Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?

Abstract

BackgroundDespite the growing use of technology in the health sector, little evidence is available on the technological performance of mobile health programs nor on the willingness of target users to utilize these technologies as intended (behavioral performance). In this case study of the Mobile Technology for Health (MOTECH) program in Ghana, we assess the platform’s effectiveness in delivering messages, along with user response across sites in five districts from 2011 to 2014.MethodsMOTECH is comprised of “Client Data Application" (CDA) which allows providers to digitize and track service delivery information for women and infants and “Mobile Midwife” (MM) which sends automated educational voice messages to the mobile phones of pregnant and postpartum women. Using a naturalist study design, we draw upon system generated data to evaluate message delivery, client engagement, and provider responsiveness to MOTECH over time and by level of facility.ResultsA total of 7,370 women were enrolled in MM during pregnancy and 14,867 women were enrolled postpa1rtum. While providers were able to register and upload patient-level health information using CDA, the majority of these uploads occurred in Community-based facilities versus Health Centers. For MM, 25% or less of expected messages were received by pregnant women, despite the majority (>77%) owning a private mobile phone. While over 80% of messages received by pregnant women were listened to, postpartum rates of listening declined over time. Only 25% of pregnant women received and listened to at least 1 first trimester message. By 6–12 months postpartum, less than 6% of enrolled women were exposed to at least one message.ConclusionsCaution should be exercised in assuming that digital health programs perform as intended. Evaluations should measure the technological, behavioral, health systems, and/or community factors which may lead to breaks in the impact pathway and influence findings on effectiveness. The MOTECH platform’s technological limitations in ‘pushing’ out voice messages highlights the need for more timely use of data to mitigate delivery challenges and improve exposure to health information. Alternative message delivery channels (USSD or SMS) could improve the platform’s ability to deliver messages but may not be appropriate for illiterate users.Trial registrationNot applicable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0421-9) contains supplementary material, which is available to authorized users.

Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study

“…Assessing scale may be premature if an intervention's effectiveness and impact have not been evaluated. There is a need to understand the implementation context of a DHI and how this impacts project fidelity [25]. Findings from this study help to provide needed context to understand the degree of sustained use, which in turn influences the resulting immunization coverage.…”

Review of patients perspective’s of m-health adoption factors in the developing world. Development of a framework

“…Research methods used in the 54 reviewed resources were: 25 qualitative papers , 9 surveys [42][43][44][45][46][47][48][49][50], 7 mixed methods [51][52][53][54][55][56][57], 4 experimental [52,[58][59][60], 3 usability assessments [8,61,62], 2 cohort studies [63,64], and 4 cross sectional studies [65][66][67][68]. Collectively they reported the spectrum of factors that affect patient adoption.…”

“…Sharing of mobile devices was the primary issue identi ed under access to mobile devices. Many projects relied upon shared use of cell phones [19,48,77]. Although the absolute proportion of shared devices varied, for example from 21% [25] to 51.4% [8], it was recognised as a limitation to implementation.…”

“…Studies reported participants from adolescents to the aged, of both genders, and broad levels of education [21,28,37,53,66]. Some studies suggested that age and gender of patients should be considered when implementing m-health systems, with different age groups having preferences for certain multimedia elements [48,66], and women given less priority in male dominated communities [37,42]. Others reported that children, the elderly and the illiterate needed assistance to initiate a service request [28], or appropriate training for them to use the device [80].…”

“…Patients must feel comfortable that an m-health system will successfully deliver what they want, and will avoid adopting an m-health system they are unfamiliar with or for which there is limited evidence of effectiveness [18,24]. Conversely, several papers reported how much patients appreciated and accepted m-health when it met their needs and made them feel valued [21,38,48,90], provided reliable and timely responses that improved quality of life [87], and facilitated two-way communication between the patient and healthcare provider [26]. This phenomenon of leaving the response promptings to the digital awareness of the patients who may have low digital literacy or the benevolence of caregivers is certainly not reliable [40,91].…”