Assessing the perspectives of users and beneficiaries of a community health worker mHealth tracking system for mothers and children in Rwanda

Abstract

IntroductionMobile Health (mHealth) programs have increasingly been used to tackle maternal and child health problems in low and middle income countries. However, few studies have evaluated how these programs have been perceived by intended users and beneficiaries. Therefore, we explored perceptions of healthcare officials and beneficiaries regarding RapidSMS Rwanda, an mHealth system used by Community Health Workers (CHWs) that was scaled up nationwide in 2013.MethodsWe conducted key informant interviews and focus group discussions with key stakeholders, providers, and beneficiaries of maternal and child health services at both the national and community levels. Semi-structured interviews were used to assess perceptions about the impact of and challenges facing the RapidSMS system. Interviews and focus group discussions were recorded (with the exception of one), transcribed verbatim, and analyzed.ResultsWe conducted a total of 28 in-depth interviews and 10 focus group discussions (93 total participants). A majority of respondents believed that RapidSMS contributed to reducing maternal and child mortality rates. RapidSMS was generally accepted by both CHWs and parents. Participants identified insufficient training, a lack of equipment, and low CHW motivation as the main challenges facing RapidSMS.ConclusionOur findings suggest that an mHealth program can be well accepted by both policymakers, health providers, and the community. We also found significant technical challenges that have likely reduced its impact. Addressing these challenges will serve to strengthen future mHealth programs.

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A realist synthesis

“…namely mHealth programme, training and support of HCPs, a communication platform, data management platform, decision support and guideline (for HCPs) and mHealth message send to HCPs, reminder messages system, a communication platform, consultation platform (for pregnant women and mothers). Our ndings are supported by many other studies [45,48,55,64].…”

“…Health system organisation § HCPs training, supervision, resource availability, support and mobilisation [4,15,60,39,42,43,[46][47][48][49][50] § Mobile phone availability and distribution to HCPs [36] § Availability of HCPs [38,59] § HCPs and CHWs collaboration [38] Socio-demographic characteristic § Individual, pre-existing HCPs level of education, [37,40] § The language spoken by HCPs [44,50] Experience with technology § Technology adoption [40,43] Network infrastructure and connectivity § Availability of network and connectivity [44,64]…”

Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

“…The lack of impact of RapidSMS on ANC services uptake was attributed to the infidelity in the implementation of the program. The study conducted in Rwanda by Musabyimana et al [47] on implementers' and community health workers' experiences of the RapidSMS program also identified challenges to the successful implementation of the program, which included lack of motivation and incentives, high turnover rates of CHWs, and lack of Our initial program theory is consistent with some existing models such as the Elaboration likelihood model (ELM) and the extensive Elaboration likelihood model (eELM) [48], and the Theoretical Domains Framework (TDF) [49] in behavior change. ELM and eELM by Adam et al [48] focused on Mobile Video intervention, which stipulates that the changes in attitude that predict a desired behavioral outcome such as exclusive breastfeeding can be explained in two pathways.…”

Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda

“…Although further research would be required to understand why RapidSMS had no impact on these indicators where there was enough room for improvement, we believe that the lack of impact could be explained, on the one hand, by the fact that the RapidSMS program was not implemented with perfect fidelity. For example, Musabyimana et al (2018) qualitative study undertaken in Rwanda to gather the experiences of the RapidSMS program implementers as well as community health workers with implementing RapidSMS identified challenges to successful implementation of RapidSMS including lack of motivation and high turn-over of CHWs, lack of regular CHW training and incentives [ 24 ]. Similarly, Condo et al (2014) identified several other factors (e.g., overwhelming workload and lack of supervision) that could hamper the effectiveness of the Rwandan community health program [ 25 ].…”