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Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries


Autoři: Lakshmi Gopalakrishnan aff001;  Laura Buback aff002;  Lia Fernald aff001;  Dilys Walker aff001;  Nadia Diamond-Smith aff002
Působiště autorů: School of Public Health, University of California, Berkeley, United States of America aff001;  Institute of Global Health Sciences, University of California, San Francisco, United States of America aff002;  Department of Obstetrics and Gynaecology, University of California, San Francisco, United States of America aff003;  Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227451

Souhrn

Background

mHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries’ perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described.

Methods

A qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose.

Findings

The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries’ views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS.

Conclusions

mHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members.

Klíčová slova:

Behavior – Behavioral and social aspects of health – Cell phones – Computer software – Children – Nutrition – Pregnancy – Social communication


Zdroje

1. Frontline Health Workers Coalition. In: Frontline Health Workers Coalition [Internet]. [cited 14 Oct 2019]. Available: https://www.frontlinehealthworkers.org/

2. Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. Development. 2004;47: 159–161. doi: 10.1057/palgrave.development.1100047

3. World Bank. World Development Report 1993: Investing in Health. New York: Oxford University Press.; 1993. Available: https://openknowledge.worldbank.org/handle/10986/5976

4. TTR_tackle.pdf. Available: https://www.who.int/healthsystems/task_shifting/TTR_tackle.pdf?ua=1

5. Astana Declaration. [cited 14 Oct 2019]. Available: https://www.who.int/primary-health/conference-phc/declaration

6. Christopher JB, Le May A, Lewin S, Ross DA. Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health. 2011;9: 27. doi: 10.1186/1478-4491-9-27 22024435

7. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13: 847. doi: 10.1186/1471-2458-13-847 24034792

8. Lassi ZS, Middleton PF, Bhutta ZA, Crowther C. Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis. Glob Health Action. 2016;9: 31408. doi: 10.3402/gha.v9.31408 27171766

9. Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, et al. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel. J Glob Health. 7. doi: 10.7189/jogh.07.010908 28685046

10. Agarwal S, Perry HB, Long L-A, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Trop Med Int Health. 2015;20: 1003–1014. doi: 10.1111/tmi.12525 25881735

11. Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Health Sci Pract. 2013;1: 160–171. doi: 10.9745/GHSP-D-13-00031 25276529

12. Modi D, Gopalan R, Shah S, Venkatraman S, Desai G, Desai S, et al. Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India. Glob Health Action. 2015;8: 26769. doi: 10.3402/gha.v8.26769 25697233

13. Prinja S, Nimesh R, Gupta A, Bahuguna P, Gupta M, Thakur JS. Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India. Trop Med Int Health. 2017;22: 895–907. doi: 10.1111/tmi.12895 28510997

14. McBride B, O’Neil JD, Hue TT, Eni R, Nguyen CV, Nguyen LT. Improving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access. J Public Health. 2018;40: ii32–ii41. doi: 10.1093/pubmed/fdy165 30252117

15. Mangwi Ayiasi R, Atuyambe LM, Kiguli J, Orach CG, Kolsteren P, Criel B. Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda. BMC Public Health. 2015;15: 560. doi: 10.1186/s12889-015-1939-3 26084369

16. Braun R, Lasway C, Agarwal S, L’Engle K, Layer E, Silas L, et al. An evaluation of a family planning mobile job aid for community health workers in Tanzania. Contraception. 2016;94: 27–33. doi: 10.1016/j.contraception.2016.03.016 27039033

17. DiCarlo A, Fayorsey R, Syengo M, Chege D, Sirengo M, Reidy W, et al. Lay health worker experiences administering a multi-level combination intervention to improve PMTCT retention. BMC Health Serv Res. 2018;18: 17. doi: 10.1186/s12913-017-2825-8 29321026

18. Medhanyie AA, Little A, Yebyo H, Spigt M, Tadesse K, Blanco R, et al. Health workers’ experiences, barriers, preferences and motivating factors in using mHealth forms in Ethiopia. Hum Resour Health. 2015;13: 2. doi: 10.1186/1478-4491-13-2 25588973

19. Entsieh AA, Emmelin M, Pettersson KO. Learning the ABCs of pregnancy and newborn care through mobile technology. Glob Health Action. 2015;8: 29340. doi: 10.3402/gha.v8.29340 26673633

20. Agarwal S, Perry HB, Long L-A, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Trop Med Int Health TM IH. 2015;20: 1003–1014. doi: 10.1111/tmi.12525 25881735

21. Amoakoh-Coleman M, Borgstein AB-J, Sondaal SF, Grobbee DE, Miltenburg AS, Verwijs M, et al. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review. J Med Internet Res. 2016;18: e226. doi: 10.2196/jmir.5533 27543152

22. Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mHealth interventions for maternal, newborn and child health in low–and middle–income countries: Systematic review and meta–analysis. J Glob Health. 6. doi: 10.7189/jogh.06.010401 26649177

23. Scott K, George AS, Ved RR. Taking stock of 10 years of published research on the ASHA programme: examining India’s national community health worker programme from a health systems perspective. Health Res Policy Syst. 2019;17: 29. doi: 10.1186/s12961-019-0427-0 30909926

24. Schneider H, Hlophe H, van Rensburg D. Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy Plan. 2008;23: 179–187. doi: 10.1093/heapol/czn006 18388133

25. Campbell C, Scott K. Retreat from Alma Ata? The WHO’s report on Task Shifting to community health workers for AIDS care in poor countries. Glob Public Health. 2011;6: 125–138. doi: 10.1080/17441690903334232 19916089

26. Agarwal S, Kirk K, Sripad P, Bellows B, Abuya T, Warren C. Setting the global research agenda for community health systems: literature and consultative review. Hum Resour Health. 2019;17. doi: 10.1186/s12960-019-0362-8 30898136

27. Rao N, Kaul V. India’s integrated child development services scheme: challenges for scaling up. Child Care Health Dev. 2018;44: 31–40. doi: 10.1111/cch.12531 29235171

28. Gragnolati M, Bredenkamp C, Gupta MD, Lee Y-K, Shekar M. ICDS and Persistent Undernutrition: Strategies to Enhance the Impact. Econ Polit Wkly. 2006;41: 1193–1201.

29. Kosec K, Avula R, Holtemeyer B, Tyagi P, Hausladen S, Menon P. Predictors of Essential Health and Nutrition Service Delivery in Bihar, India: Results From Household and Frontline Worker Surveys. Glob Health Sci Pract. 2015;3: 255–273. doi: 10.9745/GHSP-D-14-00144 26085022

30. Kapil U, Pradhan R. Integrated Child Development Services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives. Indian J Public Health. 1999;43: 21–25. 11243083

31. India IF. Has the ICDS helped reduce stunting in India? In: Ideas For India [Internet]. [cited 13 Oct 2019]. Available: http://www.ideasforindia.in/topics/human-development/has-the-icds-helped-reduce-stunting-in-india.html

32. Kandpal E. Beyond Average Treatment Effects: Distribution of Child Nutrition Outcomes and Program Placement in India’s ICDS. World Dev. 2011;39: 1410–1421. doi: 10.1016/j.worlddev.2010.12.013

33. Chanani S, Waingankar A, More NS, Pantvaidya S, Fernandez A, Jayaraman A. Participation of pregnant women in a community-based nutrition program in Mumbai’s informal settlements: Effect on exclusive breastfeeding practices. PLOS ONE. 2018;13: e0195619. doi: 10.1371/journal.pone.0195619 29621355

34. A Quick Evaluation Study of Anganwadis by NITI AAYOG. 2015 Jun. Available: https://niti.gov.in/writereaddata/files/document_publication/report-awc.pdf

35. Commission P. Evaluation Report on Integrated Child Development Services. 2011 [cited 13 Oct 2019]. Available: http://14.139.60.153/handle/123456789/207

36. National Family Health Survey. [cited 13 Oct 2019]. Available: http://rchiips.org/nfhs/NFHS-4Report.shtml

37. Borkum E, Sivasankaran A, Sridharan S, Rotz D, Sethi S, Manoranjini M, et al. Evaluation of the Information and Communication Technology (ICT) Continuum of Care Services (CCS) Intervention in Bihar. 2015 May p. 123.

38. Nimmagadda S, Gopalakrishnan L, Avula R, Dhar D, Diamond-Smith N, Fernald L, et al. Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: Study protocol for a quasi-experimental mixed methods evaluation. BMJ Open. 2019.

39. Bryman A. Social Research Methods. Oxford University Press; 2016.

40. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3: 77–101. doi: 10.1191/1478088706qp063oa

41. Dedoose, web application for managing, analyzing, and presenting qualitative and mixed method research data. Los Angeles, CA: SocioCultural Research Consultants, LLC; 2018. Available: www.dedoose.com

42. Bronfenbrenner U. Toward an Experimental Ecology of Human Development. American Psychologist; 1977. Available: https://psycnet.apa.org/record/1978-06857-001?doi = 1

43. Gupta SS, Maliye CH, Deshmukh PR, Raut AV, Dongre AR, Garg BS. Gender power dynamics in rural area of India. Int J Med Sci Public Health. 2017;6: 1473–1480.

44. Chowdhry P. Persistence of a Custom: Cultural Centrality of Ghunghat. Soc Sci. 1993;21: 91–112. doi: 10.2307/3520428

45. Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018;16: 39. doi: 10.1186/s12960-018-0304-x 30115074

46. Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015;30: 1207–1227. doi: 10.1093/heapol/czu126 25500559

47. Mishra A. ‘Trust and teamwork matter’: Community health workers’ experiences in integrated service delivery in India. Glob Public Health. 2014;9: 960–974. doi: 10.1080/17441692.2014.934877 25025872


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