BACKGROUND Studies have shown that mobile health (mHealth) technologies enhance utilization of maternal health services. However, there is limited evidence describing mHealth technology use for maternal health service delivery in sub Saharan Africa where utilization is limited and maternal morbidity and mortality are high. OBJECTIVE This systematic review with narrative synthesis will explore the role of mobile health technologies (mHealth) by community health workers on maternal health service utilization, as well as barriers and facilitators of mHealth use by community health workers supporting maternal health services. METHODS We will include studies that report the use of mHealth by community health workers on utilization of antenatal care, number of facility-based births, and completion of postnatal care visits. In these studies, we will also qualitatively identify barriers and facilitators to mHealth use by community health workers. We will search six databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, Africa Index Medicus) with additional articles identified in Google Scholar and manual screening of references of included studies. The included studies will not be limited by language or year of publication. After extracting the data using a pre-defined search strategy, two independent reviewers will identify, select and appraise studies that meet the inclusion criteria. We will use Mixed Method Appraisal tools to perform risk of bias assessments. Finally, we will perform a narrative synthesis of our outcomes. RESULTS Between July and August 2022, we conducted an initial search in the eligible databases. After removing duplications, we identified 1,111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, narrative synthesis, and assessment of methodological quality by June 2023. CONCLUSIONS This systematic review will present new and up-to-date evidence on the role of mHealth use by CHWs along the pregnancy, child birth and postnatal care continuum of care CLINICALTRIAL PROSPERO ID CRD42022346364

Background Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. Objective This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. Methods We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. Results In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. Conclusions This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. Trial Registration PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 International Registered Report Identifier (IRRID) DERR1-10.2196/44066