乌干达坎帕拉班达区综合儿童疾病社区病例管理中移动医疗对社区卫生工作者的障碍和益处：一项横断面研究。
Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study.
机构信息
Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
Department of Networks, College of Computing and Information Science, Makerere University, P.O. Box 7072, Kampala, Uganda.
出版信息
BMC Prim Care. 2024 May 20;25(1):173. doi: 10.1186/s12875-024-02430-4.
BACKGROUND
Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala.
METHODS
This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model.
RESULTS
Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology.
CONCLUSION
Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.
背景
低质量数据是中低收入国家（LMICs）社区卫生工作者（CHWs）面临的重大挑战。移动医疗（mHealth）应用程序通过使 CHWs 能够以电子方式记录和提交数据，为解决这一问题提供了一种解决方案。然而，在非正式城市住区中，CHWs 使用 mHealth 的障碍和益处仍知之甚少。本研究旨在确定坎帕拉班达教区 CHWs 使用 mHealth 的障碍和益处。
方法
本定性研究包括坎帕拉城市议会当局（KCCA）和参与 CHWs 数据收集的非政府组织的焦点人员中的 12 个关键信息访谈（KII），以及卫生部（MOH）的官员和来自坎帕拉区班达教区的 2 个男女混合焦点小组讨论（FGD）。数据使用 Atlas Ti Version 7.5.7 进行分析。进行了主题分析，并根据社会生态模型对主题进行了调整。
结果
与社会生态模型一致的机构和政策、社区和人际以及个人三个主题突出了导致 CHWs 使用 iCCM 的 mHealth 的障碍和益处的因素。可用性、可接受性和可持续性的主要障碍包括培训成本高、CHW 动力不足、基础设施限制、数据安全问题、社区意识不足和技能缺陷。相反，mHealth 提供了一些好处，例如及时提交数据、提高数据质量、地理映射能力、改进 CHW 绩效监测、社区卫生监测、具有成本效益的报告以及赋予 CHW 技术能力。
结论
尽管 mHealth 的经验有限，但 CHWs 对其潜力表示了热情。实施被视为解决多个挑战的一种解决方案，特别是在资源有限的环境中，便于获取健康信息、高效的数据报告和行政流程。成功实施 mHealth 需要解决 CHWs 的动力不足问题，确保可靠的电力和网络连接，并增强数字数据道德和管理能力。通过克服这些障碍，mHealth 可以显著提高社区层面的医疗服务水平，利用技术优化资源利用并改善健康结果。mHealth 有望改变 CHW 的实践，但要将其有效整合，需要采取有针对性的干预措施来解决系统挑战，并确保在 LMIC 环境中实现可持续实施。
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