Health worker acceptability of an mHealth platform to facilitate the prevention of mother-to-child transmission of HIV in Tanzania

Thomas, Deborah S.K.; Daly, Kristen; Nyanza, Elias C.; Ngallaba, Sospatro E.; Bull, Sheana

doi:10.1177/2055207620905409

Cited by 14 publications

(13 citation statements)

References 28 publications

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“…However, their adoption and implementation in full capacity face challenges in terms of infrastructure, training, access to better devices such as smartphones, and some hesitancies from patients and providers. Such challenges have been reported in studies from other African countries including Uganda 100 , 101 , Kenya 102 – 105 , and Tanzania 106 , 107 . A meta-analysis was not conducted due to the heterogeneous nature of the compiled studies.…”

Section: Discussionmentioning

confidence: 61%

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

et al. 2021

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The World Health Organization (WHO) recently put forth a Global Strategy on Digital Health 2020–2025 with several countries having already achieved key milestones. We aimed to understand whether and how digital health technologies (DHTs) are absorbed in Africa, tracking Ethiopia as a key node. We conducted a systematic review, searching PubMed-MEDLINE, Embase, ScienceDirect, African Journals Online, Cochrane Central Registry of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to 02 February 2021 for studies of any design that investigated the potential of DHTs in clinical or public health practices in Ethiopia. This review was registered with PROSPERO (CRD42021240645) and it was designed to inform our ongoing DHT-enabled randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT04216420). We found 27,493 potentially relevant citations, among which 52 studies met the inclusion criteria, comprising a total of 596,128 patients, healthy individuals, and healthcare professionals. The studies involved six DHTs: mHealth (29 studies, 574,649 participants); electronic health records (13 studies, 4534 participants); telemedicine (4 studies, 465 participants); cloud-based application (2 studies, 2382 participants); information communication technology (3 studies, 681 participants), and artificial intelligence (1 study, 13,417 participants). The studies targeted six health conditions: maternal and child health (15), infectious diseases (14), non-communicable diseases (3), dermatitis (1), surgery (4), and general health conditions (15). The outcomes of interest were feasibility, usability, willingness or readiness, effectiveness, quality improvement, and knowledge or attitude toward DHTs. Five studies involved RCTs. The analysis showed that although DHTs are a relatively recent phenomenon in Ethiopia, their potential harnessing clinical and public health practices are highly visible. Their adoption and implementation in full capacity require more training, access to better devices such as smartphones, and infrastructure. DHTs hold much promise tackling major clinical and public health backlogs and strengthening the healthcare ecosystem in Ethiopia. More RCTs are needed on emerging DHTs including artificial intelligence, big data, cloud, cybersecurity, telemedicine, and wearable devices to provide robust evidence of their potential use in such settings and to materialize the WHO’s Global Strategy on Digital Health.

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Section: Discussionmentioning

confidence: 61%

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

et al. 2021

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“…In addition, we found that it is crucial to identify the intended behavioural outcome of the intervention as well as the behavioural determinants before intervention development, and rely on theory and empirical research in doing so. Also, more explicit attention could have been given to both adopter and innovation characteristics to promote NAA's implementation and use [see for example ( 30 )]. Despite these limitations, we believe that this study contributes to providing valuable insights for future digital health tool developers in low- and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…One innovative solution to improve the quality of ANC might be an electronic clinical decision and support system for use by healthcare workers during ANC, as it may have the potential to guide and improve healthcare workers' performance and adherence to guidelines (26)(27)(28)(29). A study conducted in Tanzania on the use of an electronic clinical decision and support system to improve HIV care, found high acceptability of healthcare workers to use the device (30). In an effort to contribute to this solution, the Woman Centered Care Project -a project run by the African Woman Foundation between 2013 and 2017 to improve maternal health outcomes -conducted a needs assessment in Magu district, Tanzania.…”

Section: Introductionmentioning

confidence: 99%

The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

Pelt

Massar

Shields-Zeeman

et al. 2021

Front. Public Health

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It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.

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“…Such challenges have been reported in studies from other African countries including Uganda, 93,94 Kenya, 95,96,97,98 , and Tanzania. 99,100…”

Section: Discussionmentioning

confidence: 99%

The potential of digital health technologies in African context, Ethiopia

Manyazewal

Woldeamanuel

Blumberg

et al. 2021

Preprint

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The World Health Organization (WHO) recently put forth a Global Strategy on Digital Health 2020 - 2025 with several countries having already achieved key milestones. We aimed to understand whether and how digital health technologies (DHTs) are absorbed in Africa, tracking Ethiopia as a key node. We conducted a systematic review, searching PubMed-MEDLINE, ScienceDirect, African Journals Online, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to 02 February 2021 for studies of any design that investigated the potential of DHTs in clinical or public health practices in Ethiopia. This review was designed to inform our ongoing DHT-enabled randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT04216420). We found 23,897 potentially-relevant citations, among which 47 studies met the inclusion criteria, comprising a total of 594,999 patients, healthy individuals, and healthcare professionals. The studies involved seven DHTs: mHealth (25 studies, 573,623 participants); electronic health records (13 studies, 4,534 participants); telemedicine (3 studies, 445 participants); cloud-based application (2 studies, 2,382 participants); genomics data (1 study, 47 participants); information communication technology (2 studies, 551 participants), and artificial intelligence (1 study, 13,417 participants). The studies targeted six health conditions: maternal and child health (15), infectious diseases (11), non-communicable diseases (3), dermatitis (1), surgery (3), and general health conditions (14). The outcomes of interest were feasibility, usability, willingness or readiness, effectiveness, quality improvement, and knowledge or attitude towards DHTs. Four studies involved RCTs. The analysis showed that although DHTs are a relatively recent phenomenon in Ethiopia, their potential harnessing clinical and public health practices are highly visible. Their adoption and implementation in full capacity requires more training, access to better devices such as smartphones, and infrastructure. DHTs hold much promise tackling major clinical and public health backlogs and strengthening the healthcare ecosystem in Africa. More RCTs are needed on emerging DHTs including artificial intelligence, big data, cloud, genomics data, cybersecurity, telemedicine, and wearable devices to provide robust evidence of their potential use in such settings and to materialize the WHO's Global Digital Health Strategy. Keywords: Digital Health, mHealth, Electronic medical records, Telemedicine, eHealth, Information communication technology, Africa, Ethiopia.

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Health worker acceptability of an mHealth platform to facilitate the prevention of mother-to-child transmission of HIV in Tanzania

Cited by 14 publications

References 28 publications

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

The potential of digital health technologies in African context, Ethiopia

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