How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana
Introduction Despite increasing use of mHealth interventions, there remains limited documentation of ‘how and why’ they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored ‘how and why’ an mHealth intervention to support clinical deci...
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| Format: | Article |
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BMJ Publishing Group
2019-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/2/e001153.full |
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| author | Diederick E Grobbee Kerstin Klipstein-Grobusch Hannah Brown Amoakoh Evelyn Korkor Ansah Linda Yveoo Irene Agyepong |
| author_facet | Diederick E Grobbee Kerstin Klipstein-Grobusch Hannah Brown Amoakoh Evelyn Korkor Ansah Linda Yveoo Irene Agyepong |
| author_sort | Diederick E Grobbee |
| collection | DOAJ |
| description | Introduction Despite increasing use of mHealth interventions, there remains limited documentation of ‘how and why’ they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored ‘how and why’ an mHealth intervention to support clinical decision-making by front-line providers of maternal and neonatal healthcare services in a low-resource setting was used. The intervention consisted of phone calls (voice calls), text messaging (short messaging service (SMS)), internet access (data) and access to emergency obstetric and neonatal protocols via an Unstructured Supplementary Service Data (USSD). It was delivered through individual-use and shared facility mobile phones with unique Subscriber Identification Module (SIM) cards networked in a Closed User Group.Methods A single case study with multiple embedded subunits of analysis within the context of a cluster randomised controlled trial of the impact of the intervention on neonatal health outcomes in the Eastern Region of Ghana was performed. We quantitatively analysed SIM card activity data for patterns of voice calls, SMS, data and USSD. We conducted key informant interviews and focus group discussions with intervention users and manually analysed the data for themes.Results Overall, the phones were predominantly used for voice calls (64%), followed by data (28%), SMS (5%) and USSD (2%), respectively. Over time, use of all intervention components declined. Qualitative analysis showed that individual health worker factors (demographics, personal and work-related needs, perceived timeliness of intervention, tacit knowledge), organisational factors (resource availability, information flow, availability, phone ownership), technological factors (attrition of phones, network quality) and client perception of health worker intervention usage explain the pattern of intervention use observed.Conclusion How and why the mHealth intervention was used (or not) went beyond the technology itself and was influenced by individual and context-specific factors. These must be taken into account in designing similar interventions to optimise effectiveness. |
| format | Article |
| id | doaj-art-769a7cd904f14e78b204e82bf0bac3cc |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-769a7cd904f14e78b204e82bf0bac3cc2024-12-15T05:10:10ZengBMJ Publishing GroupBMJ Global Health2059-79082019-03-014210.1136/bmjgh-2018-001153How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in GhanaDiederick E Grobbee0Kerstin Klipstein-Grobusch1Hannah Brown Amoakoh2Evelyn Korkor Ansah3Linda Yveoo4Irene Agyepong5Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The NetherlandsDivision of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa1 School of Public Health, University of Ghana, Accra, Ghana4 University of Health and Allied Sciences, Ho, Ghana5 Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, Ghana5 Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, GhanaIntroduction Despite increasing use of mHealth interventions, there remains limited documentation of ‘how and why’ they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored ‘how and why’ an mHealth intervention to support clinical decision-making by front-line providers of maternal and neonatal healthcare services in a low-resource setting was used. The intervention consisted of phone calls (voice calls), text messaging (short messaging service (SMS)), internet access (data) and access to emergency obstetric and neonatal protocols via an Unstructured Supplementary Service Data (USSD). It was delivered through individual-use and shared facility mobile phones with unique Subscriber Identification Module (SIM) cards networked in a Closed User Group.Methods A single case study with multiple embedded subunits of analysis within the context of a cluster randomised controlled trial of the impact of the intervention on neonatal health outcomes in the Eastern Region of Ghana was performed. We quantitatively analysed SIM card activity data for patterns of voice calls, SMS, data and USSD. We conducted key informant interviews and focus group discussions with intervention users and manually analysed the data for themes.Results Overall, the phones were predominantly used for voice calls (64%), followed by data (28%), SMS (5%) and USSD (2%), respectively. Over time, use of all intervention components declined. Qualitative analysis showed that individual health worker factors (demographics, personal and work-related needs, perceived timeliness of intervention, tacit knowledge), organisational factors (resource availability, information flow, availability, phone ownership), technological factors (attrition of phones, network quality) and client perception of health worker intervention usage explain the pattern of intervention use observed.Conclusion How and why the mHealth intervention was used (or not) went beyond the technology itself and was influenced by individual and context-specific factors. These must be taken into account in designing similar interventions to optimise effectiveness.https://gh.bmj.com/content/4/2/e001153.full |
| spellingShingle | Diederick E Grobbee Kerstin Klipstein-Grobusch Hannah Brown Amoakoh Evelyn Korkor Ansah Linda Yveoo Irene Agyepong How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana BMJ Global Health |
| title | How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana |
| title_full | How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana |
| title_fullStr | How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana |
| title_full_unstemmed | How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana |
| title_short | How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana |
| title_sort | how and why front line health workers did not use a multifaceted mhealth intervention to support maternal and neonatal healthcare decision making in ghana |
| url | https://gh.bmj.com/content/4/2/e001153.full |
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