Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes

Abstract

BackgroundLimited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.MethodsPregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated.ResultsIn six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%).ConclusionWe have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives

“…Although the potential benefits of the PCB outcome set are recognized by key stakeholders in perinatal care, knowledge and instruments are lacking for its implementation in clinical practice, especially the collection and use of its PROMs and PREMs [ 15 ]. Some patient-reported measures of the PCB outcome set were recently collected in perinatal studies, but were used anonymously for quality improvement or research goals only [ 16 , 17 ]. Other care settings in which common barriers and facilitators to implement PROMs have been identified have been limited to chronic or planned care – such as cancer care and surgery [ 18 , 19 ].…”

Utility of Short Message Service (SMS) for Remote Data Collection for HIV in Low- and Middle-Income Countries

“…It also provides an opportunity to develop skip patterns based on prior responses. This smart logic response approach, with limited, coded numerical responses for SMS inquiries, has been tested in several studies [ 53 , 66 – 68 ]. Deploying SMS on a platform with “longitudinal memory,” where follow-up SMS inquiries sent minutes, days, or weeks after a response can resume a skip pattern from a prior SMS survey provides even more flexibility.…”

A qualitative study on professionals’ attitudes and views towards the introduction of patient reported measures into public maternity care pathway

“…For instance, the question on ethnicity was suggested to be removed. This change was made also in the adaptation of ICHOM PCB Standard Set to the local setting in Kenya [ 34 ]. In contrast to findings in Laureij et al [ 33 ], according to which the recommended timing of the data collection was appropriate, our study suggests that the time points of data collection should be adapted to fit into the local service pathway and practices.…”

“…Instead of collecting PRMs data at 6 months after the birth, collection sometime between 2-4 months postpartum would be more practical, as this is the time frame for the final maternal checkup offered in Finland. In the pilot implementation of Kenya, the first survey was administered in the third trimester of pregnancy (28th week of pregnancy) and the timeline of data collection ended 6 weeks postpartum instead of 6 months postpartum [ 34 ]. While changes are inevitable, it is worth noting that modifying the recommended questions, some of which are internationally validated scales, and adjusting the time flow will make international comparisons weaker and compromise the advantage of using standard PROMs and PREMs for cross-country benchmarking.…”

“…Although ICHOM has provided a reference guide with hands-on materials [ 32 ] to facilitate the process of implementing this standard set into routine practice, a complete pre-implementation investigation of local acceptability and applicability is required. Until recently, we are aware of only few studies formally describing and assessing the local adoption of the PRMs defined in ICHOM PCB outcome set, with two studies from Netherlands and one from Kenya [ 13 , 33 , 34 ]. Implementation research on maternity-related PRMs is quite limited.…”