Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
PLoS One. 2018 Mar 27;13(3):e0194927. doi: 10.1371/journal.pone.0194927. eCollection 2018.
Improving maternal health outcomes remains a priority in Low and Middle Income Countries. With the rapid proliferation of mobile health technologies, there is an increased interest in understanding how these technologies can effectively improve maternal health outcomes particularly maternal health seeking knowledge and behaviors. However, few studies present clear explanations of the program developers' rationale (theory of change) and contextual factors that could influence program outcomes. This mixed-methods study assesses Mobile for Mothers, a community health workers (CHW) utilized maternal mHealth intervention. We present the program developers' rationale and utilize it as a framework to guide our study that aimed to identify intervention-related and contextual factors, which influence the observed outcomes of a CHW, utilized mHealth intervention.
Quantitative methods (a questionnaire with 740 women who received the intervention and survey of 57 CHWs who utilized the intervention) and qualitative methods (12 interviews and 4 group discussions with CHWs and 20 interviews and 5 group discussions with pregnant and lactating women and 15 interviews and 2 group discussions with men) were conducted. These were used to understand how the mHealth intervention was implemented and to gain insight into contextual factors that potentially influenced the observed intervention outcomes.
Results were grouped following three categories: (1) perceptions and experiences of CHWs utilizing the mHealth technology; (2) CHW-related outcomes; and (3) contextual factors that influence maternal health-seeking behavior. The overall response of CHWs and community members to the intervention was positive. However, contextual factors like the relationship between the CHWs and their respective communities, the pregnant women's decision-making power and lack of access due to financial influenced the observed outcomes.
Mobile health applications are promising interventions for improving the performance of CHWs and health-seeking behavior of pregnant women. However, the contextual factors play a crucial role in intervention outcomes and need to be explicated by program developers during intervention design and implementation.
提高产妇健康结果仍然是中低收入国家的重点。随着移动医疗技术的快速普及，人们越来越关注这些技术如何有效地改善产妇健康结果，特别是产妇健康寻求知识和行为。然而，很少有研究清楚地解释项目开发者的基本原理（变革理论）和可能影响项目结果的背景因素。这项混合方法研究评估了 Mobile for Mothers，这是一个利用社区卫生工作者（CHW）的产妇移动健康干预措施。我们提出了项目开发者的基本原理，并将其作为框架，指导我们的研究，旨在确定影响 CHW 使用移动健康干预措施观察到的结果的干预相关和背景因素。
采用定量方法（对接受干预的 740 名妇女进行问卷调查和对使用干预措施的 57 名 CHW 进行调查）和定性方法（对 CHW 进行 12 次访谈和 4 次小组讨论，对孕妇和哺乳期妇女进行 20 次访谈和 5 次小组讨论，对男性进行 15 次访谈和 2 次小组讨论），了解移动健康干预措施的实施情况，并深入了解潜在影响观察到的干预结果的背景因素。
结果分为三类：（1）CHW 使用移动健康技术的看法和经验；（2）CHW 相关结果；（3）影响产妇寻求健康行为的背景因素。CHW 和社区成员对干预措施的总体反应是积极的。然而，一些背景因素，如 CHW 与各自社区之间的关系、孕妇的决策权以及由于财务原因导致的无法获得服务，影响了观察到的结果。
移动健康应用程序是改善 CHW 表现和孕妇寻求健康行为的有前途的干预措施。然而，背景因素在干预结果中起着至关重要的作用，项目开发者在干预设计和实施过程中需要加以说明。
