza C, Doyle AM, Bonell C, Weiss HA. Remote data collection for public health research in a COVID-19 era: ethical implications, challenges and opportunities. Health Policy Plan 2021; 36:360-368. [PMID: 33881138 PMCID: PMC7928874 DOI: 10.1093/heapol/czaa158] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- B Hensen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C R S Mackworth-Young
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - M Simwinga
- Zambart, Nationalist Road, Lusaka, Zambia
| | - N Abdelmagid
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - J Banda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - C Mavodza
- Biomedical Research and Training Institute, Seagrave Rd, Avondale, Harare, Zimbabwe.,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - A M Doyle
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C Bonell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - H A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Kajungu D, Hirose A, Rutebemberwa E, Pariyo GW, Peterson S, Guwatudde D, Galiwango E, Tusubira V, Kaija J, Nareeba T, Hanson C. Cohort Profile: The Iganga-Mayuge Health and Demographic Surveillance Site, Uganda (IMHDSS, Uganda). Int J Epidemiol 2021; 49:1082-1082g. [PMID: 32556335 DOI: 10.1093/ije/dyaa064] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Dan Kajungu
- Makerere University Centre for Health and Population Research (MUCHAP) & Iganga Mayuge HDSS, Iganga, Uganda
| | - Atsumi Hirose
- Dept Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, Imperial College, London, UK
| | | | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Peterson
- Karolinska Institutet and Uppsala University, Sweden.,Makerere University School of Public Health, Kampala, Uganda
| | - David Guwatudde
- Makerere University School of Public Health, Kampala, Uganda
| | - Edward Galiwango
- Makerere University Centre for Health and Population Research (MUCHAP) & Iganga Mayuge HDSS, Iganga, Uganda
| | - Valerie Tusubira
- Makerere University Centre for Health and Population Research (MUCHAP) & Iganga Mayuge HDSS, Iganga, Uganda
| | - Judith Kaija
- Makerere University Centre for Health and Population Research (MUCHAP) & Iganga Mayuge HDSS, Iganga, Uganda
| | - Tryphena Nareeba
- Makerere University Centre for Health and Population Research (MUCHAP) & Iganga Mayuge HDSS, Iganga, Uganda
| | - Claudia Hanson
- Dept Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Leveraging mobile phone surveys during the COVID-19 pandemic in Ecuador and Sri Lanka: Methods, timeline and findings. PLoS One 2021; 16:e0250171. [PMID: 33857226 PMCID: PMC8049475 DOI: 10.1371/journal.pone.0250171] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
Effective and rapid decision making during a pandemic requires data not only about infections, but also about human behavior. Mobile phone surveys (MPS) offer the opportunity to collect real-time data on behavior, exposure, knowledge, and perception, as well as care and treatment to inform decision making. The surveys aimed to collect coronavirus disease 2019 (COVID-19) related information in Ecuador and Sri Lanka using mobile phones. In Ecuador, a Knowledge, Attitudes and Practices (KAP) survey was conducted. In Sri Lanka, an evaluation of a novel medicine delivery system was conducted. Using the established mobile network operator channels and technical assistance provided through The Bloomberg Philanthropies Data for Health Initiative (D4H), Ministries of Health fielded a population-based COVID-19-specific MPS using Surveda, the open source data collection tool developed as part of the initiative. A total of 1,185 adults in Ecuador completed the MPS in 14 days. A total of 5,001 adults over the age of 35 in Sri Lanka completed the MPS in 44 days. Both samples were adjusted to the 2019 United Nations Population Estimates to produce population-based estimates by age and sex. The Ecuador COVID-19 MPS found that there was compliance with the mitigation strategies implemented in that country. Overall, 96.5% of Ecuadorians reported wearing a face mask or face covering when leaving home. Overall, 3.8% of Sri Lankans used the service to receive medicines from a government clinic. Among those who used the medicine delivery service in Sri Lanka, 95.8% of those who used a private pharmacy received their medications within one week, and 69.9% of those using a government clinic reported the same. These studies demonstrate that MPS can be conducted quickly and gather essential data. MPS can help monitor the impact of interventions and programs, and rapidly identify what works in mitigating the impact of COVID-19.
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40
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Rahman HZ, Matin I, Banks N, Hulme D. Finding out fast about the impact of Covid-19: The need for policy-relevant methodological innovation. WORLD DEVELOPMENT 2021; 140:105380. [PMID: 34548745 PMCID: PMC8446706 DOI: 10.1016/j.worlddev.2020.105380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this viewpoint we explore one joint research initiative in Bangladesh to illustrate how methodological innovations using mobile phone technologies and pre-existing survey databases can generate rapid and insightful data on the impacts of the Covid-19 pandemic with significant policy influence. Situating this innovation within theoretical and methodological antecedents for rapid appraisal, we show how strong local ownership can facilitate innovation, rapid research and strong policy engagement amidst even the most difficult research conditions. Such rapid surveys and analysis must remain a research priority in times of crisis. Academic researchers in partner organisations further afield must ask important questions around how they can best support such locally-led research initiatives: in preparing for, analysing or writing up the research or in joining efforts to communicate them to wider communities of policy-makers and practitioners globally.
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Affiliation(s)
| | - Imran Matin
- BRAC Institute for Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Nicola Banks
- Global Development Institute, University of Manchester, Manchester, UK
| | - David Hulme
- Global Development Institute, University of Manchester, Manchester, UK
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41
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Torres-Quintero A, Vega A, Gibson DG, Rodriguez-Patarroyo M, Puerto S, Pariyo GW, Ali J, Hyder AA, Labrique A, Selig H, Peñaloza RE, Vecino-Ortiz AI. Adaptation of a mobile phone health survey for risk factors for noncommunicable diseases in Colombia: a qualitative study. Glob Health Action 2021; 13:1809841. [PMID: 32856572 PMCID: PMC7480483 DOI: 10.1080/16549716.2020.1809841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Data collection on noncommunicable disease (NCD) behavioral risk factors has traditionally been carried out through face-to-face surveys. However, its high costs and logistical difficulties can lead to lack of timely statistics for planning, particularly in low and middle-income countries. Mobile phone surveys (MPS) have the potential to fill these gaps. Objective This study explores perceptions, feasibility and strategies to increase the acceptability and response rate of health surveys administered through MPS using interactive voice response in Colombia. Method A sequential multimodal exploratory design was used. We conducted key informant interviews (KII) with stakeholders from government and academia; focus group discussions (FGDs) and user-group tests (UGTs) with young adults and elderly people living in rural and urban settings (men and women). The KII and FGDs explored perceptions of using mobile phones for NCD surveys. In the UGTs, participants were administered an IVR survey, and they provided feedback on its usability and potential improvement. Results Between February and November 2017, we conducted 7 KII, 6 FGDs (n = 54) and 4 UGTs (n = 34). Most participants consider MPS is a novel way to explore risk factors in NCDs. They also recognize challenges for their implementation including security issues, technological literacy and telecommunications coverage, especially in rural areas. It was recommended to promote the survey using mass media before its deployment and stressing its objectives, responsible institution and data privacy safeguards. The preferences in the survey administration relate to factors such as skills in the use of mobile phones, age, availability of time and educational level. The participants recommend questionnaires shorter than 10 minutes. Conclusions The possibility of obtaining data through MPS at a population level represents an opportunity to improve the availability of risk-factor data. Steps towards increasing the acceptability and overcoming technological and methodological challenges need to be taken.
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Affiliation(s)
| | - Angela Vega
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - Stephanie Puerto
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Adnan A Hyder
- Department of Global Health, Milken Institute School of Public Health, George Washington University , Washington, DC, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Hannah Selig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - Andres I Vecino-Ortiz
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia.,Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
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Rodriguez-Patarroyo M, Torres-Quintero A, Vecino-Ortiz AI, Hallez K, Franco-Rodriguez AN, Rueda Barrera EA, Puerto S, Gibson DG, Labrique A, Pariyo GW, Ali J. Informed Consent for Mobile Phone Health Surveys in Colombia: A Qualitative Study. J Empir Res Hum Res Ethics 2021; 16:24-34. [PMID: 32975157 PMCID: PMC8132005 DOI: 10.1177/1556264620958606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Public health surveys deployed through automated mobile phone calls raise a set of ethical challenges, including succinctly communicating information necessary to obtain respondent informed consent. This study aimed to capture the perspectives of key stakeholders, both experts and community members, on consent processes and preferences for participation in automated mobile phone surveys (MPS) of non-communicable disease risk factors in Colombia. We conducted semi-structured interviews with ethics and digital health experts and focus group discussions with community representatives. There was meaningful disagreement within both groups regarding the necessity of consent, when the purpose of a survey is to contribute to the formulation of public policies. Respondents who favored consent emphasized that consent communications ought to promote understanding and voluntariness, and implicitly suggested that information disclosure conform to a reasonable person standard. Given the automated and unsolicited nature of the phone calls and concerns regarding fraud, trust building was emphasized as important, especially for national MPS deployment. Community sensitization campaigns that provide relevant contextual information (such as the name of the administering institution) were thought to support trust-building. Additional ways to achieve the goals of consent while building trust in automated MPS for disease surveillance should be evaluated in order to inform ethical and effective practice.
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Affiliation(s)
| | | | - Andres I. Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristina Hallez
- Center for Effective Global Action, University of California, Berkeley, CA, USA
| | | | | | - Stephanie Puerto
- Institute of Public Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W. Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
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Fischer F, Kleen S. Possibilities, Problems, and Perspectives of Data Collection by Mobile Apps in Longitudinal Epidemiological Studies: Scoping Review. J Med Internet Res 2021; 23:e17691. [PMID: 33480850 PMCID: PMC7864774 DOI: 10.2196/17691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background The broad availability of smartphones and the number of health apps in app stores have risen in recent years. Health apps have benefits for individuals (eg, the ability to monitor one’s health) as well as for researchers (eg, the ability to collect data in population-based, clinical, and observational studies). Although the number of health apps on the global app market is huge and the associated potential seems to be great, app-based questionnaires for collecting patient-related data have not played an important role in epidemiological studies so far. Objective This study aims to provide an overview of studies that have collected patient data using an app-based approach, with a particular focus on longitudinal studies. This literature review describes the current extent to which smartphones have been used for collecting (patient) data for research purposes, and the potential benefits and challenges associated with this approach. Methods We conducted a scoping review of studies that used data collection via apps. PubMed was used to identify studies describing the use of smartphone app questionnaires for collecting data over time. Overall, 17 articles were included in the summary. Results Based on the results of this scoping review, there are only a few studies that integrate smartphone apps into data-collection approaches. Studies dealing with the collection of health-related data via smartphone apps have mainly been developed with regard to psychosomatic, neurodegenerative, respiratory, and cardiovascular diseases, as well as malign neoplasm. Among the identified studies, the duration of data collection ranged from 4 weeks to 12 months, and the participants’ mean ages ranged from 7 to 69 years.
Potential can be seen for real-time information transfer, fast data synchronization (which saves time and increases effectivity), and the possibility of tracking responses longitudinally. Furthermore, smartphone-based data-collection techniques might prevent biases, such as reminder bias or mistakes occurring during manual data transfers. In chronic diseases, real-time communication with physicians and early detection of symptoms enables rapid modifications in disease management. Conclusions The results indicate that using mobile technologies can help to overcome challenges linked with data collection in epidemiological research. However, further feasibility studies need to be conducted in the near future to test the applicability and acceptance of these mobile apps for epidemiological research in various subpopulations.
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Affiliation(s)
- Florian Fischer
- Institut of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sina Kleen
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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Tweheyo R, Selig H, Gibson DG, Pariyo GW, Rutebemberwa E. User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study. JMIR Form Res 2020; 4:e21671. [PMID: 33270037 PMCID: PMC7746503 DOI: 10.2196/21671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/11/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant’s perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller’s identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual.
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Affiliation(s)
- Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health, Lira University, Lira, Uganda
| | - Hannah Selig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George William Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizeus Rutebemberwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Greenleaf AR, Gadiaga A, Choi Y, Guiella G, Turke S, Battle N, Ahmed S, Moreau C. Automated and Interviewer-Administered Mobile Phone Surveys in Burkina Faso: Sociodemographic Differences Among Female Mobile Phone Survey Respondents and Nonrespondents. JMIR Mhealth Uhealth 2020; 8:e17891. [PMID: 32673250 PMCID: PMC7388048 DOI: 10.2196/17891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background The remarkable growth of cell phone ownership in low- and middle-income countries has generated significant interest in using cell phones for conducting surveys through computer-assisted telephone interviews, live interviewer-administered surveys, or automated surveys (ie, interactive voice response). Objective This study aimed to compare, by mode, the sociodemographic characteristics of cell phone owners who completed a follow-up phone survey with those who did not complete the survey. Methods The study was based on a nationally representative sample of women aged 15 to 49 years who reported cell phone ownership during a household survey in Burkina Faso in 2016. Female cell phone owners were randomized to participate in a computer-assisted telephone interview or hybrid interactive voice response follow-up phone survey 11 months after baseline interviews. Completion of the phone survey was defined as participants responding to more than 50% of questions in the phone survey. We investigated sociodemographic characteristics associated with cell phone survey completion using multivariable logistic regression models, stratifying the analysis by survey mode and by directly comparing computer-assisted telephone interview and hybrid interactive voice response respondents. Results A total of 1766 women were called for the phone survey between November 5 and 17, 2017. In both the computer-assisted telephone interview and hybrid interactive voice response samples, women in urban communities and women with secondary education or higher were more likely to complete the survey than their rural and less-educated counterparts. Compared directly, women who completed the hybrid interactive voice response survey had higher odds of having a secondary education than those who completed computer-assisted telephone interviews (odds ratio 1.7, 95% CI 1.1-2.6). Conclusions In Burkina Faso, computer-assisted telephone interviews are the preferred method of conducting cell phone surveys owing to less sample distortion and a higher response rate compared with a hybrid interactive voice response survey.
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Affiliation(s)
| | - Aliou Gadiaga
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Yoonjoung Choi
- iSquared, Information x Insight, Severna Park, MD, United States
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Shani Turke
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
| | - Noelle Battle
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States.,Soins et santé, Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France
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Shah N, Mohan D, Agarwal S, Scott K, Chamberlain S, Bhatnagar A, Labrique A, Indurkar M, Ved R, LeFevre A. Novel approaches to measuring knowledge among frontline health workers in India: Are phone surveys a reliable option? PLoS One 2020; 15:e0234241. [PMID: 32598348 PMCID: PMC7323989 DOI: 10.1371/journal.pone.0234241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs’ knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Conclusions Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
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Affiliation(s)
- Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meenal Indurkar
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | - Rajani Ved
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | | | - on behalf of the Kilkari Impact Evaluation team
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Greenleaf AR, Gadiaga A, Guiella G, Turke S, Battle N, Ahmed S, Moreau C. Comparability of modern contraceptive use estimates between a face-to-face survey and a cellphone survey among women in Burkina Faso. PLoS One 2020; 15:e0231819. [PMID: 32401773 PMCID: PMC7219703 DOI: 10.1371/journal.pone.0231819] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The proliferation of cell phone ownership in Sub-Saharan Africa (SSA) presents the opportunity to collect public health indicators at a lower cost compared to face-to-face (FTF) surveys. This analysis assesses the equivalence of modern contraceptive prevalence estimates between a nationally representative FTF survey and a cell phone survey using random digit dialing (RDD) among women of reproductive age in Burkina Faso. Methods We analyzed data from two surveys conducted in Burkina Faso between December 2017 and May 2018. The FTF survey conducted by Performance Monitoring and Accountability (PMA2020) comprised a nationally representative sample of 3,556 women of reproductive age (15–49 years). The RDD survey was conducted using computer-assisted telephone interviewing and included 2,379 women of reproductive age. Results Compared to FTF respondents, women in the RDD sample were younger, were more likely to have a secondary degree and to speak French. RDD respondents were more likely to report using modern contraceptive use (40%) compared to FTF respondents (26%) and the difference remained unchanged after applying post-stratification weights to the RDD sample (39%). This difference surpassed the equivalence margin of 4%. The RDD sample also produced higher estimates of contraceptive use than the subsample of women who owned a phone in the FTF sample (32%). After adjusting for women’s sociodemographic factors, the odds of contraceptive use were 1.9 times higher (95% CI: 1.6–2.2) in the RDD survey compared to the FTF survey and 1.6 times higher (95% CI: 1.3–1.8) compared to FTF phone owners. Conclusions Modern contraceptive prevalence in Burkina Faso is over-estimated when using a cell phone RDD survey, even after adjusting for a number of sociodemographic factors. Further research should explore causes of differential estimates of modern contraceptive use by survey modes.
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Affiliation(s)
- Abigail R. Greenleaf
- Department of Population Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Aliou Gadiaga
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Institut Supérieur des Sciences de la Population, Ouagadougou, Burkina Faso
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Institut Supérieur des Sciences de la Population, Ouagadougou, Burkina Faso
| | - Shani Turke
- Department of Population Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Noelle Battle
- Department of Population Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Saifuddin Ahmed
- Department of Population Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States of America
- Gender, Sexual and Reproductive Health, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
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Drake AL, Begnel E, Pintye J, Kinuthia J, Wagner AD, Rothschild CW, Otieno F, Kemunto V, Baeten JM, John-Stewart G. The Utility of SMS to Report Male Partner HIV Self-testing Outcomes Among Women Seeking Reproductive Health Services in Kenya: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15281. [PMID: 32209530 PMCID: PMC7142744 DOI: 10.2196/15281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/16/2019] [Accepted: 12/19/2019] [Indexed: 01/03/2023] Open
Abstract
Background Use of SMS for data collection is expanding, but coverage, bias, and logistical constraints are poorly described. Objective The aim of this study is to assess the use of SMS to capture clinical outcomes that occur at home and identify potential biases in reporting compared to in-person ascertainment. Methods In the PrEP Implementation in Young Women and Adolescents program, which integrated pre-exposure prophylaxis (PrEP) into antenatal care, postnatal care, and family planning facilities in Kisumu County, Kenya, HIV-negative women 14 years of age or older were offered oral HIV self-tests (HIVSTs) to take home to male partners. Women that brought a phone with a Safaricom SIM to the clinic were offered registration in an automated SMS system (mSurvey) to collect information on HIVST outcomes. Women were asked if they offered the test to their male partners, and asked about the test process and results. HIVST outcomes were collected via SMS (sent 2.5 weeks later), in-person (if women returned for a follow-up scheduled 1 month later), or using both methods (if women initiated PrEP, they also had scheduled follow-up visits). The SMS prompted women to reply at no charge. HIVST outcomes were compared between women with scheduled follow-up visits and those without (follow-up visits were only scheduled for women who initiated PrEP). HIVST outcomes were also compared between women reporting via SMS and in-person. Results Among 2123 women offered HIVSTs and mSurvey registration, 486 (23.89%) accepted HIVSTs, of whom 359 (73.87%) were eligible for mSurvey. Additionally, 76/170 (44.7%) women with scheduled follow-up visits and 146/189 (77.3%) without scheduled follow-up visits registered in mSurvey. Among the 76 women with scheduled follow-ups, 62 (82%) had HIVST outcomes collected: 19 (31%) in-person, 20 (32%) by SMS, and 23 (37%) using both methods. Among the 146 women without scheduled visits, 87 (59.6%) had HIVST outcomes collected: 3 (3%) in-person, 82 (94%) by SMS, and 2 (2%) using both methods. SMS increased the collection of HIVST outcomes substantially for women with scheduled follow-up visits (1.48-fold), and captured 82 additional reports from women without scheduled follow-up visits. Among 222 women with reported HIVST outcomes, frequencies of offering partners the HIVST (85/95, 89% in-person vs 96/102, 94% SMS; P=.31), partners using the HIVST (83/85, 98% vs 92/96, 96%; P=.50), women using HIVST with partners (82/83, 99% vs 91/92, 99%; P=.94), and seeing partner’s HIVST results (82/83, 99% vs 89/92, 97%; P=.56) were similar between women reporting in-person only versus by SMS only. However, frequency of reports of experiencing harm or negative reactions from partners was more commonly reported in the SMS group (17/102, 16.7% vs 2/85, 2%; P=.003). Barriers to the SMS system registration included not having a Safaricom SIM or a functioning phone. Conclusions Our results suggest that the use of SMS substantially improves completeness of outcome data, does not bias reporting of nonsensitive information, and may increase reporting of sensitive information.
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Affiliation(s)
- Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Emily Begnel
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Claire W Rothschild
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Felix Otieno
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Valarie Kemunto
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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Pattnaik A, Mohan D, Chipokosa S, Wachepa S, Katengeza H, Misomali A, Marx MA. Testing the validity and feasibility of using a mobile phone-based method to assess the strength of implementation of family planning programs in Malawi. BMC Health Serv Res 2020; 20:221. [PMID: 32183805 PMCID: PMC7076956 DOI: 10.1186/s12913-020-5066-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To effectively deliver on proposed objectives, it is vital that practitioners, policymakers, and other stakeholders are able to clearly understand how strongly their large-scale program is being implemented. This study sought to test the feasibility, cost-effectiveness, and validity of a phone-based method as an innovative and cost-efficient approach to assessing program implementation strength (through an Implementation Strength Assessment - ISA), alternative to the traditional in-person field methods. METHODS We conducted 701 mobile phone and 356 in-person interviews with facility in-Charges and two types of community health workers who provide family planning services in the Dowa and Ntcheu districts in Malawi. Responses received via the phone interview were validated through in-person review of records and inspections. Sensitivity and specificity were calculated to determine validity. RESULTS Most indicators at the health facility and community health worker levels were above a 70% threshold for sensitivity. However, there were fewer indicators that met this threshold for specificity. The primary reason for lower specificity was due to poor recordkeeping. Collecting data via mobile phone was found to be feasible and twice as cost-efficient as collecting the same data via in-person inspections. CONCLUSIONS The rapid increase in mobile phone ownership and network availability in lower income countries could offer an alternative, cost-effective avenue to collect data for a better understanding of program implementation. Through rigorous assessment, this study found that using mobile phones could be a low-cost alternative to collect data on health system delivery of services, especially in places where routine data quality is poor and traditional, in-person methods are costly.
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Affiliation(s)
- Anooj Pattnaik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | | | | | - Hans Katengeza
- Reproductive Health Directorate, Ministry of Health and Population, Lilongwe, Malawi
| | | | - Melissa A. Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
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Ssemugabo C, Rutebemberwa E, Kajungu D, Pariyo GW, Hyder AA, Gibson DG. Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study. JMIR Form Res 2019; 3:e15000. [PMID: 31793889 PMCID: PMC6918213 DOI: 10.2196/15000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Dan Kajungu
- Iganga Mayuge Health and Demographic Surveillance Site, Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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