Prieto José Tomás, Zuleta Clara, Rodríguez Jorge Tulio
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala.
Centre de Recherche en Gestion, Ecole Polytechnique, France.
J Am Med Inform Assoc. 2017 Mar 1;24(2):352-360. doi: 10.1093/jamia/ocw102.
To develop a descriptive model of structural characteristics of mHealth in the context of newborn nutrition, and to assess the effects of illustrative interventions through a mixed-methods study consisting of an impact evaluation and a qualitative assessment.
We conducted a 23-week intervention with 100 mothers in rural Guatemala in 2013 and 2014. In group 1 ( n = 24), participants received health-promoting text messages. In group 2 ( n = 32), peer-to-peer groups were formed. In group 3 ( n = 30), peer-to-peer groups were formed, a health professional participated in the discussions, and participants received health-promoting messages. In the control group ( n = 14), participants were simply given a mobile phone. We measured changes in knowledge and self-reported behavior. Four focus groups in 2015 showed the perceptions of 44 additional women and the potential of the previously tested interventions in other marginalized areas.
Significant relationships were found between group membership and changes in knowledge ( P < .001), and between changes in knowledge and self-reported behavior ( P = .010). Within peer-to-peer groups, 3665 text messages were shared; discussions covered topics such as breastfeeding practices, health concerns, and emotional issues. Focus groups revealed a deficit of support for mothers, a precariousness of public services, different cultural barriers affecting access to care, and the potential for scaling up.
The complementarity of structural arrangements of mHealth interventions can play an important role in helping to encourage recommended breastfeeding attitudes along with providing rich information about challenges in rural areas.
A mixed-methods study was appropriate to compare the effects and assess the potential of mHealth strategies in a complex rural setting.
构建新生儿营养背景下移动健康（mHealth）结构特征的描述模型，并通过一项包括影响评估和定性评估的混合方法研究，评估示例性干预措施的效果。
2013年和2014年，我们在危地马拉农村对100名母亲进行了为期23周的干预。在第1组（n = 24）中，参与者接收促进健康的短信。在第2组（n = 32）中，形成了 peer-to-peer 小组。在第3组（n = 30）中，形成了 peer-to-peer 小组，一名卫生专业人员参与讨论，参与者接收促进健康的信息。在对照组（n = 14）中，参与者只是被给予一部手机。我们测量了知识和自我报告行为的变化。2015年的四个焦点小组展示了另外44名女性的看法以及先前测试的干预措施在其他边缘化地区的潜力。
发现组成员身份与知识变化之间存在显著关系（P <.001），知识变化与自我报告行为之间也存在显著关系（P =.010）。在 peer-to-peer 小组中，共分享了3665条短信；讨论涵盖了母乳喂养习惯、健康问题和情感问题等主题。焦点小组揭示了对母亲支持的不足、公共服务的不稳定、影响获得护理的不同文化障碍以及扩大规模的潜力。
移动健康干预措施的结构安排互补性在帮助鼓励推荐的母乳喂养态度以及提供有关农村地区挑战的丰富信息方面可以发挥重要作用。
一项混合方法研究适合在复杂的农村环境中比较移动健康策略的效果并评估其潜力。
