Family Health International 360, Kathmandu, Nepal.
Helen Keller International, Kathmandu, Nepal.
J Med Internet Res. 2020 Sep 11;22(9):e17659. doi: 10.2196/17659.
With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal.
This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions.
We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child's second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos.
The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers.
A text message-based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message-based mHealth intervention design in under-resourced settings.
随着移动电话的覆盖范围和拥有量在全球范围内不断扩大，移动医疗（mHealth）干预措施正越来越多地被用于提高卫生和营养服务的覆盖范围和质量。然而，在像尼泊尔这样的低收入和中等收入国家，关于 mHealth 干预措施的可行性和在方案设计过程中需要考虑的因素的证据有限。
本研究旨在通过探讨移动电话拥有和共享情况、移动电话使用和技能、对 mHealth 干预措施的兴趣、偏好和限制，研究使用短信改善卫生和营养服务的潜力。
我们对 1000 天妇女（从受孕到儿童 2 岁期间）、卫生机构工作人员和女性社区卫生志愿者（FCHV）进行了 35 次深入访谈，并进行了 8 次焦点小组讨论，参与者包括卫生机构工作人员、FCHV 和 1000 天家庭决策者（即丈夫、岳母和岳父）。我们还进行了移动电话技能测试。我们采用了框架矩阵和分析备忘录的主题分析。
本研究包括 70 名研究参与者，其中 68 名（97%）拥有手机，且手机共享并不常见。使用短信的人群中，1000 天妇女和卫生机构工作人员的报告比例高于家庭决策者和 FCHV。超过 8 成的参与者（54/64，84%）会拨打电话，而大多数（28/34，82%）1000 天妇女、卫生机构工作人员和男性决策者还可以阅读和编写短信。我们发现，1000 天妇女更喜欢教育和提醒短信，而卫生机构工作人员和 FCHV 则希望收到教育和激励短信。参与者为 1000 天妇女、家庭、FCHV 和卫生机构工作人员提出了不同类型的短信内容，并报告说不喜欢来自陌生电话号码的短信。
基于短信的 mHealth 干预措施在尼泊尔山区是可以接受的，并且有可能改善社区卫生和营养服务的利用情况，特别是通过发送会议提醒和提供信息。我们的研究结果为资源匮乏环境中的基于短信的 mHealth 干预措施设计提供了参考。
