Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project (Preprint)

Abstract

BACKGROUND Due to interconnected structural determinants including low maternal health knowledge, economic marginalization and remoteness from low-capacity health centres, ethnic minority women (EMW) in remote areas of Vietnam face severe maternal, newborn and child health (MNCH) inequities. ‘mMOM’ – a pilot mobile health intervention using SMS to improve MNCH outcomes among EMW in northern Vietnam – was implemented from 2013-2016 with promising results. Despite mMOM’s findings, and despite exacerbated MNCH inequities and digital health approaches becoming even more salient amid COVID-19, mobile health has not yet been scaled to address MNCH among EMW. OBJECTIVE To describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19-related MNCH guidance and novel technological components (mobile app, artificial intelligence chatbots); and quantitatively through expanding over a broader geographical area reaching exponentially more participants, within the evolving COVID-19 pandemic and post-pandemic context. METHODS dMOM will be conducted in 4 phases. 1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and the post-pandemic context, and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. 2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore EMW’s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centres; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. 3) dMOM will be implemented and incrementally scaled across 71 project communes. 4) dMOM will be evaluated to assess whether SMS delivery or mobile app delivery engenders better MNCH outcomes among EMW. Documentation of lessons learned and dMOM models will be shared with Vietnam’s Ministry of Health for adoption and further scaling up. RESULTS The dMOM study was funded by IDRC in November 2021, co-facilitated by the Ministry of Health, and is being co-implemented by provincial health departments in two mountainous provinces. Phase 1 (literature review; updating, adapting, and expanding intervention components) was initiated in May 2022, and phase 2 (scoping study and rapid ethnographic fieldwork) is planned to begin in December 2022. The entire study is expected to be complete in June 2025. CONCLUSIONS The dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among EMW in low resource settings in Vietnam, and provide critical information on the processes of adapting mobile health interventions to respond to COVID-19 and other future pandemics. Finally, dMOM activities, models and findings will inform a national-scale intervention led by the Ministry of Health. CLINICALTRIAL n/a