Building an evidence base to support and enhance community health workers' (informal) use of mobile phones in Ghana, Malawi and Ethiopia

建立证据基础以支持和加强加纳、马拉维和埃塞俄比亚社区卫生工作者（非正式）使用移动电话

• 批准号: MR/R003963/1
• 负责人: Kate Hampshire
• 金额: $ 24.44万
• 依托单位: Durham University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR003963%2F1
• 关键词: Building; evidence; base; support; enhance

Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, community health workers (CHWs) across the continent possess mobile phones. CHWs form a vital part of healthcare delivery across Africa and many countries are scaling up their deployment (target of 1 million CHWs).There is thus enormous untapped potential here. While much research has focussed on formal mhealth initiatives (small-scale successes, challenges of scale-up), we know almost nothing about what CHWs across Africa are doing with their own mobile phones, and with what implications for healthcare. Last year, we published what we believe to be the first study to have looked seriously at this issue (Hampshire et al, 2016, Health Policy & Planning) Our very small-scale preliminary study, based on interviews with 16 health-workers in Ghana and 18 in Malawi, revealed that CHWs used their own mobile phones regularly (often on a daily basis) to communicate with colleagues and patients, obtain help in emergencies, seek information, organise work logistics such as drug supplies, etc. By contrast, only one had ever participated in a (now defunct) formal mhealth programme. The potential for what we have called 'informal mhealth' to enhance primary care in resource-limited settings could thus be very significant. The CHWs we interviewed were innovative and adept at harnessing new features on their phones to help manage their work. However, our study also pointed towards challenges, both for patient care and health-worker wellbeing, including: the financial burden of phone costs and emotional burden of being available to patients 24/7; decreased face-to-face interaction with patients; concerns about patient confidentiality when communicating through personal phones; and difficulties in accessing reliable online information, etc. Our aim for this Foundation Grant is to build a strong evidence base of current mobile phone use among community health workers in Ghana, Malawi and Ethiopia (three countries committed to major CHW programmes), in order to enhance the effectiveness of 'informal mhealth' and address challenges. If our hypothesis is correct, and CHWs' 'informal' mobile phone use is widespread, this study could provide crucial evidence to support innovative ways to strengthen health systems in resource-limited settings. Methods:1) Comprehensive policy reviews of CHW programmes and mhealth initiatives in each country, plus analysis of health systems and contextual factors affecting implementation.2) Questionnaire survey of CHWs in each country to estimate levels of work-related mobile phone usage and collect comparable data on: (a)Split between formal and informal mhealth usage, and function/purpose (e.g. communicating with patients, colleagues, logistics, information seeking, etc.); (b) Estimated financial costs of phone use and who meets these costs; (c) Perceived benefits and challenges arising from this 'informal mhealth' for CHWs and patients.500 CHWs in Ghana and Malawi and 1000 in Ethiopia (where the total number of CHWs is much higher) will be sampled across multiple sites to cover a range of urban, semi-rural, rural settlement types. 3) Two sets focus groups of CHWs (minimum 14/country) and patients (minimum 6/country) will be convened before and after the survey, to reflect on current practices and experiences (incorporating survey findings), and to identify possible ways of supporting, enhancing and sharing good practice, and addressing challenges.4) Meetings and on-going discussions with national stake-holders throughout the project to feed into policy/practice (see impact summary).

非洲最近的通信“革命”让人们乐观地认为，使用移动电话促进健康(MHealth)可以帮助弥合医疗差距，特别是对于农村、难以接触到的人群。然而，尽管mHealth试点的扩大规模仍然有限，但整个非洲大陆的社区卫生工作者(CHW)都拥有手机。社区卫生服务是整个非洲医疗保健服务的重要组成部分，许多国家正在扩大其部署规模(目标是100万社区卫生服务)。因此，这里有巨大的未开发潜力。虽然许多研究都集中在正式的移动健康倡议(小规模的成功，扩大规模的挑战)上，但我们几乎对非洲各地的社区卫生工作者用自己的手机做了什么，以及对医疗保健有什么影响一无所知。去年，我们发表了我们认为是第一个认真研究这一问题的研究(Hampshire等人，2016，Health Policy&Planning)我们非常小规模的初步研究，基于对加纳的16名卫生工作者和马拉维的18名卫生工作者的采访，发现CHW经常(通常是每天)使用自己的手机与同事和患者沟通，在紧急情况下获得帮助，寻求信息，组织工作后勤，如药品供应等。相比之下，只有一人参加过(现已停止)正式的mHealth计划。因此，我们所称的“非正式医疗保健”在资源有限的情况下加强初级保健的潜力可能非常大。我们采访的CHW们很有创新精神，擅长利用手机上的新功能来帮助管理他们的工作。然而，我们的研究也指出了对患者护理和卫生工作者福祉的挑战，包括：电话费用的财政负担和患者全天候可用的情感负担；与患者面对面的互动减少；通过个人电话沟通时对患者保密性的担忧；以及获取可靠在线信息的困难等。我们为这项基金会赠款的目的是建立一个强有力的证据基础，证明加纳、马拉维和埃塞俄比亚(三个国家致力于主要的CHW计划)社区卫生工作者目前使用手机的情况，以提高“非正式mHealth”的有效性并应对挑战。如果我们的假设是正确的，而且社区卫生工作者的“非正式”手机使用很普遍，这项研究可能会提供关键的证据，支持在资源有限的情况下加强卫生系统的创新方法。方法：1)对每个国家的CHW方案和移动健康倡议进行全面的政策审查，并对卫生系统和影响执行的背景因素进行分析。2)对每个国家的CHW进行问卷调查，以估计与工作有关的手机使用水平，并收集关于以下方面的可比数据：(A)正式和非正式的mHealth使用情况以及职能/目的(例如，与患者、同事、后勤、寻求信息等的交流)；(B)电话使用的估计财务成本以及谁满足这些成本；加纳和马拉维的500个社区卫生组织和埃塞俄比亚的1000个社区卫生组织(那里的社区卫生组织总数要高得多)将在多个地点进行抽样，以涵盖一系列城市、半农村和农村住区类型。3)在调查前后将召集两组重点小组，即社区卫生工作者(每个国家最少14人)和患者(每个国家最少6人)，以反思当前的做法和经验(纳入调查结果)，并确定支持、加强和分享良好做法以及应对挑战的可能方式。4)在整个项目期间与国家利益攸关方举行会议和进行讨论，以纳入政策/做法(见影响摘要)。

项目成果

Informal mhealth at scale in Africa: Opportunities and challenges.

• DOI: 10.1016/j.worlddev.2020.105257
• 发表时间: 2021-04
• 期刊: World development
• 影响因子: 6.9
• 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
• 通讯作者: Kasim A

Mobile phone use and the welfare of community health nurses in Ghana: An analysis of unintended costs.

• DOI: 10.1016/j.wdp.2021.100317
• 发表时间: 2021-09
• 期刊: World development perspectives
• 影响因子: 1.9
• 作者: Abane AM;Mariwah S;Owusu SA;Kasim A;Robson E;Hampshire K
• 通讯作者: Hampshire K

Ethical implications of the widespread use of informal mHealth methods in Ghana.

加纳广泛使用非正式MHealth方法的道德含义。

• DOI: 10.1136/medethics-2021-107920
• 发表时间: 2024-07-23
• 期刊: JOURNAL OF MEDICAL ETHICS
• 影响因子: 4.1
• 作者: Owusu, Samuel Asiedu