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首页> 外文期刊>Global Health Action >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
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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

机译：开发和形成创新的移动医疗干预措施，以提高印度农村地区社区孕产妇，新生儿和儿童卫生服务的覆盖面

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Background: A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low.Objective: This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs.Design: The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural’s1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery.Results: Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff.Conclusions: The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial.
机译：背景：在印度创建了一个新的以乡村为基础的一线卫生工作者干部，称为合格的社会卫生活动家（ASHA）。但是，某些基于社区的孕产妇，新生儿和儿童健康（MNCH）服务的覆盖率仍然很低。目的：本文介绍了复杂的mHealth干预措施（ImTeCHO）的开发和形成性评估过程，以增加已证实的MNCH服务的覆盖率通过改善ASHA的性能，在印度农村地区。设计：使用了医学研究理事会（MRC）框架来开发复杂的干预措施。在ASHA提供的常规护理中，基于文献检索和SEWA Rural的三十年基层经验，发现了差距。干预措施的组成部分（mHealth策略）旨在克服护理方面的差距。该干预措施以ImTeCHO手机和Web应用程序以及交付模型的形式开发，以纳入这些mHealth策略。该干预措施于2013年的7个月内在古吉拉特邦（Gujarat）的45个村庄中的45个ASHA中进行了试点（人口：45,000），以评估该干预措施的可接受性，可行性和有效性，并确定其实施的障碍。被认为是常规护理中的空白，导致选定的MNCH服务的覆盖率较低，复杂病例也无法获得护理。因此，开发了ImTeCHO应用程序，将mHealth策略以对ASHA的工作协助的形式集成在一起，以协助安排，行为改变沟通，诊断和患者管理，以及ASHA的监督和支持。在试点期间，人们发现干预措施及其实施在很大程度上是可以接受，可行和有用的。对干预措施及其实施进行了一些更改，包括1）为ASHA设立新的帮助热线，2）进一步简化ImTeCHO激励管理系统内的流程以及3）附加的基于Web的功能，以增强对初级卫生中心的价值和监管（PHC）工作人员。结论：现在将通过一项整群随机试验来测试改良的ImTeCHO干预措施的有效性。

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