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: 10913655
• 负责人: Bethany Hedt-Gauthier
• 金额: $ 32.52万
• 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 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10913655
• 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; 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; care seeking; cost; cost estimate; design; diagnostic algorithm; diagnostic tool; 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.

项目概要/摘要 剖腹产手术的普及有助于降低孕产妇死亡率 撒哈拉非洲（SSA）；然而，随着剖腹产率的增加，与剖腹产相关的比率也随之增加 并发症。虽然在农村 SSA 进行阴道分娩的妇女通常会在她们的产房接受产后后续护理。 社区卫生工作者 (CHW) 的家中，大多数计划要求通过剖腹产分娩的妇女 由于护理的复杂性增加，返回保健中心或医院进行随访。设施- 对母亲来说，基于后续行动可能会造成经济上的灾难和身体上的负担，从而导致护理的延误 并增加发病风险。 该提案的总体目标是开发一种安全的移动医疗 (mHealth) 工具，以支持 CHW 主导的家庭医疗服务 对卢旺达农村地区剖腹产妇女术后第 5 天和第 10 天进行的随访。 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（无需互联网或蜂窝网络连接）（目标 1a）。我们 将与 Insightiv Technologies 合作开发综合性 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 名社区卫生工作者中测试新工具的可用性和可接受性（目标 2）。当我们达到80%的可用性和可接受性时，我们将继续第二阶段。 R33 阶段的拨款将研究 mHealth-CHW 工具用于剖腹产随访（目标 3）的有效性 前瞻性跟踪 450 名剖腹产妇女并实施 mHealth-CHW 工具并跟踪 下午 5 点和下午 10 点回到家中。然后，妇女们将在下午 16 点返回医院进行身体检查。 检查，我们将通过 mHealth-CHW 工具确定的诊断和并发症与那些进行比较 从体检中。然后，我们将通过随机化评估剖腹产并发症的诊断时间 1350 名女性通过 mHealth-CHW 工具与标准护理进行随访（目标 4）。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）。我们还将开展两个研究培训系列，一个是定量方法，另一个是定量方法 定性方法，以加强我们团队未来领导移动医疗研究的能力。