Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank

BMC Med Inform Decis Mak

O’Donnell

et al. 2020

Self Cite

189

Background: Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. Methods: We used the Health Belief Model to develop interview guides to explore women's perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. Results: We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry.

Section: Introductionmentioning

confidence: 99%

Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study

BMC Med Inform Decis Mak

O’Donnell

et al. 2020

Self Cite

189

“…MCH is an important area in the Palestinian healthcare system, and gestational anemia, hypertensive disorders of pregnancy, gestational diabetes mellitus and fetal growth restriction are identi ed as priority conditions for prevention [25]. Approximately 43% of pregnant women attend public ANC services, but only 13% according to the recommended national schedule, which results in low effective coverage [26].…”

Section: Palestinian Contextmentioning

confidence: 99%

eRegCom – Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial

Abbas

et al. 2020

Preprint

Self Cite

Background: This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women.Methods: This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy; and timely attendance to antenatal care. Primary analysis, at the individual-level taking the design effect of the clustering into account, will be done as intention-to-treat.Discussion: This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach.Trial registration: ISRCTN, trial registration number: 10520687, registered 18 October 2018, http://www.isrctn.com/ISRCTN10520687

“…When well-informed clients participate in the decision processes of their own clinical care, they have the potential to improve the quality content of care. Therefore, by improving the utilization and quality content of ANC and PNC services, TCC influences the uptake (coverage) and quality components of effective coverage metrics [27,28]. This paper presents a theory-driven process from conceptualization and contextual assessment, to development and evaluation of a tailored TCC intervention using individual background characteristics from the MCH eRegistry in Palestine.…”

Section: Development Of An Effective Tcc Intervention Is Complex and mentioning

confidence: 99%

Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study

O’Donnell

et al. 2019

Preprint

Self Cite

Background Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based co-design with users. Our aim is to describe the planning, development, and evaluation of a theory based TCC intervention, tailored to pregnant and postpartum women, and automated from an electronic maternal and child health registry in Palestine. Methods We used the Health Belief Model to develop interview guides to explore women’s perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction) and timely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Following the results from the Health Belief Model, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent via SMS. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. Results We found low awareness of the importance of timeliness in attending ANC and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, such complications in pregnancy. We composed actionable text messages following recommended message framing models and iteratively improved the contents with users to bridge the identified gaps. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile. Conclusions: We developed an optimized text message based TCC intervention underpinned by behavior change theories and co-designed with users following an iterative process. The effectiveness of the TCC intervention is assessed in a cluster-randomized trial (ISRCTN10520687).