Informal mhealth at scale in Africa: Opportunities and challenges.
Informal mhealth at scale in Africa: Opportunities and challenges.
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DOI：
10.1016/j.worlddev.2020.105257
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发表时间：
2021-04
影响因子：
6.9
通讯作者：
Kasim A
中科院分区：
文献类型：
--
作者：
Hampshire K;Mwase-Vuma T;Alemu K;Abane A;Munthali A;Awoke T;Mariwah S;Chamdimba E;Owusu SA;Robson E;Castelli M;Shkedy Z;Shawa N;Abel J;Kasim A
非洲各地的社区卫生工作者在工作中“非正式地”使用移动电话。非正式移动医疗是一种新兴现象，用于弥补正规医疗服务的不足。非正式的移动医疗正在大规模发展，远远超过其正式的同类服务。非正式移动医疗本身就是对当地需求和突发事件的响应。但它会带来隐性成本（财务成本和其他成本），而且分配不公平。全球数字连接的非凡增长使人们乐观地认为，移动技术可以帮助克服发展的基础设施障碍，而“移动医疗”（mhealth）是其中的一个关键组成部分。然而，虽然“正式”（自上而下）移动卫生规划继续面临可扩展性和可持续性的挑战，但我们对卫生工作者如何在工作中非正式地使用自己的移动电话知之甚少。利用来自加纳、埃塞俄比亚和马拉维的数据，我们记录了社区卫生工作者（chw）“非正式移动医疗”实践的范围、性质和可感知的影响，并询问这些实践的分配是否公平。我们实施了一项混合方法研究，结合了对三个国家的卫生院的调查，采用多阶段按比例抽样（N = 2197）和定性研究（对卫生院、客户和高层利益相关者进行访谈和焦点小组）。对调查数据进行加权，以产生具有全国或地区代表性的样本进行多变量分析；定性数据采用比较专题分析。我们的研究结果证实，与“非正式”移动医疗相比，“正式”移动医疗的覆盖范围有限：虽然只有15%的受访卫生工作者使用正式的移动医疗应用程序，但超过97%的卫生工作者报告说，他们经常以一系列创新的方式使用个人手机进行工作相关的工作。卫生工作者和客户毫不含糊地表达了对这种“非正式健康”使用的感知影响的热情看法。然而，他们也发现了非常现实的实际挑战、经济负担和其他对个人福祉的威胁；这些费用似乎不成比例地由工资最低的卫生工作者，特别是那些服务于农村地区的卫生工作者承担。与之前的小规模定性研究不同，我们的工作表明，非正式的移动医疗已经在大规模开展，远远超过了正式的移动医疗。决策者需要认真参与这一紧急卫生系统，并与实地人员密切合作，在不破坏现有良好做法的情况下解决不平等的根源。
Community health-workers across Africa use mobile phones ‘informally’ in their work. Informal mhealth is an emergent phenomenon, used to bridge gaps in formal provision. Informal mhealth is happening at scale, far outstripping its formal equivalent. Informal mhealth is inherently responsive to local needs and contingencies. But it carries hidden costs (financial and other) which are inequitably distributed. The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with ‘mobile health’ (mhealth) being a key component of this. However, while ‘formal’ (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers’ (CHWs’) ‘informal mhealth’ practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of ‘formal’ compared with ‘informal’ mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this ‘informal health’ usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
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DOI：
10.1136/eb-2012-100885
发表时间：
2013-06-01
期刊：
Evidence-based medicine
影响因子：
--
作者：
Buijink, Arthur Willem Gerard;Visser, Benjamin Jelle;Marshall, Louise
通讯作者：
Marshall, Louise
影响因子：
1.2
作者：
Donou-Adonsou, Ficawoyi;Lim, Sokchea;Mathey, Samuel A.
通讯作者：
Mathey, Samuel A.
影响因子：
1.9
作者：
Aricat, Rajiv George;Ling, Rich
通讯作者：
Ling, Rich
影响因子：
2.9
作者：
Haenssgen, Marco J.
通讯作者：
Haenssgen, Marco J.
影响因子：
5.4
作者：
Hackett, Kristy M.;Kazemi, Mina;Sellen, Daniel W.
通讯作者：
Sellen, Daniel W.