Kinshella Mai-Lei Woo, Sheikh Sana, Bawani Sohail, La Michelle, Sharma Sumedha, Vidler Marianne, Magee Laura A, von Dadelszen Peter, Bhutta Zulfiqar, Qureshi Rahat Najam, Payne Beth A
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
Front Glob Womens Health. 2021 May 14;2:645705. doi: 10.3389/fgwh.2021.645705. eCollection 2021.
PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Pakistan on Lady Health Workers' (LHWs) knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool. An evaluation was designed for health care workers involved in the Community-Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Sindh Province, Pakistan (NCT01911494). A semi-structured focus group guide was developed based on the Technology Acceptance Model (TAM), which theorizes that an individual's behavioral intention to use a system is determined by perceived usefulness and ease of use. Preliminary qualitative analysis was undertaken by the Pakistan and Canadian teams to create a coding framework for full qualitative analysis, which was completed using NVivo12. Three key informant interviews were conducted with two Lady Health Supervisors and one Senior Medical Officer. Sixty-two LHWs were included in three focus group discussions. LHWs found the POM app easy to use and useful for their work as a helpful repository for maternal health information and guiding counseling and management of pre-eclampsia. LHWs reported increased knowledge and confidence in their work. Availability of clinical homecare, including postpartum, was felt to positively impact healthcare provided to pregnant and postpartum women. Potential community level impacts included strengthening relationships between health care providers and communities and between LHWs and the health system. LHWs shared reports of earlier care-seeking and increased awareness of maternal health issues by community members. LHWs carry a large burden of responsibility for community health in rural Pakistan and appreciated the investment in their skills and capacity during the CLIP trial with the POM app. Investing in communications technology for community health workers through improved referrals and follow up may strengthen cohesiveness of the health system overall.
移动中的PIERS（POM）是一款移动健康应用程序，旨在支持社区卫生工作者识别和管理有子痫前期不良结局风险的妇女。本研究的目的是评估在巴基斯坦使用POM对女性健康工作者（LHWs）与护理子痫前期妇女相关的知识和自我效能的影响，以及他们对该工具有用性的看法。为参与2014年至2016年在巴基斯坦信德省进行的子痫前期社区层面干预（CLIP）整群随机试验的医护人员设计了一项评估（NCT01911494）。基于技术接受模型（TAM）开发了一份半结构化焦点小组指南，该模型理论认为，个人使用系统的行为意图由感知有用性和易用性决定。巴基斯坦和加拿大团队进行了初步定性分析，以创建用于全面定性分析的编码框架，该分析使用NVivo12完成。与两名女性健康监督员和一名高级医务官进行了三次关键信息访谈。62名LHWs参加了三次焦点小组讨论。LHWs发现POM应用程序易于使用，对他们的工作很有用，是孕产妇健康信息的有用知识库，可指导子痫前期的咨询和管理。LHWs报告称，他们在工作中的知识和信心有所增加。包括产后护理在内的临床家庭护理的可用性被认为对为孕妇和产后妇女提供的医疗保健有积极影响。潜在的社区层面影响包括加强医疗保健提供者与社区之间以及LHWs与卫生系统之间的关系。LHWs分享了社区成员更早寻求护理和提高对孕产妇健康问题认识的报告。在巴基斯坦农村，LHWs对社区健康负有重大责任，并赞赏在CLIP试验期间通过POM应用程序对他们的技能和能力进行的投资。通过改进转诊和随访为社区卫生工作者投资通信技术可能会增强整个卫生系统的凝聚力。
