Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study

Abstract

Background A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is ...

Effectiveness of Theory of Planned Behavior-Based Educational Intervention on Newborn Care in Pregnant Mothers: A quasi-experimental study

“…The positive effects of educational intervention were reported in the studies by Alam in Bangladesh on education via weekly voice messaging [17], Murthy in India on education via mHealth voice messaging service on newborn care [18], Wu in China on education using WeChat social network for improving exclusive breastfeeding [19] and de Jongh on education via SMS for improving self-e cacy skills of patients and vulnerable groups of pregnant mothers [40]. However, According to the researchers, the effectiveness of mHealth interventions need to be studied further.…”

“…Alam [17], Murthy [18] and Wu [19] in their studies conducted in Bangladesh, India and China, respectively, have also emphasized on the necessity of educating pregnant mothers regarding newborn care and conducting more research in this regard.…”

Effectiveness of Theory of Planned Behavior-Based Educational Intervention on Newborn Care in Pregnant Mothers: A quasi-experimental study

“…The positive effects of educational intervention were reported in the studies by Alam in Bangladesh on education via weekly voice messaging [17], Murthy in India on education via mHealth voice messaging service on newborn care [18], Wu in China on education using WeChat social network for improving exclusive breastfeeding [19] and de Jongh on education via SMS for improving self-e cacy skills of patients and vulnerable groups of pregnant mothers [40]. However, According to the researchers, the effectiveness of mHealth interventions need to be studied further.…”

“…Alam [17], Murthy [18] and Wu [19] in their studies conducted in Bangladesh, India and China, respectively, have also emphasized on the necessity of educating pregnant mothers regarding newborn care and conducting more research in this regard.…”

Mobile consulting (mConsulting) as an option for accessing healthcare services for communities in remote rural areas and urban slums in low- and middle- income countries: A mixed methods study

“…This timeframe coincides with the emergence of WHO guidance on digital interventions for health systems 11 and recognises the rapidly changing nature of digital technology. Building on our previous reviews of two-way digital clinical communication [12][13][14][15][16][17][18] , with added parameters for LMIC contexts, we identified seven systematic reviews [19][20][21][22][23][24][25] and five empirical studies [26][27][28][29][30] involving mConsulting in LMICs, as per our definition 7 (see, Appendix 1, for our search strategy).…”