McNabb Marion, Chukwu Emeka, Ojo Oluwayemisi, Shekhar Navendu, Gill Christopher J, Salami Habeeb, Jega Farouk
Pathfinder International, Watertown, Massachusetts, United States of America.
Pathfinder International Nigeria, Abuja, Nigeria.
PLoS One. 2015 May 5;10(5):e0123940. doi: 10.1371/journal.pone.0123940. eCollection 2015.
Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.
Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.
Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.
These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.
鉴于尼日利亚熟练医疗服务提供者短缺，一线社区卫生推广工作者（CHEWs）通常负责在初级卫生中心提供孕产妇和儿童健康服务。2012年，我们在尼日利亚北部的20个初级卫生中心引入了移动病例管理和决策支持应用程序，并进行了一项前后测试研究，以评估该应用程序的引入是否对这一较低级别医疗人员提供的产前护理服务质量产生影响。
该应用程序使用CommCare移动平台，动态指导CHEWs执行产前护理方案，并实时收集客户数据。应用程序中还嵌入了13个健康教育音频片段，以改善和规范客户咨询。为了检测质量变化，我们制定了一个由25项指标组成的基于证据的质量评分，并总共进行了266次客户出院访谈。我们分析了基线和终线数据，以评估总体质量评分的变化以及产前护理关键要素提供情况的变化。
总体而言，质量评分从基线时的13.3分提高到终线时的17.2分（p<0.0001），满分25分，其中与健康咨询、提供的技术服务和健康教育质量相关的改善最为显著。
这些研究结果表明，引入低成本的移动病例管理和决策支持应用程序可以促使行为改变，并提高较低级别的医疗工作者提供的服务质量。未来的研究应采用更严格的实验设计，以探索对客户健康结果的潜在长期影响。
