Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

Abstract

Background Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers. Method We undertook a realist synthesis. An electronic search of five online databases (PubMed/Medline, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories. Results We formulated two configurational models illustrating how and why mHealth impacts implementation and uptake of maternal and child health care. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation and perceived ease of use and usefulness. These mechanisms are influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms are influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity and awareness. Conclusion Models developed in this study provide a detailed understanding of implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required.

Mobile health applications: awareness, attitudes, and practices among medical students in Malaysia

“…MHealth applications are used by all age groups such as maternal-child groups and older adults [16,17]. During the COVID-19 pandemic, these applications improved the healthcare accessibility and streamlined in-hospital practice workflow and public health systems [18,19].…”

“…However, age and phase of study did not affect awareness of health and fitness or COVID-19 applications. None of the other demographic features measured were correlated with the respondents' attitudes toward the three categories of applications (Supplementary Table 13,14,15,16,17,18,19,20 and 21).…”

Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review

“…However, the reviews focused on the roles of mHealth in clinical/health outcomes,14 21 lifestyle behaviours22 or the specific perinatal period 23. Some reviews were conducted only among either low/middle-income countries or high-income countries24–26 or a specific type of mHealth service, such as mobile apps or short messaging services (SMS) 14 15 22 24. Therefore, this study aimed to review evidence from all studies designs conducted in countries of varying income levels to comprehensively investigate the roles of mHealth in the psychosocial health of pregnant women and mothers.…”

What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria

“…Despite growing recognition that technology use can improve FHWs' motivation and performance ( 41 , 49 ), few studies have explained the underlying reasoning ( 50 ) for how technology interacts with FHWs, health systems and the implementation context to shape FHW motivation, performance, and quality of MNCH care ( 42 ). Our study identified five mechanisms by which digital technology generated impact which showed that access to tablet devices that were simple to use, and continuous engagement with clinical videos, led to increased knowledge, based on which FHWs: (i) felt confident, better trained and (ii) motivated to do their work.…”