Where there is no phone: The benefits and limitations of using intermediaries to extend the reach of mHealth to individuals without personal phones in Malawi

Larsen-Cooper, Erin; Bancroft, Emily; O'Toole, Maggie; Jezman, Zachariah

doi:10.11564/29-1-714

Cited by 11 publications

(31 citation statements)

References 22 publications

(30 reference statements)

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“…Although there is a growing number of mobile phones in Africa, most poor and rural women do not own smartphones [ 13 ]. Furthermore, in rural areas, mobile phone networks may not always support internet-based apps [ 33 ]. In such a context, technologically sophisticated interventions based on smartphones would serve little purpose.…”

Section: Resultsmentioning

confidence: 99%

“…In such a context, technologically sophisticated interventions based on smartphones would serve little purpose. In addition to the ubiquity of the functionalities across phone types, the use of basic phone functionalities also ensured that the users were already familiar with such functionalities from their normal mobile phone use [ 13 , 23 , 26 , 29 , 33 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Hence, maternal clients could adopt the interventions regardless of their mobile phone ownership status. However, for CCPF, the use of community volunteers faced a number of challenges, such as sustaining volunteer motivation, challenges in accessing volunteers, phone maintenance, and mobile phone charging [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review

Maliwichi

Chigona

Sowon

2021

JMIR Mhealth Uhealth

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Background Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review

Maliwichi

Chigona

Sowon

2021

JMIR Mhealth Uhealth

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“…The two remaining papers were mixed-methods studies. 60 , 61 The first 60 concerns the MoTeCH initiative in northern Ghana; a complex system comprising several different processes and the engagement with multiple target groups. Aimed to improve community-based primary health care, MoTeCH sends weekly educational voice messages to pregnant women and young mothers.…”

Section: Resultsmentioning

confidence: 99%

“…The last pilot 61 concerned a mixed-methods exploration of the potential of working with community volunteers as intermediaries to extend access to mHealth for individuals with no phone. Borrowing the volunteers' phones, beneficiaries could call a toll-free hotline or receive text or voice messages on reproductive, maternal, and new-born health topics.…”

Section: Resultsmentioning

confidence: 99%

Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa

Krah

Kruijf

2016

DIGITAL HEALTH

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BackgroundAfrica is labelled the world's fastest-growing ‘mobile region’. Considering such growth and the fragility of the continent's healthcare, mHealth has flourished. This review explores mHealth for community health in Africa in order to assess its still ambivalent evidence base.MethodsUsing PubMed, Web of Science, OvidSP and Google Scholar, a systematic review was conducted of one decade (2005–2015) of peer-reviewed literature on mHealth in Africa. Data analysis focused on qualifications of success and failure. Impact evaluations of project assessments (n = 65) were complemented with general analyses/overviews of mHealth's effectiveness (n = 35).ResultsReview of these texts reveals ambivalence in the appraisal of mHealth; essentially, the critical stance in general analyses/overviews is absent from project assessments. Especially weak evidence concerning sustainability and scalability is stressed in overviews. Project assessments are more optimistic. Their analysis suggests a causal connection between simplicity and success. Effective interventions are thus characterized by straightforward design and modest objectives. Greatest impediments of impact are general technology-related issues and intervention inappropriateness due to insufficient understanding of beneficiaries and specific context of use (circumstantial complications).ConclusionDistinguishing between these two categories of complications helps to break the deadlock that marks the mHealth debate and add nuance to claims that mHealth's evidence base is weak. Constructive realism – rather than unfounded optimism or pessimism without nuance – should guide the design of interventions. Besides anticipative of technology-related complications, such realism must lead to either basic interventions or to smart mHealth shaped by deep understanding of the context of implementation.

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Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis

Odendaal

Watkins

Leon

et al. 2020

Cochrane Database of Systematic Reviews

214

198

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Where there is no phone: The benefits and limitations of using intermediaries to extend the reach of mHealth to individuals without personal phones in Malawi

Abstract: The purpose of this study is to identify the benefits and limitations associated with intermediaries to provide access to and increase utilization of an mHealth intervention amongst people without personal phones in Balaka District

Cited by 11 publications

References 22 publications

Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review

Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review

Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa

Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis

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