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Knop MR, Nagashima-Hayashi M, Lin R, Saing CH, Ung M, Oy S, Yam ELY, Zahari M, Yi S. Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review. BMC Med 2024; 22:196. [PMID: 38750486 PMCID: PMC11095039 DOI: 10.1186/s12916-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years. METHODS A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures. RESULTS From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive. CONCLUSIONS This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.
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Affiliation(s)
- Marianne Ravn Knop
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ruixi Lin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Esabelle Lo Yan Yam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA.
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Janssen P, Lecke S, Renner R, Zhang W, Vedam S, Norman WV, Bayrampour H, Tough S, Murray J, Muhajarine N, Dennis CL. Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom. BMJ Open 2024; 14:e081730. [PMID: 38238058 PMCID: PMC10806627 DOI: 10.1136/bmjopen-2023-081730] [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: 11/05/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth and low birth weight. Barriers to prenatal class attendance faced by parents in Canada include geography, socioeconomic status, age, education, and, among Indigenous peoples and other equity-deserving groups, stigma. To address the need for easily accessible and reliable information, we created 'SmartMom', Canada's first prenatal education programme delivered by short message service text messaging. SmartMom provides evidence-based information timed to be relevant to each week of pregnancy. The overall goal of SmartMom is to motivate the adoption of positive prenatal health behaviours with the ultimate goal of improving health outcomes among women and their newborns. METHODS AND ANALYSIS We will conduct a two-arm single-blinded randomised controlled trial. Blinding of participants to trial intervention will not be possible as they will be aware of receiving the intervention, but data analysts will be blinded. Our primary research questions are to determine if women experiencing uncomplicated pregnancies randomly assigned to receive SmartMom messages versus messages addressing general topics related to pregnancy but without direction for behaviour change, have higher rates of: (1) weight gain within ranges recommended for prepregnancy body mass index and (2) adherence to Canadian guidelines regarding attendance at prenatal care appointments. ETHICS AND DISSEMINATION The study has been granted a Certificate of Approval, number H22-00603, by the University of British Columbia Research Ethics Board. To disseminate our findings, we are undertaking both integrated and end-of-grant knowledge translation, which will proactively involve potential end-users and stakeholders at every phase of our project. TRIAL REGISTRATION NUMBER NCT05793944.
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Affiliation(s)
- Patricia Janssen
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- SmartMom Mobile Health Education, Vancouver, British Columbia, Canada
| | - Sara Lecke
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Zhang
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul's hospital, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Dept of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Hamideh Bayrampour
- Family Practice, Midwifery Program, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne Tough
- Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jennifer Murray
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazeem Muhajarine
- Dept of Community Health and Epidemiology, U of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cindy Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Mu D, Li H, Wang D, Yang X, Wang S. Analysis of Environmental and Social Significant Factors Affecting the Flow of Maternal Patients in Jilin, China. Front Public Health 2022; 10:780452. [PMID: 35669749 PMCID: PMC9164295 DOI: 10.3389/fpubh.2022.780452] [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: 09/29/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background With the implementation of China's Two-child policy, the number of pregnant women has been increasing year by year in recent years. However, the pregnancy success rate of pregnant women is declining year by year, and it is almost necessary for all the elderly mothers to do pregnancy protection. Objective The purpose of this study is to analyze the social and environmental factors that affect the patient flow of pregnant women in Jilin area of China, and further utilize the favorable factors to avoid the negative effects of adverse factors, so as to improve the pregnancy success rate and eugenics level. Methods Monthly patient flow data from 2018 to 2020 were collected in the obstetrics department of the First Hospital of Jilin University. The decompose function in R software was used to decompose the time series data, and the seasonal and trend change rules of the data were obtained; the significant factors influencing patient flow were analyzed by using Poisson regression model, and the prediction model was verified by using assumptions, such as the normal distribution of residuals and the constant difference of residuals. Results Temperature in environmental factors (P = 4.00E−08) had a significant impact on the flow of obstetric patient. The flow of patients was also significantly affected by the busy farming (P = 0.0013), entrance (P = 3.51E−10) and festivals (P = 0.00299). The patient flow was accompanied by random flow, but also showed trend change and seasonal change. The trend of change has been increasing year by year. The seasonal variation rule is that the flow of patients presents a trough in February every year, and reaches the peak in July. Conclusion In this article, Poisson regression model is used to obtain the social and environmental significant factors of obstetric patient flow. According to the significant factors, we should give full play to significant factors to further improve the level of eugenics. By using time series decomposition model, we can obtain the rising trend and seasonal trend of patient flow, and then provide the management with decision support, which is conducive to providing pregnant women with higher level of medical services and more comfortable medical experience.
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Affiliation(s)
- Dongmei Mu
- Department of Clinical Research, The First Hospital of Jilin University, Changchun, China.,School of Public Health, Jilin University, Changchun, China
| | - Hua Li
- Department of Abdominal Ultrasound, The First Hospital of Jilin University, Changchun, China.,School of Public Health, Jilin University, Changchun, China
| | - Dongxuan Wang
- Department of Abdominal Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Xinyu Yang
- School of Public Health, Jilin University, Changchun, China
| | - Shutong Wang
- School of Public Health, Jilin University, Changchun, China
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Yu Z, Liu Y, Yu Y, Han H, Li Y. The Study on Public-Interest Short Message Service (SMS) in China during the COVID-19 Pandemic: Mobile User Survey and Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7915. [PMID: 34360208 PMCID: PMC8345619 DOI: 10.3390/ijerph18157915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 01/13/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has greatly threatened the global health system and triggered the public health emergency. In order to manage the COVID-19 pandemic, healthcare and prevention information have been delivered through omni-media channels (e.g., television, radio, social platform, etc.). As a traditional outlet, the short message service (SMS) can timely provide abundant anti-epidemic alerts to mobile users. In this paper, we aim to investigate mobile users' attitudes toward COVID-19 public-interest SMS sent from government authorities and then explore the insight from messaging texts collected between January and April 2020 in China. In general, respondents show a positive attitude towards content and the necessity of public-interest SMS during the pandemic. However, we find that gender and age differences not only affect content evaluation, but also influence reading and forwarding behaviors. For the necessity of SMS, it shows significant difference between the 18-25-year-old and over 40-year-old group, with the middle and elder group showing serious attitudes and giving higher remarks than the youth due to the habits of media usage. However no significant difference is presented between females and males. In terms of content, the category of topics and releasing institutions are analyzed, respectively. Due to the centralized responses and coordination of prevention and control in China, the messages from COVID-19 disposal organizations (e.g., municipal steering group and provincial CDC) account for more than 70% among four cities.
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Affiliation(s)
- Zhiyuan Yu
- School of Journalism and Communication, Shandong University, Jinan 250100, China; (Z.Y.); (Y.L.); (H.H.); (Y.L.)
| | - Yanghongyun Liu
- School of Journalism and Communication, Shandong University, Jinan 250100, China; (Z.Y.); (Y.L.); (H.H.); (Y.L.)
| | - Yongan Yu
- School of Physical Education, Shandong University, Jinan 250061, China
| | - Hongju Han
- School of Journalism and Communication, Shandong University, Jinan 250100, China; (Z.Y.); (Y.L.); (H.H.); (Y.L.)
| | - Yalin Li
- School of Journalism and Communication, Shandong University, Jinan 250100, China; (Z.Y.); (Y.L.); (H.H.); (Y.L.)
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Si Y, Zhou Z, Su M, Hu H, Yang Z, Chen X. Comparison of health care utilization among patients affiliated and not affiliated with healthcare professionals in China. BMC Health Serv Res 2020; 20:1118. [PMID: 33272275 PMCID: PMC7713311 DOI: 10.1186/s12913-020-05895-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Doing "more" in healthcare can be a major threat to the delivery of high-quality health care. It is important to identify the supplier-induced demand (SID) of health care. This study aims to test SID hypothesis by comparing health care utilization among patients affiliated with healthcare professionals and their counterpart patients not affiliated with healthcare professionals. METHODS We used coarsened exact matching to compare the health care utilization and expenditure between patients affiliated and not affiliated with healthcare professionals. Using cross-sectional data of the China Labour-force Dynamics Survey (CLDS) in 2014, we identified 806 patients affiliated with healthcare professionals and 22,788 patients not affiliated with healthcare professionals. The main outcomes were outpatient proportion and expenditure as well as inpatient proportion and expenditure. RESULTS The matched outpatient proportion of patients not affiliated with healthcare professionals was 0.6% higher (P = 0.754) than that of their counterparts, and the matched inpatient proportion was 1.1% lower (P = 0.167). Patients not affiliated with healthcare professionals paid significantly more (680 CNY or 111 USD, P < 0.001) than their counterparts did per outpatient visit (1126 CNY [95% CI 885-1368] vs. 446 CNY [95% CI 248-643]), while patients not affiliated with healthcare professionals paid insignificantly less (2061 CNY or 336 USD, P = 0.751) than their counterparts did per inpatient visit (15583 CNY [95% CI 12052-19115] vs. 17645 CNY [95% CI 4884-30406]). CONCLUSION Our results lend support to the SID hypothesis and highlight the need for policies to address the large outpatient care expenses among patients not affiliated with healthcare professionals. Our study also suggests that as the public becomes more informed, the demand of health care may persist while heath care expenditure per outpatient visit may decline sharply due to the weakened SID. To address misbehaviors and contain health care costs, it is important to realign provider incentives.
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Affiliation(s)
- Yafei Si
- School of Risk & Actuarial Studies & CEPAR, The University of New South Wales, 223 Anzac Parade, Sydney, NSW, 2052, Australia
- UNSW Ageing Futures Institute, The University of New South Wales, 223 Anzac Parade, Sydney, NSW, 2052, Australia
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Min Su
- School of Public Administration, Inner Mongolia University, No. 235 College Road, Hohhot, 010021, Inner Mongolia, China
| | - Han Hu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zesen Yang
- Department of Political Science, Tsinghua University, Qinghua Yuan Street, No.1 Haidian District, Beijing, 100084, China
- School of Government, Sun Yat-Sen University, No.135, Xingangxi Road, Guangzhou, 510275, Guangdong, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA.
- Department of Economics, Yale University, 60 College Street, New Haven, CT, 06520, USA.
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Su Y, Heitner J, Yuan C, Si Y, Wang D, Zhou Z, Zhou Z. Effect of a Text Messaging-Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e19953. [PMID: 33141099 PMCID: PMC7671841 DOI: 10.2196/19953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 01/06/2023] Open
Abstract
Background Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China’s cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China’s 2016 two-child policy has heightened the implications of national cesarean section trends. Objective This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods Participants were pregnant women presenting for antenatal care at a clinic in Xi’an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother’s birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few “basic” messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman’s gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women’s likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2015-011016
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Affiliation(s)
- Yanfang Su
- School of Medicine, University of Washington, Seattle, WA, United States
| | | | - Changzheng Yuan
- The Children's Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,Nutrition Department, Harvard School of Public Health, Boston, MA, United States
| | - Yafei Si
- School of Risk & Actuarial Studies and Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia
| | - Dan Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhiying Zhou
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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