How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana
How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana
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DOI：
10.1136/bmjgh-2018-001153
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发表时间：
2019-03-01
影响因子：
8.1
通讯作者：
Agyepong, Irene
中科院分区：
文献类型：
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作者：
Amoakoh, Hannah Brown;Klipstein-Grobusch, Kerstin;Agyepong, Irene
引言尽管越来越多地使用移动保健干预措施，仍然有有限的文件'如何和为什么'，他们被使用，因此，对受益人的健康结果观察到的影响背后的解释机制。我们探讨了“如何以及为什么”移动健康干预，以支持临床决策的孕产妇和新生儿保健服务的一线供应商在低资源的设置被使用。干预措施包括电话（语音通话）、短信（短信服务（SMS））、互联网接入（数据）以及通过非结构化补充服务数据（USSD）获取产科和新生儿紧急协议。它是通过个人使用和共享设施的移动的电话与独特的用户识别模块（SIM）卡联网在一个封闭的UserGroup.Methods一个单一的案例研究与多个嵌入式子单元的分析范围内的集群随机对照试验的干预措施对新生儿健康的影响在加纳东部地区进行。我们定量分析了SIM卡活动数据的语音呼叫，短信，数据和USSD模式。我们进行了关键的线人访谈和焦点小组讨论与干预用户和手动分析数据的themes.Results总体而言，手机主要用于语音通话（64%），其次是数据（28%），短信（5%）和USSD（2%），分别。随着时间的推移，所有干预成分的使用都有所下降。定性分析表明，卫生工作者个人因素（人口统计学、个人和工作相关需求、对干预及时性的感知、隐性知识）、组织因素（资源可用性、信息流、可用性、电话拥有率）、技术因素（电话的损耗，网络质量）和客户对卫生工作者干预使用的看法解释了观察到的干预使用模式。结论如何以及为什么使用移动健康干预（或不）超越了技术本身，并受到个人和特定环境因素的影响。在设计类似的干预措施时必须考虑到这些因素，以优化效果。
Introduction Despite increasing use of mHealth interventions, there remains limited documentation of 'how and why' they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored 'how and why' an mHealth intervention to support clinical decision-making by frontline providers of maternal and neonatal healthcare services in a low-resource setting was used. The intervention consisted of phone calls (voice calls), text messaging (short messaging service (SMS)), internet access (data) and access to emergency obstetric and neonatal protocols via an Unstructured Supplementary Service Data (USSD). It was delivered through individual-use and shared facility mobile phones with unique Subscriber Identification Module (SIM) cards networked in a Closed User Group.Methods A single case study with multiple embedded subunits of analysis within the context of a cluster randomised controlled trial of the impact of the intervention on neonatal health outcomes in the Eastern Region of Ghana was performed. We quantitatively analysed SIM card activity data for patterns of voice calls, SMS, data and USSD. We conducted key informant interviews and focus group discussions with intervention users and manually analysed the data for themes.Results Overall, the phones were predominantly used for voice calls (64%), followed by data (28%), SMS (5%) and USSD (2%), respectively. Over time, use of all intervention components declined. Qualitative analysis showed that individual health worker factors (demographics, personal and work-related needs, perceived timeliness of intervention, tacit knowledge), organisational factors (resource availability, information flow, availability, phone ownership), technological factors (attrition of phones, network quality) and client perception of health worker intervention usage explain the pattern of intervention use observed.Conclusion How and why the mHealth intervention was used (or not) went beyond the technology itself and was influenced by individual and context-specific factors. These must be taken into account in designing similar interventions to optimise effectiveness.