Patient-centered mobile technology interventions to improve maternal health in Uganda

项目摘要 背景：产前保健（ANC）是预防孕产妇和围产期发病率和死亡率的支柱 但乌干达对这些服务的利用率仍然很低。因此，产妇和围产期死亡率 是世界上最高的。短消息服务（SMS）和其他移动的健康（mHealth） 已经提出了促进积极健康行为和加强知情决策的干预措施， 为围产期的妇女做准备。这些干预措施被假设为通过以下方式改善结果： 知识转让和加强获得社会支持的机会。然而，对移动健康的评价很少， 在撒哈拉以南非洲开展了改善产妇护理的干预措施，那里的社会和 推动成功干预的背景因素各不相同，这些干预措施的公共卫生影响是 可能会很棒。很少有研究还审查了理论知情的方法，以制定干预措施， 最大限度地提高最终用户的可接受性。应聘者：我是姆巴拉拉科技大学的讲师 在流行病学、研究方法和数据分析方面接受过基本培训，出版了12份出版物（6份首次出版， 作者）。我申请这个K43奖，以确保培训和指导，在开发和采用低 在低资源环境中采取成本高、针对具体情况的新干预措施，改善母婴健康。指导： 为了实现这一目标，我已经确定了一个强大的辅导团队，在生殖健康方面的专业知识（博士。 马修斯和Mugyenyi），移动健康，方法学和流行病学（Siedner博士），定性方法（博士。 Ware），职业发展和项目实施（教授。Obua）。凭借这支强大的团队， 多学科的导师和正式的教学法在确定的重点领域的培训将使我能够获得 必要的技能和实践经验，以告知，设计，采用和测试新的干预战略， 改善资源匮乏地区的母婴健康。培训：我需要额外的经验，指导 培训：1）为制定干预措施而征求最终用户反馈意见的定性方法，2） 以患者为中心的干预开发和评估的技术接受度，以及3）实验性 研究设计，以评估对孕妇的干预措施。研究：我建议1）进行定性研究 研究确定妇女参与产前护理的障碍和促进因素， 设施，并描述他们对基于移动健康的社会支持干预的偏好; 2）开发和 根据这些定性结果反复评估干预措施; 3）试点测试干预措施，以评估 可行性、可接受性和初步功效，以提高ANC利用率和熟练分娩。本培训和 结果将使我能够在该奖项的第5年撰写R 01申请，以评估 与常规护理相比，基于移动健康的社会支持干预可改善孕产妇和儿童健康 乌干达的成果。我的最终目标是成为一名独立调查员， 制定和评估文化上知情的解决方案，以降低母婴死亡率。

PROJECT SUMMARY Background: Antenatal care (ANC) is a mainstay of preventing maternal and perinatal morbidity and mortality but utilization of these services in Uganda remains low. Consequently, maternal and perinatal mortality rates are among the highest in the world. Short message service (SMS) and other mobile health (mHealth) interventions have been proposed to promote positive health behavior and strengthen informed decision- making for women in the perinatal period. Such interventions are hypothesized to improve outcomes through knowledge transfer and strengthened access to social support. However, few evaluations of mHealth interventions to improve maternal care have been conducted in sub-Saharan Africa, where social and contextual factors that drive successful interventions differ, and the public health impact of such interventions is likely to be great. Few studies have also examined theory-informed methods to develop interventions to maximize end-user acceptability. Candidate: I am a lecturer at Mbarara University of Science and Technology with basic training in epidemiology, research methods and data analysis, resulting in 12 publications (6 first- authored). I am applying for this K43 award to secure training and mentorship in developing and adopting low cost, context-specific novel interventions to improve maternal-child health in low resource settings. Mentoring: To accomplish this goal, I have identified a strong mentorship team with expertise in reproductive health (Drs. Matthews & Mugyenyi), mHealth, methodology and epidemiology (Dr. Siedner), qualitative methods (Dr. Ware), career development and project implementation (Professor. Obua). Leveraging this strong team of multidisciplinary mentors and formal didactics in the identified focus areas of training will enable me to obtain requisite skills and hands-on experience to inform, design, adopt and test novel intervention strategies to improve maternal-child health in low resource settings. Training: I require additional experience, mentorship and training in: 1) qualitative methods to elicit end-user feedback for development of interventions, 2) technology acceptance for patient-centered intervention development and evaluation, and 3) experimental study designs to evaluate interventions in pregnant women. Research: I propose to 1) conduct a qualitative study to identify barriers and facilitators to women’s engagement in ANC, decisions to deliver in health facilities, and characterize their preferences for an mHealth-based, social support intervention; 2) develop and iteratively evaluate the intervention based on these qualitative results; 3) pilot test the intervention to assess feasibility, acceptability and preliminary efficacy to improve ANC utilization and skilled births. This training and results will position me to write an R01 application in year 5 of this award to evaluate the effectiveness of an mHealth-based social support intervention compared to routine care to improve maternal and child health outcomes in Uganda. My ultimate goal is to become an independent investigator, with expertise in development and evaluation of culturally informed solutions to reduce maternal-child mortality.