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      Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project

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      Author(s): , MPH 1 , 2 , , MA, PhD 3 , 4 , , MA, PhD 5 , 6 , , MPH, MD 3 , , PhD 7 , , PhD 1 ,
      Editor(s):
      Other contributor(s): (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      Publication date (Electronic):
      Journal: JMIR Research Protocols
      Publisher: JMIR Publications
      Keywords: mobile health, Vietnam, maternal health, reproductive health, health equity

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          Abstract

          Background

          Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers.

          Objective

          The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam.

          Methods

          This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system.

          Results

          The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components.

          Conclusions

          This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam.

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          Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review

          Stephanie Sondaal, Joyce Linda Browne, Mary Amoakoh-Coleman … (2016)
          Introduction Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC. Methods The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014–April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis. Results In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results. Conclusion mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth’s impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.
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            Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial

            Stine Lund, Birgitte B Nielsen, Maryam Hemed … (2014)
            Background Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns’ survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining. We evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. We aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy. Methods This study was an open label pragmatic cluster-randomised controlled trial with primary healthcare facilities in Zanzibar as the unit of randomisation. 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. 24 primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text-message and voucher component. Primary outcome measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. Results The mobile phone intervention was associated with an increase in antenatal care attendance. In the intervention group 44% of the women received four or more antenatal care visits versus 31% in the control group (OR, 2.39; 95% CI, 1.03-5.55). There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although not statistically significant. Conclusions The wired mothers’ mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services, more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred. Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource-limited settings. Trial registration ClinicalTrials.gov, NCT01821222.
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              Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world.

              Tigest Tamrat, Stan Kachnowski (2012)
              Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.
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                Author and article information

                Contributors
                John O'Neil:
                Faculty of Health SciencesSimon Fraser University8888 University DriveBurnaby, BC, V5A1S6Canada1 778 782 53611 778 782 5927joneil@sfu.ca
                ORCID: http://orcid.org/0000-0001-6370-4564
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: January 2018
                Publication date (Electronic): 11 January 2018
                Volume: 7
                Issue: 1
                Electronic Location Identifier: e6
                Affiliations
                [1] 1 Faculty of Health Sciences Simon Fraser University Burnaby, BC Canada
                [2] 2 Gender and Sexual Health Initiative British Columbia Centre for Excellence in HIV/AIDS Vancouver, BC Canada
                [3] 3 Institute of Population, Health and Development Hanoi Viet Nam
                [4] 4 Nossal Institute for Global Health University of Melbourne Melbourne Australia
                [5] 5 Education Technology Innovation University Health Network Toronto, ON Canada
                [6] 6 Institute for Health Policy Management and Evaluation Department of Psychiatry University of Toronto Toronto, ON Canada
                [7] 7 Vietnam eHealth Medical Investment and Communication Hanoi Viet Nam
                Author notes
                Corresponding Author: John O'Neil joneil@ 123456sfu.ca
                Author information
                http://orcid.org/0000-0003-2226-5600
                http://orcid.org/0000-0003-1447-6600
                http://orcid.org/0000-0002-2748-2658
                http://orcid.org/0000-0002-4486-4535
                http://orcid.org/0000-0002-1741-669X
                http://orcid.org/0000-0001-6370-4564
                Article
                Publisher ID: v7i1e6
                DOI: 10.2196/resprot.7912
                PMC ID: 5785686
                PubMed ID: 29326095
                SO-VID: bb2aac3c-7bac-4e9f-95d5-bf325ed76bf5
                Copyright © ©Bronwyn McBride, Liem Thanh Nguyen, David Wiljer, Nguyen C Vu, Cuong K Nguyen, John O'Neil. Originally published in JMIR Research Protocols (http://resprot.jmir.org), 11.01.2018.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://resprot.jmir.org, as well as this copyright and license information must be included.

                History
                Date received : 1 May 2017
                Date revision requested : 4 July 2017
                Date revision received : 28 August 2017
                Date accepted : 17 November 2017
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: mobile health,vietnam,maternal health,reproductive health,health equity
                Data availability:
                Keywords: mobile health, vietnam, maternal health, reproductive health, health equity

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