Understanding women’s, caregivers’, and providers’ experiences with home-based records: A systematic review of qualitative studies

Abstract

Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants’ reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records’ potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems.

How Should Home-Based Maternal and Child Health Records Be Implemented? A Global Framework Analysis

“…There was evidence to suggest that health care workers in low-income settings valued HBRs, and especially integrated multi-focus HBRs, for the information provided, convenience, and long-term value. 7 This was especially true in settings where facility-based record systems were incomplete or incorrect. In addition, studies indicated that HBRs that incorporated not only the data recording function but also the additional health education function provided a common talking point for patients and health care workers, enhancing patient-provider communication.…”

“…This study was part of the evidence synthesis for the World Health Organization (WHO) recommendations on HBRs for MNCH 3 alongside a quantitative systematic review and meta-analysis of peer-reviewed literature 6 and a qualitative review of peer-reviewed literature. 7 The guidelines, published in September 2018, recommend HBRs as a tool to improve MNCH outcomes. 3 Studies summarized within the quantitative review and meta-analysis found that HBRs had statistically significant effects on improving antenatal care attendance and supportive household environments; however, the evidence base is small and of low to very low certainty.…”

“…3,6 Despite less quantitative data on MNCH outcomes, there were significant data from the qualitative and quantitative studies, as well as from the respondents in this study, that emphasized that women, caregivers, and health care workers value HBRs. 3,6,7 There is evidence that they can improve patient-provider communication, continuity of care, 7,9 and increase women's feelings of control and empowerment. 7,10 Including and empowering women and children by encouraging them and their caregivers to be health literate and actively participate in their own care is a key step toward achieving universal health coverage.…”

“…3,6,7 There is evidence that they can improve patient-provider communication, continuity of care, 7,9 and increase women's feelings of control and empowerment. 7,10 Including and empowering women and children by encouraging them and their caregivers to be health literate and actively participate in their own care is a key step toward achieving universal health coverage. 11 Unfortunately, despite being underpinned by research, many evidence-based interventions never gain traction in routine practice or they only do so after many years.…”

“…14,25 The majority of existing literature studied HBRs in high-income countries. 3,6,7 This study sought to identify a broad understanding of the HBR implementation process in low-and middle-income countries (LMICs) and the possible facilitators and barriers to each implementation component. What are the causes of ineffective implementation, and why do they persist?…”