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      Understanding the Role of mHealth and Other Media Interventions for Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: An Evidence Review

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          Abstract

          Given the high morbidity and mortality among children in low- and middle-income countries as a result of preventable causes, the U.S. government and the United Nations Children's Fund convened an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change on June 3–4, 2013, in Washington, D.C. This article summarizes evidence for technological advances associated with population-level behavior changes necessary to advance child survival and healthy development in children under 5 years of age in low- and middle-income countries. After a rigorous evidence selection process, the authors assessed science, technology, and innovation papers that used mHealth, social/transmedia, multiplatform media, health literacy, and devices for behavior changes supporting child survival and development. Because of an insufficient number of studies on health literacy and devices that supported causal attribution of interventions to outcomes, the review focused on mHealth, social/transmedia, and multiplatform media. Overall, this review found that some mHealth interventions have sufficient evidence to make topic-specific recommendations for broader implementation, scaling, and next research steps (e.g., adherence to HIV/AIDS antiretroviral therapy, uptake and demand of maternal health service, and compliance with malaria treatment guidelines). While some media evidence demonstrates effectiveness in changing cognitive abilities, knowledge, and attitudes, evidence is minimal on behavioral endpoints linked to child survival. Population level behavior change is necessary to end preventable child deaths. Donors and low- and middle-income countries are encouraged to implement recommendations for informing practice, policy, and research decisions to fully maximize the impact potential of mHealth and multimedia for child survival and development.

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          Most cited references31

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          Human population: the next half century.

          Joel Cohen (2003)
          By 2050, the human population will probably be larger by 2 to 4 billion people, more slowly growing (declining in the more developed regions), more urban, especially in less developed regions, and older than in the 20th century. Two major demographic uncertainties in the next 50 years concern international migration and the structure of families. Economies, nonhuman environments, and cultures (including values, religions, and politics) strongly influence demographic changes. Hence, human choices, individual and collective, will have demographic effects, intentional or otherwise.
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            Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia

            Background In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Methods Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Results Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Conclusions Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.
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              Stages of change in the modification of problem behaviors.

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                Author and article information

                Contributors
                Journal
                J Health Commun
                J Health Commun
                uhcm20
                UHCM
                Journal of Health Communication
                Taylor & Francis Group
                1081-0730
                1087-0415
                6 May 2014
                10 September 2014
                : 19
                : sup1 , Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: A Review of the Evidence
                : 164-189
                Affiliations
                [ a ]Division of Clinical Research , National Institute for Allergy and Infectious Diseases , Bethesda , Maryland , USA
                [ b ]Columbia University Mailman School of Public Health , New York , New York , USA
                [ c ]The John Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
                [ d ]Health Behavior Health Education Department, School of Public Health , University of Michigan , Ann Arbor , Michigan , USA
                [ e ]PCI Media Impact , New York , New York , USA
                [ f ]Blue Butterfly Collaborative , Portland , Maine , USA
                [ g ]United Nations Children's Fund , New York , New York , USA
                Author notes
                Division of Clinical Research, National Institute of Allergy and Infectious Diseases, 6700B Rockledge Drive , Bethesda , MD , 20892 , USA E-mail: ehiggs@ 123456niaid.nih.gov
                Article
                929763 Journal of Health Communication, Vol. 19, No. S1, pp. 164–189
                10.1080/10810730.2014.929763
                4255285
                25207452
                3f949c94-af90-4734-b446-034b9e402a01
                Copyright @ 2014

                This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.

                History
                Page count
                Figures: 1, Tables: 1, References: 61, Pages: 26
                Categories
                Evidence Summit Review Articles

                Communication & Media studies
                Communication & Media studies

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