Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

Mackintosh, Nicola; Gong, Qian; Hadjiconstantinou, Michelle; Verdezoto, Nervo

doi:10.1016/j.socscimed.2021.114299

Cited by 14 publications

(12 citation statements)

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“…While previous reviews focusing on digital health intervention outcomes in LMIC are available across different disciplines [26,[35][36][37], there is a lack of coherence with regard to what digital maternal health means across these fields. Cross-disciplinary reviews are becoming increasingly important [38] for providing a holistic understanding across fields. However, there are few attempts that consolidate learning from across different disciplines in the context of digital health technologies but are limited in relation to MCH in LMIC.…”

Section: Scoping Review Rationale and Study Overviewmentioning

confidence: 99%

Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

Till¹,

Mkhize²,

Farao³

et al. 2023

J Med Internet Res

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Background Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods We conducted a scoping review using the 6-stage framework by Arksey and O’Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy.

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Section: Scoping Review Rationale and Study Overviewmentioning

confidence: 99%

Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

Till¹,

Mkhize²,

Farao³

et al. 2023

J Med Internet Res

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“…Only a small number of studies have used the candidacy construct to examine maternity care or women’s health 10,11 and research on digital health and maternity care has remained very limited. 12 Yet the distinctive features of antenatal care warrant specific attention, given its critical role in securing positive pregnancy outcomes, safeguarding women’s wellbeing and mitigating inequalities for under-served groups. Antenatal care is distinguished by the reality that most women and their babies remain well throughout pregnancy, but a range of high-risk concerns may emerge at any stage, and some may not be easily detected or assessed without specialist review by qualified professionals.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy

Hinton

Kuberska

Dakin

et al. 2023

J Health Serv Res Policy

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Objective We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond. Methods We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy. Results We found that remote antenatal care had far-reaching effects on access when understood through the lens of candidacy. It altered women’s own identification of themselves and their babies as eligible for antenatal care. Navigating services became more challenging, often requiring considerable digital literacy and sociocultural capital. Services became less permeable, meaning that they were more difficult to use and demanding of the personal and social resources of users. Remote consultations were seen as more transactional in character and were limited by lack of face-to-face contact and safe spaces, making it more difficult for women to make their needs – both clinical and social – known, and for professionals to assess them. Operational and institutional challenges, including problems in sharing of antenatal records, were consequential. There were suggestions that a shift to remote provision of antenatal care might increase risks of inequities in access to care in relation to every feature of candidacy we characterised. Conclusion It is important to recognise the implications for access to antenatal care of a shift to remote delivery. It is not a simple swap: it restructures many aspects of candidacy for care in ways that pose risks of amplifying existing intersectional inequalities that lead to poorer outcomes. Addressing these challenges through policy and practice action is needed to tackle these risks.

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“…They seek information with a fine balance between awareness and information seeking, with the risk of increasing anxiety and confusion [ 7 ]. By accessing apps and digital information during pregnancy, women may be seeking to understand normality , to help them to check if their experiences or symptoms are to be expected or something they should take action on [ 8 ]. Pregnant women often seek the experiences of others to support their decision-making or to make them feel more informed when raising discussions with professionals [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The national child health and well-being charity, Best Beginnings, launched the Baby Buddy app in November 2014 [ 8 ]. The charity describes the Baby Buddy app as “an electronically delivered health intervention” that is intended to support and guide women through pregnancy (antenatal period) and the first 6 months of their child’s life (postnatal period).…”

Section: Introductionmentioning

confidence: 99%

“…The app was co-designed with mothers to inform and empower women of all ages and from wide sociodemographic backgrounds, so that all expectant parents can search for and benefit from high-quality information and support during pregnancy. Best Beginnings worked closely with HCPs to ensure that the Baby Buddy app provided evidence-based information [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry

Bailey¹,

Nightingale²,

Thomas³

et al. 2022

JMIR Mhealth Uhealth

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Background Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions Although this study included a small sample, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID) RR2-10.1017/S1463423618000294

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Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

Cited by 14 publications

References 84 publications

Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy

First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry

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