Integration of a patient-centered mobile health intervention (Support-Moms) into routine antenatal care to improve maternal health in Uganda

将以患者为中心的移动健康干预措施（Support-Moms）纳入常规产前护理，以改善乌干达的孕产妇健康

• 批准号: 10641272
• 负责人: Esther Cathyln Atukunda
• 金额: $ 48.84万
• 依托单位: MBARARA UNIVERSITY/SCIENCE/ TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-05 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641272
• 关键词: Adopted; Africa South of the Sahara; Anxiety; Appointment; Behavioral; Birth; Birth Weight; Cessation of life; Child; Childbirth; Communication; Consolidated Framework for Implementation Research; Cost Analysis; Data; Decision Making; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Enrollment; Environment; Evaluation; Fostering; Friends; Future; Health; Health Benefit; Health Personnel; Health Policy; Health Services; Health Services Accessibility; Health care facility; Health system; Individual; Infant; Institution; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning; Maternal Health; Maternal Mortality; Mental Depression; Morbidity - disease rate; National Institute of Child Health and Human Development; Newborn Infant; Notification; Outcome; Participant; Perinatal; Perinatal mortality demographics; Pilot Projects; Positioning Attribute; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Proctor framework; Public Health; Quality of life; Quality-Adjusted Life Years; Questionnaires; Randomized; Randomized, Controlled Trials; Readiness; Records; Research Personnel; Resource Allocation; Risk; Rural; Schedule; Scientist; Services; Social Network; Social support; Taxonomy; Techniques; Telephone; Testing; Trust; Uganda; United States National Institutes of Health; Visit; Voice; Woman; Women' s Health; antenatal care; arm; care systems; coping; coping mechanism; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; cost-effectiveness ratio; effectiveness measure; effectiveness outcome; effectiveness testing; effectiveness/implementation trial; empowerment; experience; fetal; implementation intervention; implementation outcomes; implementation strategy; improved; incremental cost; incremental cost-effectiveness; intervention delivery; mHealth; maternal morbidity; multidisciplinary; obstetrical complication; patient oriented; perinatal morbidity; perinatal outcomes; post pregnancy; prevent; primary outcome; public health relevance; routine care; scale up; secondary outcome; service utilization; skills; social; social engagement; standard of care; success; uptake

PROJECT SUMMARY/Abstract Antenatal care (ANC) and skilled births are mainstays of preventing maternal and perinatal morbidity and mortality. Despite expanded availability of skilled birth attendants and referral health systems, Ugandan women have low ANC use and skilled births, resulting in one of the highest maternal mortality ratios and perinatal mortality rates in the world. Mobile health (mHealth) interventions can support individuals to internalize risks, need, and benefits of health services with high intervention delivery success. Provision of multiple messaging approaches—such as scheduled SMS, telephone voice messages and social support engagement—can empower individuals to seek and access care, and improve health outcomes. However, despite successes in pilot studies, there is little data on effectiveness, appropriateness, feasibility, fidelity and incremental costs needed to adopt, or scale up such strategies in sub–Saharan Africa, where the public health impact of such interventions is likely to be the greatest. As part of a K43 career development award (PI Atukunda), we used behavioral frameworks to develop a user-centered mHealth-based, audio-SMS messaging application to support pregnant women to use maternity care services in rural Uganda (Support-Moms app). The app shared health-related information and engaged social support networks via scheduled SMS/audio reminders and upcoming ANC appointment notifications. In a randomized 3-arm pilot study (n=120) comparing standard of care (SOC), scheduled messaging (SM), and scheduled messaging plus social supporter engagement (SS), we observed high intervention uptake, acceptability, and feasibility. All women whose social supporters were engaged on the app attended ≥4 ANC visits, compared to 83% and 50% of women receiving only messages and SOC, respectively. Nearly all women in the SS arm (98%) had a skilled delivery compared to 78% and 70% in SM and SOC groups, respectively. We now propose a type 2 hybrid implementation-effectiveness trial to evaluate and implement the Support-Moms intervention into routine care. We will test the effectiveness of the intervention in a randomized controlled trial (N=824); our primary outcome will be the proportion of healthcare provider-led skilled births (Aim 1). We will apply Proctor’s implementation outcomes framework to evaluate acceptability, feasibility, appropriateness, and fidelity, and conduct in-depth interviews with users and key stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) to refine implementation strategies for future scale-up (Aim 2). We will assess costs and cost-effectiveness of implementing Support-Moms into routine care (Aim 3). We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service utilization. This proposal directly responds to NIH and NICHD priorities described in PAR-22-105 and PAR-22-132 to reduce preventable causes of maternal deaths and improve health for women during and after pregnancy.

项目概要/摘要 产前护理和熟练接生是预防孕产妇和围产期发病率的支柱 and mortality.尽管有更多的熟练助产士和转诊保健系统， 妇女很少使用产前护理和熟练分娩，导致孕产妇死亡率最高， 围产期死亡率。移动的健康干预措施可以支持个人 将风险、需求和卫生服务的好处内化，并成功地实施干预措施。提供 多种消息传递方式--如定时短信、电话语音消息和社交支持 保健-可以使个人有能力寻求和获得保健，并改善健康结果。然而，在这方面， 尽管试点研究取得了成功，但关于有效性、适当性、可行性、忠实性 以及在撒哈拉以南非洲采用或扩大此类战略所需的增量成本， 这些干预措施对健康的影响可能是最大的。 作为K43职业发展奖（PI Atukunda）的一部分， 一个以用户为中心的基于移动健康的音频短信应用程序，支持孕妇使用 乌干达农村地区的孕产妇保健服务（母亲支持应用程序）。该应用程序共享与健康相关的信息 并通过预定的短信/音频提醒和即将到来的ANC预约参与社会支持网络 notifications.在一项随机化3组初步研究（n=120）中， 消息传递（SM）和计划消息传递加上社交支持者参与（SS），我们观察到高 干预的吸收、可接受性和可行性。所有其社会支持者参与了 app参加了≥4次ANC访视，而仅接受消息和SOC的女性分别为83%和50%， 分别SS组几乎所有妇女（98%）都有熟练的分娩，而SM组为78%和70% 和SOC组。我们现在提出一个类型2混合实施效果试验， 评估并将支持妈妈的干预措施纳入日常护理。我们将测试 随机对照试验（N=824）中的干预;我们的主要结局将是 保健提供者主导的熟练分娩（目标1）。我们将采用普罗克特的实施成果框架 评估可接受性、可行性、适当性和忠诚度，并对以下人员进行深入访谈 用户和主要利益攸关方了解实施研究综合框架（CFIR） 完善今后扩大规模的执行战略（目标2）。我们将评估成本和成本效益 将支持妈妈纳入常规护理（目标3）。我们假设支持妈妈将是一个 提高产妇服务利用率有效和成本效益高的战略。这一建议直接回应了 PAR-22-105和PAR-22-132中描述的NIH和NICHD优先事项，以减少 产妇死亡率和改善妇女怀孕期间和怀孕后的健康。