Improving health worker performance through text messaging: A mixed-methods evaluation of a pilot intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy in West Nile, Uganda.

Christian Rassi,Clare E. Strachan,Sam Siduda Gudoi,Georgia R. Gore-Langton,Kirstie Graham,Sinwan Basharat,Rebecca King,Celine Christiansen-Jucht,Badru Gidudu Walimbwa,Henk D. F. H. Schallig

doi:10.1371/journal.pone.0203554

Abstract

Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and outcomes of an mHealth intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in two districts of West Nile, Uganda. In both districts, selected health workers (N = 48) received classroom training on malaria in pregnancy. All health workers in one district (N = 49) subsequently received 24 text messages reinforcing the training content. The intervention was evaluated using a mixed-methods approach, including four focus group discussions with health workers and three in-depth interviews with district health officials, health worker knowledge assessments one month (N = 90) and six months (N = 89) after the classroom training, and calculation of IPTp coverage from participating health facilities’ (N = 16) antenatal care registers covering six months pre- and post-intervention. Complementing classroom training with text messaging was found to be a feasible, acceptable and inexpensive approach to improving health worker performance. The messages served as reminders to those who had attended the classroom training and helped spread information to those who had not. Health workers in the district where text messages were sent had significantly better knowledge of IPTp, achieving an increased composite knowledge score of 6.00 points (maximum score: 40) compared with those in the district where only classroom training was provided. Average facility coverage of three doses of IPTp was also significantly higher where text messages were sent (85.8%) compared with the district where only classroom training was provided (54.1%). This intervention shows promise for the improvement of health worker performance for delivery of IPTp, and could have significant broader application.

Highlights

Health worker performance and mobile healthPoor health worker performance has long been recognised as a major obstacle to quality health service provision, especially in low and middle income countries (LMICs) [1]
There are strong indications that the approach resulted in improved health worker performance in terms of knowledge of IPTp and increased coverage of IPTp
These findings are in line with those reported by two similar studies conducted in LMICs

Summary

Introduction

Poor health worker performance has long been recognised as a major obstacle to quality health service provision, especially in low and middle income countries (LMICs) [1]. Due to its potential to distribute information to large target audiences and at low cost over extended periods of time, even in hard-to-reach areas and among underserved populations, mHealth is increasingly seen as a scalable strategy for overcoming common health system constraints such as population growth, challenging access to services, inadequate workforce or limited financial resources [5]. In Uganda, almost 22 million mobile phones are registered in a population of 34.6 million While this is below average in East Africa, the number of mobile phone subscriptions in Uganda is growing faster than in any other country in the region [8]

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Results

Discussion

Conclusion