Perceptions on a mobile health intervention to improve maternal child health for Syrian refugees in Turkey: Opportunities and challenges for end-user acceptability

Abstract

BackgroundMobile health (mhealth) technology presents an opportunity to address many unique challenges refugee populations face when accessing healthcare. A robust body of evidence supports the use of mobile phone-based reminder platforms to increase timely and comprehensive access to health services. Yet, there is a dearth of research in their development for displaced populations, as well as refugee perspectives in design processes to improve effective adoptions of mhealth interventions.ObjectiveThis study aimed to explore healthcare barriers faced by Syrian refugee women in Turkey, and their perceptions of a maternal-child health mobile application designed to provide antenatal care and vaccine services. These findings guided development of a framework for enhancing acceptability of mobile health applications specific to refugee end-users.MethodsSyrian refugee women who were pregnant or had at least one child under the age of 2 years old at the time of recruitment (n = 14) participated in semi-structured in-depth interviews. Participants had the opportunity to directly interact with an operational maternal-child health mobile application during the interview. Using a grounded theory approach, we identified critical factors and qualities mhealth developers should consider when developing user-friendly applications for refugees.ResultsIt was observed that a refugee's perception of the mobile health application's usability was heavily influenced by past healthcare experiences and the contextual challenges they face while accessing healthcare. The in-depth interviews with refugee end-users identified that data security, offline capability, clear-user directions, and data retrievability were critical qualities to build into mobile health applications. Among the features included in the maternal-child health application, participants most valued the childhood vaccination reminder and health information features. Furthermore, the application's multi-lingual modes (Arabic, Turkish, and English) strengthened the application's usability among Syrian refugee populations living in Turkey.ConclusionsThe inclusion of refugee perceptions in mhealth applications offers unique developer insights for building more inclusive and effective tools for vulnerable populations. Basic upfront discussions of the mobile application's health goals and its personal value to the user may improve their long-term use. Further prospective research is needed on retention and use of mobile health applications for refugee women and other displaced populations.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…They need to have clear aims and a position in the health care pathway that is understood by patients and professionals, with comprehensive and trusted information provided about the qualities and services of the devices and targeted health condition [ 56 , 57 , 93 , 118 , 142 , 174 , 177 , 178 , 186 , 190 , 214 , 221 , 228 , 250 , 252 , 259 , 265 , 266 , 273 ]. They should also be easy and straightforward to understand and use [ 1 , 4 , 13 , 19 , 40 , 42 , 117 , 135 , 141 , 150 , 193 , 194 , 203 , 208 , 217 , 250 , 252 , 265 , 266 , 273 ], as well as have the ability to be personalized according to patient needs and preferences [ 4 , 13 , 62 , 117 , 208 , 216 , 217 , 220 , 246 ]. Finally, a key property and enabler of the reimbursement of digital therapeutics is their interaction with the target population: they should be co-designed and coimplemented with patients and health professionals to maximize the likelihood of their uptake by the relevant stakeholders, with the recognition of the fact that engagement might differ across population groups in different countries [ 4 , 13 , 19 , 40 , 47 , 56 , …”

“…With respect to structure measures, the interoperability of digital therapeutics (ie, the ability to communicate with local health informatics systems, such as electronic health records) was the most often emphasized requirement from a design viewpoint [ 1 , 4 , 13 , 15 , 17 , 19 , 44 , 45 , 54 , 57 , 61 , 66 , 80 , 82 , 103 , 106 , 107 , 110 , 111 , 124 , 147 , 189 - 192 , 197 , 199 , 200 , 202 , 222 , 224 , 230 , 231 , 246 , 264 - 266 , 270 , 273 ]. However, it is important that digital therapeutics remain compliant with local privacy and security legislation and prevent direct-to-consumer advertisements through the application [ 4 , 47 - 49 , 51 , 57 , 93 , 115 , 125 , 138 , 187 , 211 , 219 , 220 , 224 ], as well as identification through secondary data sharing [ 79 , 91 , 93 , 138 , 217 ]. The hardware and software requirements [ 63 , 91 , 163 , 194 , ...…”

“…However, it is important that digital therapeutics remain compliant with local privacy and security legislation and prevent direct-to-consumer advertisements through the application [ 4 , 47 - 49 , 51 , 57 , 93 , 115 , 125 , 138 , 187 , 211 , 219 , 220 , 224 ], as well as identification through secondary data sharing [ 79 , 91 , 93 , 138 , 217 ]. The hardware and software requirements [ 63 , 91 , 163 , 194 , 233 ], implementation and upkeep costs [ 41 , 63 , 65 , 133 , 146 , 198 , 211 , 231 , 237 , 238 , 254 ], required input and oversight from health professionals [ 11 , 107 , 254 , 265 ], ability to work without a constant internet connection [ 91 , 135 , 217 , 233 ], price [ 165 , 222 ], and scalability were also deemed important factors, as they dictate the investment threshold for adopting digital therapeutics and how widely and cost-effectively digital therapeutics can be deployed, including the potential to realize economies of scale [ 164 , 199 , 231 , 265 ].…”

“…They need to have clear aims and a position in the health care pathway that is understood by patients and professionals, with comprehensive and trusted information provided about the qualities and services of the devices and targeted health condition [56,57,93,118,142,174,177,178,186,190,214,221,228,250,252,259,265,266,273]. They should also be easy and straightforward to understand and use [1,4,13,19,40,42,117,135,141,150,193,194,203,208,217,250,252,265,266,273], as well as have the ability to be personalized according to patient needs and preferences [4,13,62,117,208,216,217,220,…”

A Scoping Review of Digital Technologies in Antenatal Care: Recent Progress and Applications of Digital Technologies

“…Most of the studies included in the present review used mobile apps[89, 86, 69,55, 78,33,90,52,91, 66, 56, 67,33,35,37, 76, 38, 80, 87,39,92,47, 81,70, 58, 68,75, 85], six studies used one-or two-way text messaging systems[73, 64, 65, 83, 48, 84], two studies used web-based cloud apps (59, 60), and only one study mentioned the use of a clinical decision support system to support antenatal health care(1). Twenty-two studies used synchronised telehealth communication either through audio/telephone consultation[63,42,45, 46] or virtual care…”