Feasibility of using telephone interviews and internet-based message services during the COVID-19 pandemic in rural Sri Lanka: experiences of the Rajarata Pregnancy Cohort

Abstract

The COVID-19 pandemic has challenged population health researchers to use remote data collection methods to avoid faceto-face interaction. A proper assessment of the feasibility of these methods in low-resource settings is lacking. We share our experience from telephone interviews conducted among pregnant women in the Rajarata Pregnancy Cohort in Sri Lanka. Among 3374 participants, 3284 (98.4%) and 496 (14.7%) had mobile and fixed-access phones respectively. During interviews, 1576 (51.9%) of participants were non-contactable. Of these, there were 157 (5.1%) wrong numbers, 889 (29.1%) were unavailable/phone switched off and 479 (15.7%) didn't answer their phone. Telephone interviews were completed only among 1438 (42.6%). Of these, 476 (33.1%) used messaging apps. In this local setting, these methods led to selection bias and inequity in health message delivery. If other ways to target vulnerable people in rural areas are not in place, the adoption of a telephone-based strategy to health message delivery may worsen health disparity during the COVID-19 pandemic. These facts aid in the planning and implementation of research and health promotion initiatives in rural areas of low-and middle-income nations throughout the world.

Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review

“…However, further work is required to establish the viability of this program. Using a large-scale, population-based pregnancy cohort, Jayasinghe and colleagues [ 68 ] recruited 3374 first-trimester pregnant women registered with midwives at the field prenatal clinics to assess the feasibility and the coverage and feasibility of app-based interventions and generalizability of telephone interviews for psychological support during the pandemic. The study revealed that mHealth led to selection bias and that mHealth may not be the best strategy for interventions in this remote area.…”

“…However, the results of the synthesized studies demonstrate the similarities and differences between participant characteristics and intervention modalities used from prenatal through delivery and postpartum. For instance, there were considerable differences in study participants ages, with most studies using both the birth age of the mother and gestation age, while a few studies did not include age but referenced the age of participants as women of reproductive age [ 100 ] or pregnant women [ 68 , 101 , 103 , 109 , 124 , 125 ], or women with children under 2 years old [ 105 , 113 , 126 ]. Likewise, although two studies conducted in the US used a similar mHealth intervention delivered via Headspace™ app and with patients with moderate-to-moderately-severe depression as well as duration (use of app for 10 to 20 minutes a day for 6 weeks), they focused on different stages of pregnancy, gestation age and patient birth ages.…”

“…Numerous studies have already demonstrated how digital technologies can address healthcare challenges such as those placed by the coronavirus [ 68 , 69 ] on pregnancy care and health-seeking behaviors of pregnant women during the pandemic [ 45 , 70 , 71 ]. Additionally, studies evaluating provider and patient experiences with digital-enabled consultations and appointments during the coronavirus crisis report high usage, patient and provider satisfaction [ 45 , 72 – 77 ], and that both personal and organizational factors motivate implementation [ 78 , 79 ].…”

Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

“…With the permission of pregnant women during recruitment of the RaPCo, we collected their telephone numbers to contact them to share the investigation results and follow-up data collection. We held a telephone interview using a pretested interviewer guide with close-ended questions and collected details on the routine utilisation of antenatal/postnatal health services and household financial information during the pandemic 33. Data collection was based on five major categories: (1) whether income was affected during the outbreak, (2) financial assistance received, (3) the status of using maternal health services, (4) the assistance of the PHM and (5) the assistance of household members/neighbours (online supplemental file 1).…”

Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka

“…A considerable number of participants were not contactable through a given contact number. This issue was identified at the later stages of follow-up of the cohort as well amidst the COVID-19 pandemic as an obstacle to research using telephones 22…”