mHealth-Community Health Worker tool for comprehensive post-cesarean follow-up in rural Rwanda

用于卢旺达农村地区剖腹产后全面随访的移动医疗社区卫生工作者工具

• 批准号: 10268606
• 负责人: Bethany Hedt-Gauthier
• 金额: $ 20.63万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268606
• 关键词: Africa; Africa South of the Sahara; Algorithmic Software; Algorithms; Caring; Cells; Cellular Phone; Cesarean section; Clinical; Collaborations; Community Health Aides; Complication; Computer software; Country; Development; Diagnosis; Diagnostic; Ensure; Face; Failure; Feedback; Financial Hardship; Focus Groups; Future; Goals; Grant; Health; Health care facility; Health system; Home; Home visitation; Hospitals; Image; Internet; Intervention; Lead; Libraries; Machine Learning; Maternal Mortality; Methods; Monitor; Morbidity - disease rate; Mothers; Phase; Physical Examination; Population; Postoperative Period; Postpartum Period; Qualitative Methods; Randomized; Recovery; Reporting; Research; Research Training; Risk; Running; Rural; Rwanda; Sampling; Series; Surgical Wound Infection; Surveys; Technology; Telephone; Testing; Time; Training; Travel; Vagina; Woman; Work; arm; base; care seeking; cost; cost estimate; design; experience; follow-up; implementation fidelity; mHealth; mortality; novel; postcesarean section; postpartum care; primary outcome; programs; prospective; randomized trial; standard of care; support tools; tool; usability

Project Summary/Abstract Increased access to cesarean sections (c-sections) has contributed to the decline of maternal mortality in sub- Saharan Africa (SSA); however, as the rate of c-sections has increased, so has the rate of c-section related complications. While women who deliver vaginally in rural SSA often receive postpartum follow-up care in their homes from community health workers (CHWs), most programs require that women who deliver via c-section return to health centers or hospitals for follow-up because of the increased complexity of their care. Facility- based follow-up can be financially catastrophic and physically burdensome for mothers, leading to delays in care and increased risk for morbidity. The overall goal of this proposal is to develop a safe mobile health (mHealth) tool to support CHW-led home- based follow-up for women delivering via c-section in rural Rwanda at postoperative days (PODs) 5 and 10. In the first R21 phase, we will develop a software library for an existing photo-based surgical site infection (SSI) diagnostic algorithm to run locally on a smartphone (without internet or cell network connection) (Aim 1a). We will work with Insightiv Technologies to develop the comprehensive mHealth-CHW tool, including incorporating the SSI diagnostic algorithm software library and integrating three CHW usability assessments into the design phase (Aim 1b). Finally, we will test the usability and acceptability of the new tool in a group of 30 CHWs (Aim 2). When we achieve 80% usability and acceptability, we will continue to the second phase. The R33 phase of the grant will study the validity of the mHealth-CHW tool for c-section follow-up (Aim 3) by prospectively following 450 women delivering via c-section and implementing the mHealth-CHW tool and follow- up in their homes at PODs 5 and 10. The women will then return to the hospital at POD 16 for a physical examination and we will compare diagnoses and complications identified via the mHealth-CHW tool to those from the physical exam. We will then evaluate the time-to-diagnosis for c-section complications by randomizing 1350 women to follow-up by the mHealth-CHW tool versus standard of care (Aim 4). Finally, we will assess the acceptability of mHealth-CHW follow-up in 40 women who have delivered via c-section through focus group discussions (Aim 5). We will also conduct two research training series, one in quantitative methods and one in qualitative methods, to strengthen our team's ability to lead mHealth research in the future.

项目总结/摘要 剖腹产手术的增加有助于降低产妇死亡率， 撒哈拉非洲（SSA）;然而，随着剖腹产率的增加， 并发症虽然在撒哈拉以南非洲农村地区，经阴道分娩的妇女经常在产后接受后续护理， 从社区卫生工作者（CHW）的家中，大多数项目要求通过剖腹产分娩的妇女， 返回保健中心或医院接受后续治疗，因为他们的护理更加复杂。设施- 对母亲来说，基于基础的后续行动可能是经济上的灾难性和身体上的负担，导致护理的延误 和发病风险增加。 该提案的总体目标是开发一种安全的移动的健康（mHealth）工具，以支持CHW领导的家庭健康。 卢旺达农村地区剖腹产妇女术后第5天和第10天的随访。在 在第一个R21阶段，我们将为现有的基于照片的手术部位感染（SSI）开发一个软件库 在智能手机上本地运行的诊断算法（没有互联网或手机网络连接）（目标1a）。我们 将与Insightiv Technologies合作开发全面的mHealth-CHW工具，包括将 SSI诊断算法软件库，并将三个CHW可用性评估集成到设计中 阶段（目标1b）。最后，我们将在30个CHW（Aim）中测试新工具的可用性和可接受性 2）。当我们达到80%的可用性和可接受性时，我们将继续进入第二阶段。 R33阶段的补助金将研究mHealth-CHW工具用于剖腹产随访的有效性（目标3）， 前瞻性地跟踪450名通过剖腹产分娩的妇女，并实施mHealth-CHW工具，并跟踪- 在五号和十号监控点的家中这些妇女将于POD 16返回医院进行体检 检查，我们将比较通过mHealth-CHW工具确定的诊断和并发症与 然后，我们将通过随机分组评估剖腹产并发症的诊断时间 通过mHealth-CHW工具与标准护理（目标4）对1350名女性进行随访。最后，我们将评估 通过焦点小组对40名剖腹产妇女进行mHealth-CHW随访的可接受性 讨论（目标5）。我们还将举办两个研究培训系列，一个是定量方法，另一个是 定性方法，以加强我们的团队在未来领导移动健康研究的能力。