TY - JOUR
T1 - Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition
T2 - A cluster randomized controlled trial in Bihar, India
AU - the Ananya Study Group
AU - Carmichael, Suzan L.
AU - Mehta, Kala
AU - Srikantiah, Sridhar
AU - Mahapatra, Tanmay
AU - Chaudhuri, Indrajit
AU - Balakrishnan, Ramkrishnan
AU - Chaturvedi, Sharad
AU - Rahee, Hina
AU - Borkum, Evan
AU - Trehan, Shamik
AU - Weng, Yingjie
AU - Kaima, Rajani
AU - Sivasankaran, Anitha
AU - Sridharan, Swetha
AU - Rotz, Dana
AU - Tarigopula, Usha Kiran
AU - Bhattacharya, Debarshi
AU - Atmavilas, Yamini
AU - Pepper, Kevin T.
AU - Rangarajan, Anu
AU - Darmstadt, Gary L.
AU - Atmavilas, Yamini
AU - Bhattacharya, Debarshi
AU - Borkum, Evan
AU - Carmichael, Suzan
AU - Chaudhuri, Indrajit
AU - Creanga, Andreea
AU - Dutt, Priyanka
AU - Irani, Laili
AU - Kaimal, Rajani
AU - Mahapatra, Tanmay
AU - Mehta, Kala
AU - Mitra, Radhirani
AU - Pepper, Kevin
AU - Raheel, Hina
AU - Rangarajan, Anu
AU - Saggurti, Niranjan
AU - Sastryg, Padmapriya
AU - Schooley, Janine
AU - Srikantiah, Hemant Shahij Sridhar
AU - Tarigopula, Usha Kiran
AU - Ward, Victoria
AU - Weng, Yingjie
AU - Wilhelm, Jess
N1 - Funding Information:
Figure 1. Description of core features of the ICT-CCS intervention by objective, and the core interventions of the Ananya program that were supported by the ICT-CCS intervention. ICT-CCS – Information Communication Technology Continuum of Care Service, FLW – frontline worker.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019
Y1 - 2019
N2 - Background mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hardto- reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. Methods The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICTCCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. Results The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted. Conclusions Important improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.
AB - Background mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hardto- reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. Methods The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICTCCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. Results The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted. Conclusions Important improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.
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U2 - 10.7189/jogh.09.020424
DO - 10.7189/jogh.09.020424
M3 - Article
C2 - 31788233
AN - SCOPUS:85076007424
SN - 2047-2978
VL - 9
JO - Journal of global health
JF - Journal of global health
IS - 2
M1 - 020424
ER -