Community Health Workers and Use of mHealth: Improving Identification of Pregnancy Complications and Access to Care in the Dominican Republic

Abstract

This article presents the feasibility and acceptability of using mobile health technology by community health workers (CHWs) in San Juan Province, Dominican Republic, to improve identification of pregnancy complications and access to care for pregnant women. Although most women in the Dominican Republic receive four antenatal care visits, poor women and adolescents in remote areas are more likely to have only one initial prenatal visit to verify the pregnancy. This community-based research began when community leaders raised concern about the numbers of their mothers who died in childbirth annually; San Juan's maternal mortality rate is 144/100,000 compared to the Caribbean rate of 85/100,000. Eight CHWs in three communities were taught to provide third-trimester antenatal assessment, upload the data on a mobile phone application, send the data to the local physician who monitored data for "red flags," and call directly if a mother had an urgent problem. Fifty-two pregnant women enrolled, 38 were followed to delivery, 95 antenatal care postintake were provided, 2 urgent complications required CHW home management of mothers, and there were 0 deaths. Stakeholders endorsed acceptability of intervention. Preliminary data suggest CHWs using mobile health technology is feasible, linking underserved and formal health care systems with provision of primary care in mothers' homes.

Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review

“…Primarily, these studies tend to have a small sample size. For example, Bonnell et al (2018) included 8 CHWs and 52 pregnant women in three locations in the San Juan province of the Dominican Republic, while Mangwi Ayiasi et al (2015) included 36 interviews with women seeking maternity care and 26 key informant interviews in Uganda in their study. Although these studies were able to explore the use of mHealth qualitatively, the sample size does not allow for an assessment of any potentially statistically significant quantitative measures or outcomes, or for the drawing of conclusions that are generalizable to more diverse populations.…”

“…Braun et al (2013) found that the majority of programs utilizing mHealth technology use by CHWs addressed issues related to maternal, sexual, and reproductive health, with more than half of this group specifically focused on HIV/AIDS. The reoccurring themes in CHWs and mHealth research included a focus on maternal health among populations of women living in low-and middle-income countries and rural areas (Bonnell et al, 2018). Such research also detailed how CHWs are able to bridge the gap between formal health care and lowincome or harder to reach communities (Braun et al, 2013), improve the health knowledge of midwives (S. Lee, Chib, & Kim, 2011), and speed up access to health data (Little et al, 2013).…”

Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

“…The included papers were published from 1987 to 2018, with more than half (n=13) published in 2017 (n=5) and 2018 (n=8). A total of eight [36][37][38][39][40][41][42][43] papers were published in the United Kingdom, followed by the United States (n=4) [44][45][46][47], Belgium (n=4) [48][49][50][51], Dominican Republic (n=1) [52], Netherlands (n=1) [53], and Guatemala (n=1) [54]. One study [55] described two different versions of a telemonitoring intervention being implemented in Nigeria, Mozambique, Pakistan, and India.…”

“…All interventions collected maternal blood pressure, with some interventions collecting additional metrics such as heart rate; weight; activities; urinalysis for glucose and protein; symptoms of preeclampsia such as headache, epigastric pain, and visual symptoms; temperature; peripheral capillary oxygen saturation; and psychosocial signs and symptoms. In addition, four articles [51][52][53][54] collected data from the fetus, including fetal heart rate and kick count. A total of six unique studies [37,38,[41][42][43]45,46] reported interventions in which only maternal blood pressure was collected.…”

Exploring perspectives, preferences and needs of a telemonitoring program for women at high risk for preeclampsia in a tertiary health facility of Karachi: a qualitative study protocol

“…Several retrospective and prospective studies have recommended the use of home blood pressure monitoring (HBPM) in pregnancy because of its potential benefits including fewer hospital visits, better blood pressure control, and cost savings [12][13][14][15]. A scoping review conducted in 2019 found 16 unique TM interventions from 20 studies [12,14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] for patients at high-risk for hypertensive disorders of pregnancy, but these studies have not translated to sustained programs [34]. The scoping review concluded that TM for hypertension during pregnancy was feasible, convenient, and cost-effective.…”