mHealth Tools to Improve Service Delivery Quality of an Evidence-Based Family Home Visiting Intervention to Prevent Family Violence among High Risk Families in Sierra Leone

项目总结 拟议的探索性研究将试点以家庭为重点的行为健康干预，同时还 开发和试行创新且经济高效的mHealth工具，以支持社区卫生工作者 塞拉利昂服务不足的西部农村地区。这一双重重点将有助于建设迫切需要的能力 提供循证精神健康服务，以减少家庭暴力和严厉的育儿做法； 以及有效使用移动健康战略，以改善医疗保健提供和质量。新加坡政府 塞拉利昂对其社区卫生工作者方案进行了大量投资，并确定了创新的 利用技术改进性能监控、监控数据收集和运行状况数据使用 高优先级。这项研究将利用政府在社区卫生倡议和移动健康方面的投资 将创新作为一种战略，以解决困扰证据交付的关键医疗人员限制- 以干预冲突后塞拉利昂的弱势家庭为基础。这项研究将试点由移动健康支持的 提供文化适应版的《家庭加强儿童早期干预》 发展(FSI-ECD)。FSI-ECD在改善父母情绪方面表现出了有效性 监管和减少家庭暴力和严厉的育儿做法。研究的目的是： 目标1.采用以用户为中心的五阶段设计方法来开发和测试mHealth工具，以改进 社区卫生工作者的培训、监督和忠诚度监测。 目标2.开展第二类实施--有效性随机对照试点研究，以评估 MHealth支持的FSI-ECD的可行性、可接受性和对父母心理的初步影响 年有6-36个月孩子的高危家庭(n=40)的健康、情绪调节和家庭暴力 与接受标准护理的对照家庭(n=40)进行比较。父母的心理健康，情绪调节， 家庭暴力和育儿做法将在基线、干预后和6个月内进行评估 后续行动。将通过以下方式评估FSI-ECD和mHealth工具的可行性、可接受性和采用率 量化措施和关键线人访谈。试点研究还将综合成本效益 分析以评估由mHealth支持的FSI-ECD与标准护理的经济价值。 目标3.利用已建立的关系和政府合作伙伴加强能力 在塞拉利昂开展移动健康研究和提供高质量的医疗服务。合作伙伴包括马克尼大学， 科学、技术和创新局以及卫生和卫生部。 这项研究将为扩大知识、促进合作和发展当地 在塞拉利昂的研究专长。研究结果将为计划中的R01资助的混合动力实施提供参考 研究将mHealth支持的精神健康服务整合到现有提供平台的有效性试验 并在低资源环境下扩大由mHealth支持的对服务提供商的培训和监督。

PROJECT SUMMARY The proposed exploratory research will pilot a family-focused, behavioral health intervention while also developing and piloting innovative and cost-effective mHealth tools to support Community Health Workers in Sierra Leone's underserved, rural Western region. This dual focus will help build urgently needed capacity both for delivery of evidence-based mental health services to reduce family violence and harsh parenting practices, and for effective use of mHealth strategies to improve healthcare delivery and quality. The Government of Sierra Leone has invested heavily in its Community Health Worker Programme and has identified innovative use of technology to improve performance monitoring, surveillance data collection, and health data usage as a high priority. This study will leverage government investments in community health initiatives and mHealth innovations as a strategy to address critical healthcare workforce limitations that plague delivery of evidence- based interventions to vulnerable families in post-conflict Sierra Leone. The study will pilot mHealth-supported delivery of a culturally adapted version of the Family Strengthening Intervention for Early Childhood Development (FSI-ECD). The FSI-ECD has demonstrated effectiveness in improving parental emotion regulation and reducing family violence and harsh parenting practices. Study aims are to: Aim 1. Employ a five-stage user-centered design approach to develop and test mHealth tools to improve training, supervision, and fidelity monitoring of Community Health Workers. Aim 2. Conduct a Type II Implementation-Effectiveness Randomized Controlled Pilot Study to assess feasibility, acceptability, and preliminary effects of mHealth-supported delivery of FSI-ECD on parent mental health, emotion regulation, and familial violence in high risk families with children aged 6–36 months (n=40) in comparison to control families (n=40) who receive standard care. Parental mental health, emotion regulation, household violence, and parenting practices will be assessed at baseline, post-intervention and 6-month follow-up. Feasibility, acceptability, and adoption of the FSI-ECD and mHealth tools will be assessed via quantitative measures and key informant interviews. The pilot study will also integrate a cost-effectiveness analysis to assess the economic value of the mHealth-supported delivery of the FSI-ECD vs. standard care. Aim 3. Leverage well-established relationships and government partners to strengthen capacity for mHealth research and quality healthcare delivery in Sierra Leone. Partners include the University of Makeni, the Directorate of Science, Technology and Innovation, and the Ministry of Health and Sanitation. This study will provide a foundation for expanding knowledge, fostering collaboration, and developing local research expertise in Sierra Leone. Study findings will inform a planned R01-funded Hybrid Implementation Effectiveness trial to study mHealth-supported mental health services integrated into existing delivery platforms and to scale up mHealth-supported training and supervision of service providers in low resource settings.