Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation (Preprint)

Abstract

BACKGROUND Maternal and child health (MCH) is a major global health concern due to the increasing socioeconomic and healthcare inequalities, especially impacting low-and-middle-income countries (LMICs). Digital health technologies are creating opportunities to address the social determinants of maternal and child health by facilitating access to information or providing practical and other forms of support throughout the maternity journey. Previous reviews exist in different disciplines that synthesize digital health intervention outcomes in LMICs. However, contributions in this space are scattered across publications in different disciplines lacking coherence in what digital maternal health means across these fields. Cross-disciplinary reviews are becoming increasingly important to provide a holistic understanding across fields. While there are few attempts that consolidate learning from across different disciplines in the context of digital health technologies, however, they are limited in relation to maternal and child health. OBJECTIVE This cross-disciplinary scoping review aims to synthesize the existing published literature in three major disciplines on the use of digital health interventions for MCH in LMICs, with a particular focus on Sub-Saharan Africa. We also engaged with several cross-disciplinary researchers and grassroots organizations to further validate the papers included in the scoping review and explored the challenges of implementing digital health interventions for MCH in the Global South METHODS We conducted a scoping review using Arksey and O’Malley’s five-stage framework across three disciplines, including public health, social sciences applied to health, and human-computer interaction research in healthcare. The following scholarly databases were searched: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science and PLOS. To complement the review, we further conducted 27 in-depth interviews with cross-disciplinary researchers and grassroots practitioners. We inquired about: additional MCH projects in LMICs, community challenges they faced, and the role of community-based co-design methods while implementing digital health interventions for MCH in LMICs. RESULTS During the search 284, peer-reviewed articles were identified. After removing 41 duplicates, 141 papers met our inclusion criteria: 34 from Social Sciences applied to Health, 58 from Public Health, and 49 from Human-Computer Interaction research in healthcare. These papers were selected for further analysis, then tagged (labeled) by three researchers using a custom data extraction framework obtaining the following findings. First, the scope of digital health technologies was found to target: 1) health education (e.g., breastfeeding, child nutrition), 2) care and follow-up of health service utilization (to support Community Health Workers - CHWs), 3) maternal mental health, and 4) nutritional and health outcomes. The technologies used to deliver these interventions included mobile apps, SMS, Voice Messaging (audio messages, reminders), web-based applications, social media (e.g., Facebook, Twitter, WhatsApp), movies and videos (e.g., digital storytelling and digital media education), and wearable or sensor-based devices. Second, the review identified several key challenges: a) little attention has been given to understanding the lived experiences of the communities these interventions targeted, b) key role players (e.g., fathers, grandparents, and other family members) are often excluded from studies, technologies and many studies are designed considering nuclear families that do not represent the family structures of the local cultures, c) usability and other short-term user studies are often confused with co-design, and d) there is an overemphasis on designing technology to support health services and little to no consideration designing technology to support the wellbeing of caregivers and children. CONCLUSIONS Digital health interventions aimed to support Maternal and Child Health (MCH) have shown steady growth in Africa and other LMIC settings. Unfortunately, the potential role of the community was found to be negligible as these interventions do not often include the communities early and inclusively enough in the design process. These interventions are likely to be ineffective in the long term if delivered without the involvement of the direct beneficiaries We highlight the key opportunities for technology aimed at the MCH arena in LMICs, such as: More affordable mobile data, better access to smartphones and wearable technologies and the rise of custom-developed, culturally appropriate mobile applications, which are more suited to low literacy users. We also focus on threats such as an over-reliance on SMS and text-based communications and the difficulty of MCH research and technological interventions translating into policy.