Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada.
J Glob Health. 2019 Dec;9(2):020425. doi: 10.7189/jogh.09.020425.
Behavior change communication (BCC) to improve health and caring practices is an integral component of efforts to improve maternal, newborn and child health (MNCH). Mobile phones are widely available in low- and middle-income countries (LMIC), presenting new opportunities for BCC delivery. There is need for delivery science to determine how best to leverage mobile phone technology for BCC to improve MNCH practices.
We conducted a scoping review of studies and project reports documenting the feasibility, implementation or effectiveness of using mobile phones for BCC delivery related to MNCH in LMIC. Data were extracted and synthesized from three sources: i) systematic search of three electronic databases (PubMed, MedLine, Scopus); ii) grey literature search, including mHealth databases and websites of organizations implementing mHealth projects; iii) consultation with researchers and programme implementers. Records were screened using pre-determined inclusion criteria and those selected were categorized according to their primary intervention delivery approaches. We then performed a descriptive analysis of the evidence related to both effectiveness and implementation for each delivery approach.
The systematic literature search identified 1374 unique records, 64 of which met inclusion criteria. The grey literature search added 32 records for a total of 96 papers in the scoping review. Content analysis of the search results identified four BCC delivery approaches: direct messaging, voice counseling, job aid applications and interactive media. Evidence for the effectiveness of these approaches is growing but remains limited for many MNCH outcomes. The four approaches differ in key implementation elements, including frequency, length and complexity of communication, and potential for personalization. These elements influence resource allocation and are likely to impact effectiveness for BCC targeting complex, habitual MNCH practices.
This scoping review contributes to the evidence-base on the opportunities and limitations of using mobile phones for BCC delivery aiming to improve MNCH practices. The incorporation of mobile phone technology in BCC interventions should be guided by formative research to match both the content and delivery approach to the local context. We recommend five areas for further research, including both effectiveness and implementation studies on specific delivery approaches.
行为改变沟通（BCC）可改善健康和护理实践，是改善孕产妇、新生儿和儿童健康（MNCH）努力的一个组成部分。在中低收入国家（LMIC），手机广泛普及，为 BCC 传播提供了新的机会。需要有传播科学来确定如何最好地利用手机技术进行 BCC，以改善 MNCH 实践。
我们对记录在中低收入国家（LMIC）使用手机进行 BCC 以改善 MNCH 相关实践的可行性、实施或效果的研究和项目报告进行了范围审查。数据从三个来源中提取和综合：i）对三个电子数据库（PubMed、MedLine、Scopus）进行系统搜索；ii）灰色文献搜索，包括 mHealth 数据库和实施 mHealth 项目的组织网站；iii）与研究人员和方案实施者协商。记录使用预先确定的纳入标准进行筛选，选择的记录根据其主要干预措施交付方法进行分类。然后，我们对每种交付方法的有效性和实施相关证据进行了描述性分析。
系统文献搜索确定了 1374 个独特的记录，其中 64 个符合纳入标准。灰色文献搜索增加了 32 个记录，范围审查共有 96 篇论文。对搜索结果的内容分析确定了四种 BCC 交付方法：直接消息传递、语音咨询、工作辅助应用程序和互动媒体。这些方法的有效性证据不断增加，但对于许多 MNCH 结果而言仍然有限。这四种方法在关键实施要素方面存在差异，包括沟通的频率、长度和复杂性，以及个性化的潜力。这些要素影响资源分配，可能会影响针对复杂、习惯性 MNCH 实践的 BCC 效果。
本范围审查有助于为使用手机进行 BCC 传播以改善 MNCH 实践的机会和限制提供证据基础。在 BCC 干预中纳入手机技术应通过形成性研究来指导，使内容和交付方法与当地情况相匹配。我们建议进行五个领域的进一步研究，包括针对特定交付方法的有效性和实施研究。
