The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth

Cramer, Mary E.; Mollard, Elizabeth; Ford, Amy; Kupzyk, Kevin; Wilson, Fernando A.

doi:10.1111/phn.12543

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…• embedded in community or local organizations, rather than hiring new CHWs specifically for research (23,24,26,27,31,33,35,36,42). This is largely because CHWs could incorporate intervention activities into their existing work after the conclusion of the study.…”

Section: Moore Et Al (36)mentioning

confidence: 99%

Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review

Coulter

Ingram

McClelland

et al. 2020

Front. Public Health

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Community health workers (CHWs) are increasingly involved as members of health intervention research teams. Given that CHWs are engaged in a variety of research roles, there is a need for better understanding of the ways in which CHWs are incorporated in research and the potential benefits. This scoping review synthesizes evidence regarding the kinds of health research studies involving CHWs, CHWs' roles in implementing health intervention research, their positionality on research teams, and how their involvement benefits health intervention research. The scoping review includes peer-reviewed health intervention articles published between 2008-2018 in the U.S. A search of PubMed, Embase and CINAHL identified a total of 3,129 titles and abstracts, 266 of which met the inclusion criteria and underwent full text review. A total of 130 articles were identified for a primary analysis of the research and the level of CHWs involvement, and of these 23 articles were included in a secondary analysis in which CHWs participated in 5 or more intervention research phases. The scoping review found that CHWs are involved across the spectrum of research, including developing research questions, intervention design, participant recruitment, intervention implementation, data collection, data analysis, and results dissemination. CHW positionality as research partners varied greatly across studies, and they are not uniformly integrated within all stages of research. The majority of these studies employed a community based participatory research (CBPR) approach, and CBPR studies included CHWs as research partners in more phases of research relative to non-CBPR studies. This scoping review documents specific benefits from the inclusion of CHWs as partners in health intervention research and identifies strategies to engage CHWs as research partners and to ensure that CHW contributions to research are well-documented.

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Section: Moore Et Al (36)mentioning

confidence: 99%

Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review

Coulter

Ingram

McClelland

et al. 2020

Front. Public Health

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“…For instance, text messaging technology improves early infant diagnosis, adherence to recommended diagnostic testing, and participant engagement in lifestyle change interventions [ 92 – 94 ]. More sophisticated interventions have found their way into smartphone-based technology, some of which are accessible even without an internet connection [ 95 , 96 ]. Internet accessibility is important because a number of study participants noted internet connectivity as a barrier for patients who live in low resource communities.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access

Coombs

Campbell

Caringi

2022

BMC Health Serv Res

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Background Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution. Methods We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings. Results Five key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. Conclusions Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.

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“…Although CHWs have shown promise to effectively provide social support, assist with goal setting, demonstrate a positive effect on patient activation, and reinforce education to address diabetes and other CVD risk factors, 45–47 much of the work pertaining to technology-supported interventions have focused on maternal and child health, health in addition to human immunodeficiency virus/AIDS, and sexual and reproductive health 48–51 . A smartphone platform intervention combined with CHW reinforcement in rural pregnant women showed promise for improving birth outcomes in rural communities 52 …”

Section: Discussionmentioning

confidence: 99%

“…[48][49][50][51] A smartphone platform intervention combined with CHW reinforcement in rural pregnant women showed promise for improving birth outcomes in rural communities. 52 Of the CHW studies targeting diabetes management, the technology used was limited to phone-based coaching and glucometer training. 53 We could identify only 2 studies, 1 predominantly rural and 1 urban, where CHWs used mHealth technologies to address CVD risk in the United States.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Disease Risk in Rural Adults

et al. 2022

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BackgroundCardiovascular disease (CVD) risk reduction programs led by a nurse/community health worker team are effective in urban settings. This strategy has not been adequately tested in rural settings.ObjectiveA pilot study was conducted to examine the feasibility of implementing an evidence-based CVD risk reduction intervention adapted to a rural setting and evaluate the potential impact on CVD risk factors and health behaviors.MethodsA 2-group, experimental, repeated-measures design was used; participants were randomized to a standard primary care group (n = 30) or an intervention group (n = 30) where a registered nurse/community health worker team delivered self-management strategies in person, by phone, or by videoconferencing. Outcomes were measured at baseline and at 3 and 6 months. A sample of 60 participants was recruited and retained in the study.ResultsIn-person (46.3%) and telephone (42.3%) meetings were used more than the videoconferencing application (9%). Mean change at 3 months differed significantly between the intervention and control groups for CVD risk (−1.0 [95% confidence interval (CI), −3.1 to 1.1] vs +1.4 [95% CI, −0.4 to 3.3], respectively), total cholesterol (−13.2 [95% CI, −32.1 to 5.7.] vs +21.0 [95% CI, 4.1–38.1], respectively), and low-density lipoprotein (−11.5 [95% CI, −30.8 to 7.7] vs +19.6 [95% CI, 1.9–37.2], respectively). No between-group differences were seen in high-density lipoprotein, blood pressure, or triglycerides.ConclusionsParticipants receiving the nurse/community health worker–delivered intervention improved their risk CVD profiles, total cholesterol, and low-density lipoprotein levels at 3 months. A larger study to explore the intervention impact on CVD risk factor disparities experienced by rural populations is warranted.

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The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth

Abstract: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at-risk population to appreciate the impact of the intervention.

Cited by 12 publications

References 18 publications

Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review

Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review

A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access

Cardiovascular Disease Risk in Rural Adults

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