Abstract
BackgroundWhile community health workers are being recognized as an integral work force with growing responsibilities, increased demands can potentially affect motivation and performance. The ubiquity of mobile phones, even in hard-to-reach communities, has facilitated the pursuit of novel approaches to support community health workers beyond traditional modes of supervision, job aids, in-service training, and material compensation. We tested whether supportive short message services (SMS) could improve reporting of pregnancies and pregnancy outcomes among community health workers (Health Surveillance Assistants, or HSAs) in Malawi.Methods and FindingsWe designed a set of one-way SMS that were sent to HSAs on a regular basis during a 12-month period. We tested the effectiveness of the cluster-randomized intervention in improving the complete documentation of a pregnancy. We defined complete documentation as a pregnancy for which a specific outcome was recorded. HSAs in the treatment group received motivational and data quality SMS. HSAs in the control group received only motivational SMS. During baseline and intervention periods, we matched reported pregnancies to reported outcomes to determine if reporting of matched pregnancies differed between groups and by period. The trial is registered as ISCTRN24785657.ConclusionsStudy results show that the mHealth intervention improved the documentation of matched pregnancies in both the treatment (OR 1.31, 95% CI: 1.10–1.55, p<0.01) and control (OR 1.46, 95% CI: 1.11–1.91, p = 0.01) groups relative to the baseline period, despite differences in SMS content between groups. The results should be interpreted with caution given that the study was underpowered. We did not find a statistically significant difference in matched pregnancy documentation between groups during the intervention period (OR 0.94, 95% CI: 0.63–1.38, p = 0.74). mHealth applications have the potential to improve the tracking and data quality of pregnancies and pregnancy outcomes, particularly in low-resource settings.
Highlights
The field of global health has set ambitious goals, including the Millennium Development Goals and the recently defined Sustainable Development Goals [1]
Study results show that the mHealth intervention improved the documentation of matched pregnancies in both the treatment and control groups relative to the baseline period, despite differences in short message services (SMS) content between groups
We did not find a statistically significant difference in matched pregnancy documentation between groups during the intervention period. mHealth applications have the potential to improve the tracking and data quality of pregnancies and pregnancy outcomes, in lowresource settings
Summary
The field of global health has set ambitious goals, including the Millennium Development Goals and the recently defined Sustainable Development Goals [1] These initiatives have catalyzed donor support and country engagement to make progress on education, health, and socio-economic development [2]. CHWs are gaining job responsibilities, recognition, and financial compensation due to skilled health worker shortages [4,5,6,7]. Their community presence has the potential to minimize access and utilization barriers by bringing health care services closer to the population they serve [3,8]. We tested whether supportive short message services (SMS) could improve reporting of pregnancies and pregnancy outcomes among community health workers (Health Surveillance Assistants, or HSAs) in Malawi
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