The Effect of a Community Health Worker Utilized Mobile Health Application on Maternal Health Knowledge and Behavior: A Quasi-Experimental Study

Ilozumba, Onaedo; Belle, Sara Van; Dieleman, Marjolein; Liem, Loan; Choudhury, Murari; Broerse, Jacqueline E W

doi:10.3389/fpubh.2018.00133

Cited by 32 publications

(55 citation statements)

References 17 publications

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“…These results corroborate extensive previous global evidence [19-23] as well as findings from neighborhing Uttar Pradesh [24-28] – a state which shares many sociodemographic and health system characteristics with Bihar – demonstrating that increasing the number and quality of FLW interactions with beneficiaires through outreach and home visitation can improve a variety of RMNCHN outcomes, including skin-to-skin care, immediate breastfeeding and complementary feeding. Our study extends these findings, however, and shows that FLW reach to beneficiaries through home visitation and their effectiveness in advancing the adoption of health-promoting and life-saving RMNCHN practices can be increased through use of the ICT-CCS mHealth tool.…”

Section: Discussionsupporting

confidence: 89%

“…Some prior mHealth interventions involving use of multi-facted phone-based applications by FLWs to improve RMNCHN do exist. Interventions in rural Tanzania and the state of Jharkhand, India (the latter involved ASHAs) reported that the interventions resulted in increased facility deliveries [22,23]. An mHealth intervention for ASHAs in the state of Uttar Pradesh did not observe effects on facility delivery, but did observe improvements in maternal use of iron-folic acid tablets and report of complications before and after delivery, which was likely related to improved knowledge [24].…”

Section: Discussionmentioning

confidence: 99%

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Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India

Carmichael¹,

Mehta²,

Srikantiah³

et al. 2019

Journal of Global Health

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BackgroundmHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource – especially hard-to-reach – settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes.MethodsThe Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups.ResultsThe ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted.ConclusionsImportant improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India

Carmichael¹,

Mehta²,

Srikantiah³

et al. 2019

Journal of Global Health

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“…Several studies have shown that mobile ICTs can improve the performance of CHAs in their ability to perform health promotion, collect and report timely information regarding family health, provide health services such as vaccines, and refer families to appropriate local health services (3,(47)(48)(49)(50)(51)(52)(53). Additionally, when a mobile ICT tools are used by a CHA, the device can increase the confidence the caregivers have in the messages being transmitted and increase the confidence the CHAs have in their own work (47,48,51,52,(54)(55)(56).…”

Section: Exploration Stage: Identifying Challenges and Solutionsmentioning

confidence: 99%

The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon

Westgard

Fleming

2020

Front. Public Health

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It is essential to analyze the local context and implementation components to effectively deliver evidence-based solutions to public health problems. Tools provided by the field of implementation science can guide practitioners through a comprehensive implementation process, making innovations more adaptable, efficient, and sustainable. It is equally important to report on the design and implementation process so others can analyze, replicate, and improve on the progress made from an intervention. The current study reports on the design and implementation of an mHealth intervention to improve child health in the Amazon of Peru. The study aims to provide insight into how an implementation science tool can be used to improve implementation and reporting of an evidence-based intervention in a global health setting. Methods: Implementation of a community-based mHealth intervention is analyzed and reported through the lens of the Active Implementation Frameworks (AIF). The AIF is used to analyze the design, implementation, adaptation, and monitoring of the intervention. The implementation process is categorized in the four stages of implementation. The results of the analysis and subsequent implementation activities are reported. Results: The exploration stage was used to learn about the local context in the Amazonian communities and identify an evidence-based solution to address poor child health. Several potential solutions were combined to create an innovative mHealth tool. During the installation stage, the stakeholders worked together to improve the intervention and plan for implementation through human-centered design. The providers in the field were trained and data was gathered to monitor implementation. During initial implementation stage, electronic tablets were distributed to community health agents and continuous quality improvement activities allowed for rapid improvements to be implemented. The intervention moved on to full implementation stage as acceptance and fidelity approached 100%. Conclusion: The AIF highlighted several potential barriers to implementation that may have been overlooked without the guidance of a science-based implementation tool. Reporting on the implementation process shows how implementation science tools can Westgard and Fleming Implementation Science Tools for mHealth be used to foresee and address potential threats to successful implementation. The results of this study provide insight into the components of implementation in Amazonian communities, as well as the process of using implementation science tools in any global health setting.

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“…The majority of studies focused on the use of a rapid messaging system and were in rural settings in India and Africa. Many studies found that technology use led to improved maternal health outcomes (Ilozumba, Dieleman, et al, ; Ilozumba, Van Belle, et al, ; Ngabo et al, ). In addition, Bhatt et al () and Jarolimova et al () found that screening and referral tracking improved through the use of technology by CHWs.…”

Section: Introductionmentioning

confidence: 99%

Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi

Wilson

Lee

Klas

et al. 2020

Health Soc Care Community

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Community health workers (CHWs) have been effectively utilised in resource‐limited settings to combat a growing demand for health access that cannot be met by the current workforce. The purpose of this study was to evaluate a CHW training programme in Malawi that integrated technology into rehabilitation care delivery. This was a retrospective cross‐sectional study of a training programme conducted in December 2018. The participants were a convenience sample of all active home‐based palliative care CHWs at St. Gabriel's Hospital (n = 60). The data collected included the following: a written pre‐ and post‐knowledge test, skills competency checklist and a post‐training programme survey. Descriptive frequencies described skill competency and quantitative responses from the post‐training programme survey. Paired t test (α = 0.05) analysis determined the significance of knowledge acquisition. Themes in the narrative responses in the post‐training survey were identified. Both training programme groups showed significantly greater knowledge on the post‐test (M = 9.50, SD = 0.861; M = 9.43, SD = 0.971) compared to the pre‐test (M = 7.97, SD = 1.351; M = 7.90, SD = 1.900); t(29) = 6.565, p < .001; t(29) = 4.104, p < .001 for Group 1 and Group 2, respectively. All participants demonstrated skill competency in 100% of the skills. All participants responded that the training programme helped them review skills and understand how to use technology ‘A lot’ on a Likert scale (no, a little, some, a lot). Facilitators of their work included training programmes, phones, communication with the hospital and collaboration amongst CHWs. Barriers included transportation needs, lack of patient care supplies and lack of caregiver compliance. Overall, utilisation of their knowledge and skills from the training programmes helped their patients make improvements in mobility and function that are meaningful to their quality of life in the village. This study highlights the importance of assessing programmes in low‐resource settings with a focus on feasibility and developing local capacity.

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The Effect of a Community Health Worker Utilized Mobile Health Application on Maternal Health Knowledge and Behavior: A Quasi-Experimental Study

Cited by 32 publications

References 17 publications

Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India

Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India

The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon

Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi

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