Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?
Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?
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DOI：
10.1186/s12911-017-0421-9
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发表时间：
2017-03-14
影响因子：
3.5
通讯作者：
Moorthy, Anitha
中科院分区：
文献类型：
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作者：
LeFevre, Amnesty E.;Mohan, Diwakar;Moorthy, Anitha
背景资料：尽管卫生部门越来越多地使用技术，但几乎没有证据表明移动的卫生方案的技术性能，也没有证据表明目标用户愿意按预期使用这些技术（行为性能）。在加纳的移动的健康技术（MOTECH）项目的案例研究中，我们评估了该平台在传递信息方面的有效性，沿着的是2011年至2014年五个地区的用户响应。方法：MOTECH由“客户数据应用程序”（CDA）和“移动的助产士”（MM）组成，客户数据应用程序允许提供者记录和跟踪妇女和婴儿的服务提供信息。它向孕妇和产后妇女的移动的手机发送自动教育语音消息。使用一个自然主义者的研究设计，我们利用系统生成的数据，以评估消息传递，客户参与，和供应商的响应MOTECH随着时间的推移，并通过facility.Results水平：共7,370名妇女参加了MM在怀孕期间和14,867名妇女参加产后1 rtum。虽然提供者能够使用CDA注册和上传患者级别的健康信息，但这些上传大多发生在社区设施而不是卫生中心。对于MM，25%或更少的预期消息由孕妇接收，尽管大多数（> 77%）拥有私人移动的电话。虽然孕妇收到的信息中有80%以上得到了倾听，但产后倾听率随着时间的推移而下降。只有25%的孕妇在怀孕前三个月收到并收听了至少一条信息。产后6-12个月，不到6%的登记妇女接触到至少一个messages.Conclusions：应谨慎行事，假设数字健康计划按预期执行。评价应衡量可能导致影响路径中断并影响成效结论的技术、行为、卫生系统和/或社区因素。MOTECH平台在“推送”语音信息方面的技术局限性凸显了更及时地使用数据以减轻交付挑战并改善健康信息暴露的必要性。替代消息传递渠道（USSD或SMS）可以提高平台传递消息的能力，但可能不适合文盲用户。
Background: Despite 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.Methods: MOTECH 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.Results: A 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.Conclusions: Caution 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.