Ag Ahmed Mohamed Ali, Gagnon Marie-Pierre, Hamelin-Brabant Louise, Mbemba Gisele Irène Claudine, Alami Hassane
Centre de recherche du CHU de Québec-Université Laval, Québec, Canada.
Faculty of Nursing, Université Laval, Québec, Canada.
Mhealth. 2017 Jun 6;3:22. doi: 10.21037/mhealth.2017.05.04. eCollection 2017.
Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens ., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce maternal morbidity and mortality in SSA, but knowledge on how these interventions can succeed and move to scale is limited. Success factors identified in this review can provide guidance on elements that should be considered in the design and implementation of telehealth and mhealth for maternal health in SSA.
撒哈拉以南非洲（SSA）的许多妇女获得医疗保健的机会仍然有限，而这仍是孕产妇死亡率和发病率的一个重要决定因素。移动健康（mhealth）和远程医疗等信息通信技术（ICTs）可以通过应对妇女遇到的各种障碍（无论是社会文化、经济、地理还是组织方面的障碍）来帮助促进这种获得医疗保健的机会。然而，多种因素促成了移动健康和远程医疗实施及使用的成功，若要这些技术超越试点项目阶段，就必须考虑这些因素。本系统文献综述的目的是综合关于远程医疗和移动健康实施及使用的成功因素的实证知识，以促进SSA地区孕产妇保健服务的可及性。所采用的方法基于Cochrane协作网的方法，包括在六个数据库中使用标准化语言进行文献检索、选择符合纳入标准的研究、数据提取、研究质量评估以及结果综合。共识别出93篇文章，从中纳入了七项研究，其中六项是关于移动健康的。基于Broens等人提出的框架，我们将成功因素归纳为五类：（I）技术，如维护、故障排除和培训用户的技术支持、良好的网络覆盖、能源供应以及用户友好性；（II）用户接受度，不受限制地使用设备、对工作人员有用、具备足够的读写能力或以前的使用经验等因素有助于提高用户接受度；（III）短期和长期资金；（IV）组织因素，如有组织良好的卫生系统以及干预措施的有效协调；（V）政治或立法方面，在这种情况下是政府大力支持大规模部署技术。远程医疗和移动健康是降低SSA地区孕产妇发病率和死亡率的有前景的解决方案，但关于这些干预措施如何能够成功并扩大规模的知识有限。本综述中确定的成功因素可为SSA地区孕产妇健康的远程医疗和移动健康设计与实施中应考虑的要素提供指导。
