Impact of smartphone-assisted prenatal home visits on women's use of facility delivery: Results from a cluster-randomized trial in rural Tanzania
Impact of smartphone-assisted prenatal home visits on women's use of facility delivery: Results from a cluster-randomized trial in rural Tanzania
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DOI：
10.1371/journal.pone.0199400
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发表时间：
2018-06-18
期刊：
影响因子：
3.7
通讯作者：
Sellen, Daniel
中科院分区：
文献类型：
--
作者：
Hackett, Kristy;Lafleur, Curtis;Sellen, Daniel
背景在坦桑尼亚农村，大约一半的分娩是由熟练的提供者提供帮助的。医疗点移动电话应用程序有望增加对社区卫生工作者的工作支持，旨在通过提高设施交付意识、访问和吸收来确保安全孕产。我们对一个基于智能手机的应用程序进行了对照评估，该应用程序旨在帮助社区卫生工作者收集数据、提供教育、识别妊娠危险征兆和转诊。方法随机选择32个村庄的社区卫生工作者，随机进行智能手机(干预)和纸质(对照)培训，以便在孕妇家访期间使用。主要的结果衡量标准是572名妇女的产后报告，这些妇女随机参加了一项通过家访进行的调查。混合效应模型被用来解释受试者的聚集和其他影响设施交付的测量因素。发现智能手机干预与显著更高的设施交付相关：在干预地区，74%的母亲在卫生机构分娩或在运输途中分娩，而在对照地区，这一比例为63%。在接受智能手机辅助卫生工作者咨询的妇女中，提供医疗设施的几率是生活在对照村庄的妇女的两倍(OR，1.96；CI，1.21-3.19；调整后的分析)。干预区妇女在怀孕期间接受社区卫生工作者两次或更多访问的可能性比对照组妇女高(72%比60%；卡方=6.9；p<；0.01)。以前的设施交付、接受产前护理和到最近设施的距离也是设施交付的强大独立预测因素。说明社区卫生工作者使用智能手机增加了设施交付，这可能是通过增加产前家访的频率。基于智能手机的工作辅助可能会加强社区卫生工作者的支持和有效性，作为针对安全孕产的干预方案的一个组成部分。
BackgroundAbout half of births in rural Tanzania are assisted by skilled providers. Point-of-care mobile phone applications hold promise in boosting job support for community health workers aiming to ensure safe motherhood through increased facility delivery awareness, access and uptake. We conducted a controlled comparison to evaluate a smartphone-based application designed to assist community health workers with data collection, education delivery, gestational danger sign identification, and referrals.MethodsCommunity health workers in 32 randomly selected villages were cluster-randomized to training on either smartphone (intervention) or paper-based (control) protocols for use during household visits with pregnant women. The primary outcome measure was postnatal report of delivery location by 572 women randomly selected to participate in a survey conducted by home visit. A mixed-effects model was used to account for clustering of subjects and other measured factors influencing facility delivery.FindingsThe smartphone intervention was associated with significantly higher facility delivery: 74% of mothers in intervention areas delivered at or in transit to a health facility, versus 63% in control areas. The odds of facility delivery among women counseled by smartphone-assisted health workers were double the odds among women living in control villages (OR, 1.96; CI, 1.21-3.19; adjusted analyses). Women in intervention areas were more likely to receive two or more visits from a community health worker during pregnancy than women in the control group (72% vs. 60%; chi-square = 6.9; p < 0.01). Previous facility delivery, uptake of antenatal care, and distance to the nearest facility were also strong independent predictors of facility delivery.InterpretationCommunity health worker use of smartphones increased facility delivery, likely through increased frequency of prenatal home visits. Smartphone-based job aids may enhance community health worker support and effectiveness as one component of intervention packages targeting safe motherhood.