Management challenges in mHealth: failures of a mobile community health worker surveillance programme in rural Nepal

Meyers, David J.; Filkins, Malina; Bangura, Alex Harsha; Sharma, Richa; Baruwal, Ashma; Pande, Sami; Halliday, Scott; Schwarz, Dan; Schwarz, Ryan; Maru, Duncan Smith-Rohrberg

doi:10.1136/bmjinnov-2015-000102

Cited by 20 publications

(20 citation statements)

References 13 publications

(10 reference statements)

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“…Similarly, a study conducted to assess the feasibility of using smartphones in maternal health care in Ethiopia reported that the health care providers who did not have previous exposure to smart phones and electronic devices were able to use the phones effectively in day-to-day maternal health care service delivery [ 48 ]. A pilot programme in rural Nepal which tested the feasibility of using mobile phones for collecting health surveillance data reported that community health workers can collect health surveillance data accurately using mobile technology if they are trained adequately [ 31 ]. There have also been studies in Nepal that demonstrated limited uptake of mental illness detection strategies among community health volunteers [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have assessed the feasibility and effectiveness of the application of mobile technology in health care delivery within the country. These studies have attempted to test if mobile devices can support maternal and new born child healthcare, particularly for patient data collection to send reminders for follow-up and assess signs and symptoms of illness [ 30 ]; gather health surveillance data from rural areas [ 31 ]; SMS reporting of neonatal health information and malaria surveillance [ 32 ]; support health workers in the rural district hospitals, including provision of remote specialists services [ 33 ]; aiding community health volunteers to engage persons with mental illness in treatment initiation at primary care facilities [ 34 ]; and remote supervision for mental health services [ 35 ]. None of these studies has attempted to assess the feasibility of an app-based decision aid for mental health diagnoses in primary care.…”

Section: Introductionmentioning

confidence: 99%

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Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

Pokhrel¹,

Karmacharya²,

Salisbury

et al. 2021

BMC Med Inform Decis Mak

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Background In recent years, a significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications. The use of mobile technology can help to reduce a number of barriers for mental health care such as providers’ workload, lack of qualified personnel, geographical and attitudinal barriers to seek treatment. This study assessed the perception of Nepali primary healthcare workers about the feasibility, acceptability, and benefits of using a mobile app-based clinical guideline for mental health care. Method A qualitative study was conducted in two districts Chitwan and Ramechhap of Nepal with purposively selected medical officers (n = 8) and prescribing primary healthcare workers (n = 35) who were trained in the World Health Organization mental health Gap Action Program Intervention Guide. Semi-structured interviews and focus group discussions were conducted in Nepali, audio recorded, transcribed and translated into English for data analysis. Data were analysed manually using a thematic analysis approach. Results The majority of the healthcare workers and medical officers reported a high level of interest, motivation and positive attitudes towards the mobile app-based clinical guidelines for detection and treatment of people with mental disorders in primary care. They respondents suggested that several features and functions should be included in the app: suggestive diagnosis and treatment options; clinical data recording system; sending messages to patients to promote follow-up visits; allow offline functions; minimal typing options and content to be available in Nepali language. The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities, enabling remote supervision, helping verification of health workers’ diagnosis and treatment; and increasing patients’ trust in the treatment. Lack of reliable internet connection in health facilities, possibility of distracting interaction between patient and provider, and confidentiality were the key factors potentially hindering the use of the app. Conclusion The suggested functions and features as well as the potential risk factors highlighted by the health workers, will be considered when further developing the mobile app-based clinical guidelines, training modality and materials, and the supervision system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

Pokhrel¹,

Karmacharya²,

Salisbury

et al. 2021

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

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“…While integrating mobile health solutions in CHWs workflow, another significant challenge faced by CHWs are management related challenges. A mobile phones system was implemented in rural Nepal to collect health surveillance data; however, it did not reach its fullest potential due to several management related challenges such as, leadership transitions, poor process design and a lack of consistent vision of how to operationalize the data [31]. The researchers concluded that for any mHealth intervention to be successful in a low-resourced settings, institutional buy-in, appropriate and actionable data collection techniques, and effective process management are essential and should be taken in to consideration [31].…”

Section: Challenges Of Using Mobile Phones For Community Health Workersmentioning

confidence: 99%

Using mobile phones to improve community health workers performance in low-and-middle-income countries

2020

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Background: In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to accomplish more although they may not obtain the required support to perform their duties. The health systems of LMICs, have given very little attention to the work environment of CHWs; which has negatively affected CHWs productivity, and quality of services. This debate is intended to explore the potential of mobile phone technology in LMICs for improving CHWs performance and effectiveness. Discussion: To improve CHWs productivity, some studies involved the use of mobile phones for data collection and reporting, while other studies used mobile technology for patient to provider communication, patient education, CHWs supervision, and monitoring and evaluation. A wide range of benefits exists for using mobile phones including reduction in CHWs workload, improvement in data collection, reporting and monitoring, provision of quality healthcare services, supportive supervision, better organization of CHWs tasks and improvement in community health outcomes. However, a number of studies suggests that CHWs encounter unique challenges when adopting and using mobile health solutions for health service delivery such as, lack of CHWs training on new mHealth solutions, weak technical support, issues of internet connectivity and other administrative challenges. Future research efforts should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs. Conclusion: Future research efforts and policy dialogue should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs.

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“…Prior research has shown promising use of text messages to improve uptake of health facility maternal and child health services in LMICs [ 5 , 6 ] and FCHV mobile phone use for data collection and disease surveillance following adequate training and support in Nepal [ 19 , 20 ]. Our study findings suggest that text messages could also be used to increase uptake of community health and nutrition services, such as HMGs meetings led by FCHVs, in Nepal and in similar low-resource settings.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study

et al. 2020

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Background With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal. Objective This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions. Methods We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos. Results The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers. Conclusions A text message–based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message–based mHealth intervention design in under-resourced settings.

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Management challenges in mHealth: failures of a mobile community health worker surveillance programme in rural Nepal

Cited by 20 publications

References 13 publications

Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

Using mobile phones to improve community health workers performance in low-and-middle-income countries

Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study

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