Thomas Deborah Sk, Daly Kristen, Nyanza Elias C, Ngallaba Sospatro E, Bull Sheana
Department of Geography and Earth Sciences, University of North Carolina at Charlotte, USA.
Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, USA.
Digit Health. 2020 Feb 4;6:2055207620905409. doi: 10.1177/2055207620905409. eCollection 2020 Jan-Dec.
Health workers (HWs) are increasingly using mobile health (mHealth) technologies in low-resource settings. Understanding HW acceptability of mHealth is critical to increasing the scale of mHealth solutions. We examined pre- and post-pilot clinical knowledge and acceptability of a tablet-based platform, the Tanzania Health Information System (T-HIT), targeting HWs delivering prevention of mother-to-child transmission (PMTCT) of HIV services in seven health facilities in Misungwi District, Tanzania.
We developed a survey based on the diffusion of innovation theory and administered it to 27 HWs before and after a 3-month pilot of T-HIT. Using a Wilcoxon signed-rank test, we analyzed changes in acceptability defined as attitudes towards and self-efficacy for system use comparing pre- and post-test assessment scores and changes in knowledge of clinical care. Using analysis of variance, we explored these changes, stratifying health facilities by level of care and by distance from the district hospital.
Post-pilot scores showed statistically significant improvement from pre-test for the total survey ( = -2.67, < 0.008) and for questions concerning system attitude ( = -2.63, < 0.008). HWs in hospitals and health centers exhibited a lower initial level of system acceptability in attitude than those in dispensaries and a significant improvement in overall mean acceptability over the pilot (95% CI 0.004-0.0187). HWs working more than 20 km from the hospital had a lower initial level of both system knowledge and acceptability than their less remote counterparts, but demonstrated larger improvements in knowledge and acceptability over time, although this change was not statistically significant.
The pilot demonstrates that HWs in PMTCT in Misungwi have a high acceptability of mHealth solutions. Using an mHealth solution can facilitate HW delivery of PMTCT care in rural and remote settings. Consideration of acceptability is important for fostering mHealth scale and program sustainability.
在资源匮乏地区，卫生工作者（HWs）越来越多地使用移动健康（mHealth）技术。了解HWs对mHealth的接受程度对于扩大mHealth解决方案的规模至关重要。我们在坦桑尼亚米苏恩维区的七个卫生机构中，对提供预防艾滋病毒母婴传播（PMTCT）服务的HWs，研究了基于平板电脑的平台——坦桑尼亚卫生信息系统（T-HIT）试点前后的临床知识和接受程度。
我们基于创新扩散理论开发了一项调查，并在T-HIT进行为期3个月的试点前后，对27名HWs进行了调查。使用Wilcoxon符号秩检验，我们分析了接受程度的变化，接受程度定义为对系统使用的态度和自我效能感，比较测试前后的评估分数以及临床护理知识的变化。使用方差分析，我们探讨了这些变化，按护理级别和与地区医院的距离对卫生机构进行分层。
试点后的分数显示，总调查（z = -2.67，p < 0.008）以及关于系统态度的问题（z = -2.63，p < 0.008），与测试前相比有统计学上的显著改善。医院和卫生中心的HWs在态度上对系统的初始接受程度低于药房的HWs，并且在试点期间总体平均接受程度有显著提高（95% CI 0.004 - 0.0187）。在距离医院20多公里处工作的HWs，其系统知识和接受程度的初始水平低于距离较近的同行，但随着时间的推移，他们在知识和接受程度方面有更大的改善，尽管这种变化没有统计学意义。
该试点表明，米苏恩维区从事PMTCT工作的HWs对mHealth解决方案有较高的接受程度。使用mHealth解决方案可以促进HWs在农村和偏远地区提供PMTCT护理。考虑接受程度对于促进mHealth规模和项目可持续性很重要。
