"I am not telling. The mobile is telling": Factors influencing the outcomes of a community health worker mHealth intervention in India
"I am not telling. The mobile is telling": Factors influencing the outcomes of a community health worker mHealth intervention in India
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DOI：
10.1371/journal.pone.0194927
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发表时间：
2018-03-27
期刊：
影响因子：
3.7
通讯作者：
Broerse, Jacqueline E. W.
中科院分区：
文献类型：
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作者：
Ilozumba, Onaedo;Dieleman, Marjolein;Broerse, Jacqueline E. W.
改善产妇保健结果仍然是低收入和中等收入国家的一个优先事项。随着移动保健技术的迅速普及，人们越来越有兴趣了解这些技术如何有效改善孕产妇保健结果，特别是孕产妇保健知识和行为。然而，很少有研究清楚地解释了项目开发者的基本原理（变化理论）和可能影响项目结果的环境因素。这项混合方法研究评估了移动母亲，社区卫生工作者（CHW）利用孕产妇移动健康干预。我们提出了程序开发人员的基本原理，并利用它作为一个框架来指导我们的研究，旨在确定干预相关和背景因素，这些因素影响了利用移动健康干预的CHW的观察结果。材料与方法采用定量方法（对740名接受干预的妇女进行问卷调查，对57名接受干预的保健女工进行调查）和定性方法（对保健女工进行12次访谈和4次小组讨论，对孕妇和哺乳期妇女进行20次访谈和5次小组讨论，对男性进行15次访谈和2次小组讨论）。这些被用来了解移动健康干预是如何实施的，并深入了解可能影响观察到的干预结果的背景因素。结果将结果分为三类：(1)卫生工作者使用移动医疗技术的看法和经验；(2) chw相关结局；(3)影响孕产妇求医行为的环境因素。保健员及社区成员对干预措施的整体反应是正面的。然而，卫生院与各自社区的关系、孕妇的决策权以及因经济原因无法获得服务等背景因素影响了观察结果。结论移动健康应用程序是提高妇幼保健服务绩效和改善孕妇就医行为的有效干预手段。然而，环境因素在干预结果中起着至关重要的作用，需要在干预设计和实施过程中由程序开发人员加以阐明。
IntroductionImproving maternal health outcomes remains a priority in Low and Middle Income Countries. With the rapid proliferation of mobile health technologies, there is an increased interest in understanding how these technologies can effectively improve maternal health outcomes particularly maternal health seeking knowledge and behaviors. However, few studies present clear explanations of the program developers' rationale (theory of change) and contextual factors that could influence program outcomes. This mixed-methods study assesses Mobile for Mothers, a community health workers (CHW) utilized maternal mHealth intervention. We present the program developers' rationale and utilize it as a framework to guide our study that aimed to identify intervention-related and contextual factors, which influence the observed outcomes of a CHW, utilized mHealth intervention.Materials and methodsQuantitative methods (a questionnaire with 740 women who received the intervention and survey of 57 CHWs who utilized the intervention) and qualitative methods (12 interviews and 4 group discussions with CHWs and 20 interviews and 5 group discussions with pregnant and lactating women and 15 interviews and 2 group discussions with men) were conducted. These were used to understand how the mHealth intervention was implemented and to gain insight into contextual factors that potentially influenced the observed intervention outcomes.ResultsResults were grouped following three categories: (1) perceptions and experiences of CHWs utilizing the mHealth technology; (2) CHW-related outcomes; and (3) contextual factors that influence maternal health-seeking behavior. The overall response of CHWs and community members to the intervention was positive. However, contextual factors like the relationship between the CHWs and their respective communities, the pregnant women's decision-making power and lack of access due to financial influenced the observed outcomes.ConclusionMobile health applications are promising interventions for improving the performance of CHWs and health-seeking behavior of pregnant women. However, the contextual factors play a crucial role in intervention outcomes and need to be explicated by program developers during intervention design and implementation.