Maternal and Child Health Division, icddr,b, Dhaka 1212, Bangladesh.
Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
Nutrients. 2024 Oct 10;16(20):3429. doi: 10.3390/nu16203429.
BACKGROUND/OBJECTIVES: An Android platform-based customised app and web-linked system was developed to aid in implementing selected nutrition interventions by community health workers (CHWs) in a community-based cluster randomised trial (c-RCT) in rural Bangladesh. METHODS: Here, we describe the architecture of the intervention delivery system, and explore feasibility of employing mHealth as CHWs' job aid, employing a mixed-method study design covering 17 visits per mother-child dyad. We analysed CHWs' real-time visit information from monitoring and documentation data, and CHWs' qualitative interviews to explore the advantages and barriers of using mHealth as a job aid. RESULTS: Intervention coverage was high across the arms (>90%), except around the narrow perinatal period (51%) due to mothers' cultural practice of moving to their parents' homes and/or hospitals for childbirth. CHWs mentioned technical and functional advantages of the job aid including device portability, easy navigability of content, pictorial demonstration that improved communication, easy information entry, and automated daily scheduling of tasks. Technical challenges included charging tablets, especially in power cut-prone areas, deteriorated battery capacity over continuous device usage, unstable internet network in unsupportive weather conditions, and device safety. Nevertheless, onsite supervision and monitoring by expert supervisors remained important to ensure intervention quality. CONCLUSIONS: With appropriate training and supervision, CHWs utilised the tablet-based app proficiently, attaining high coverage of long-term visits. mHealth was thus useful for designing, planning, scheduling, and delivering nutrition interventions through CHWs, and for monitoring and supervision by supervisors. Therefore, this application and job aid can be adopted or replicated into the currently developing national health systems platform for improving coverage and quality of preventive maternal and child nutrition services. In addition, continuous supportive supervision by skilled supervisors must be accompanied to ensure CHWs' task quality. Finally, future studies should rigorously assess undesirable health and environmental effects of mHealth before and after mainstreaming, effective interventions addressing device-induced health hazards should be designed and scaled up, and effective e-waste management must be ensured.
背景/目的：为了在孟加拉国农村的一项基于社区的整群随机对照试验（c-RCT）中帮助社区卫生工作者（CHWs）实施选定的营养干预措施，我们开发了一个基于 Android 平台的定制应用程序和网络链接系统。
方法：在这里，我们描述了干预交付系统的架构，并探讨了将移动健康作为 CHWs 的工作辅助工具的可行性，采用了一项混合方法研究设计，涵盖了每个母婴对子的 17 次访问。我们从监测和文件记录数据中分析了 CHWs 的实时访问信息，并对 CHWs 进行了定性访谈，以探讨将移动健康作为工作辅助工具的优势和障碍。
结果：各干预组的干预覆盖率都很高（>90%），除了在狭窄的围产期（51%）期间，由于母亲们的文化习俗，她们会搬到父母家或医院分娩。CHWs 提到了工作辅助工具的技术和功能优势，包括设备便携性、内容易于导航、图片演示提高了沟通效果、信息输入方便、以及任务的自动日常安排。技术挑战包括给平板电脑充电，特别是在经常停电的地区；连续使用设备会导致电池容量恶化；在天气条件不佳时，不稳定的网络连接；以及设备安全问题。然而，现场监督和专家监督仍然是确保干预质量的重要手段。
结论：经过适当的培训和监督，CHWs 熟练地使用了基于平板电脑的应用程序，实现了长期访问的高覆盖率。因此，移动健康对于通过 CHWs 设计、规划、安排和提供营养干预措施，以及监督者进行监测和监督非常有用。因此，该应用程序和工作辅助工具可以被采用或复制到当前正在开发的国家卫生系统平台中，以提高预防母婴营养服务的覆盖率和质量。此外，必须配备有技能的监督者进行持续的支持性监督，以确保 CHWs 的任务质量。最后，在将移动健康纳入主流之前和之后，应该严格评估其对健康和环境的不良影响，设计和扩大针对设备引起的健康危害的有效干预措施，并确保有效的电子废物管理。
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