Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review

Abstract

Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving maternal health services in sub-Saharan Africa (SSA).Objective: This mixed method systematic review addresses two objectives: 1) The impact of mHealth use by CHWs on antenatal care (ANC), facility-based births, and postnatal care (PNC) utilization in SSA; 2) Identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase utilization of ANC, facility-based births and PNC in SSA using a sociotechnical system (STS) approach. Methods:We searched for articles in six databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) up to September 2022, with additional articles identified from Google Scholar. After article selection, two independent reviewers performed screening of titles and abstracts, full-text screening, and data extraction using Covidence software. Additionally, we manually screened the reference list of included articles. Finally, we performed a narrative synthesis of the outcomes.Results: Among the 2594 records retrieved, ten studies (a total of 22 articles) met the inclusion criteria and underwent data extraction. The studies were published from 2012 to 2022 in six countries. Among the studies reporting on ANC outcomes, 43% (three out of seven) reported that mHealth use by CHWs increased ANC utilization. Similarly, in studies reporting on facilitybased births, 89% (eight out of nine) demonstrated an increase due to mHealth use by CHWs. Additionally, in PNC studies, 75% (three out of four) showed increased PNC utilization associated with mHealth use by CHWs. Many studies reported on the importance of addressing factors around the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, ease of mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with increased ANC, facility-based births, and PNC in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs.