Evaluation of an mHealth Intervention to Improve Women's Access to Maternal Health Services in Rural Tanzania
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Toronto
- Enrollment
- 572
- Primary Endpoint
- Delivery in a facility
Study Overview
Brief Summary
This study investigates whether training Community Health Workers (CHW) to use a smartphone-based prenatal counseling application as a "job aid" instead of the existing paper based standard is associated with increased women's use of maternal health services in Singida region, Tanzania.
Detailed Description
In low-income countries, frontline community health workers (CHWs) have potential to improve women's access to maternal health services through prenatal counseling and referral. However, CHW performance can often be enhanced with sufficient training, incentives, supportive supervision and job aids. Smartphone-based applications designed to assist CHWs with referrals, health education and client counseling may improve the quality of care delivered during household visits. There is a need for rigorous scientific studies on the impact of such interventions.
This study investigates whether CHWs' use of a smartphone-based application increases women's use of maternal health services in Singida region, Tanzania. It is hypothesized that smartphone-assisted counselling by CHWs can increase use of health facility-based delivery services compared to a control group of CHWs using standard paper-based protocols. This study is conducted within the context of larger project - SUSTAIN-MNCH Project (Supporting Systems to Improve Nutrition, Maternal, Newborn and Child Health), implemented by World Vision through multiple partners.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 16 Years to 49 Years (Child, Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •client of one of the CHWs enrolled in the mHealth study
- •visited at least once by a CHW following intervention (baseline training for CHWs) and during their most recent pregnancy
- •most recent delivery was a live birth and the child is still living
Exclusion Criteria
- Not provided
Arms & Interventions
Control (paper based)
Women received prenatal household visits from CHWs who were trained on the Tanzania Ministry of Health and Social Welfare's National integrated Maternal, Newborn and Child Health (i-MNCH) paper-based protocols, i.e. received intervention "SUSTAIN Paperbased training of CHW (SOC)"
Intervention: SUSTAIN Paperbased training of CHW (SOC) (Behavioral)
Intervention (Smart phone assisted)
Women received prenatal household visits from CHWs trained on the following:
A) National i-MNCH programme; and B) Smartphone-assisted counseling protocol: a smartphone application designed to assist with identification of danger signs during pregnancy, referral to health facilities, and MNCH counseling
, i.e. received intervention "SUSTAIN Smartphone training of CHW (SP+)"
Intervention: SUSTAIN Paperbased training of CHW (SOC) (Behavioral)
Intervention (Smart phone assisted)
Women received prenatal household visits from CHWs trained on the following:
A) National i-MNCH programme; and B) Smartphone-assisted counseling protocol: a smartphone application designed to assist with identification of danger signs during pregnancy, referral to health facilities, and MNCH counseling
, i.e. received intervention "SUSTAIN Smartphone training of CHW (SP+)"
Intervention: SUSTAIN Smartphone training of CHW (SP+) (Behavioral)
Outcomes
Primary Outcomes
Delivery in a facility
Time Frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Participant delivered at or on the way to a health facility, measured by retrospective report at time of interview, after delivery
Antenatal care attendance
Time Frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Whether participant attended 4 ANC visits or more during their most recent pregnancy
Secondary Outcomes
- Gestational age at first contact/ANC(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Iron supplementation during pregnancy(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- HIV screening HIV Screening(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- De-worming treatment during pregnancy(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Bednet use(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Malaria prophylaxis during pregnancy(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Tetanus Toxoid Vaccination(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Referrals(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Referral uptake(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Presence of partner at ANC(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Birth plan(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Early initiation of breastfeeding(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Exclusive breastfeeding at 7 days(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- BCG vaccination(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
- Maternal knowledge of danger signs during pregnancy(Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months))
Investigators
Daniel Sellen
Professor
University of Toronto