A rural community-based investigation to assess mHealth for family planning advice in district Multan

Background: Globally, Pakistan is the 5th populous country. To increase the use of family planning services by public private business model, Punjab Population Innovation Fund selected “Connect4fp” project implemented by International Rescue Committee organization. The purpose of this research was to determine the impact of mobile health(mHealth) advice on family planning in project area. This project was implemented in 9 Union councils of district Multan, Pakistan. The innovative idea of this project was the use of mobile phones to spread family planning knowledge among community in the form of Interactive Voice Response (IVR) as well as Short Message Service (SMS) (i.e., text messages). Methods: A cross-sectional study targeted 197 men as well as women (mostly married women of reproductive age) receiving mobile messages or recorded robocalls from the project area. The purpose was to assess their family planning knowledge and awareness by using structured Likert scale questionnaire. Secondly the viewpoint about mHealth and its effect on family planning was determined from 40 private providers and 27 Family planning Champions (who were part of the project) by telephonic interviews. Their response was quantified by using Likert scale. Descriptive statistics were calculated of the study’s main variables. The association of family planning knowledge of community members was determined to their contraceptive use by using Chi square. Results:  The results specified that 60% community members included in this study told that their family planning knowledge is increased due to this mHealth program. 36% Private providers while 75% FP Champions were agreed that family planning patients are increased due to this mHealth program. Conclusion: Mobile messages and robocalls about family planning sent in local language positively contributed to increase FP knowledge and awareness in community. This may trigger communication about family planning within couples, as a result increase use of family planning services.

The efficacy of a personalized mhealth coaching program during pregnancy on maternal diet, supplement use, and physical activity: Protocol for a parallel-group randomized controlled trial

Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration.Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program\u27s effect on maternal and offspring health outcomes and assessment of its compliance and usability.Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit.Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023.Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries.Trial registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446.International registered report identifier (irrid): DERR1-10.2196/31611

Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features

Background Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother’s and the offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual …Peer reviewe

Raskaussovellukset, käyttö ja toiminnallisuudet

Tiivistelmä. Tämän tutkimuksen aiheena on raskaussovellukset. Raskaussovellukset ovat mobiililaitteille suunnattuja sovelluksia, joiden pääasiallisena tarkoituksena on tukea ja antaa tietoa raskaana olevalle henkilölle raskauden eri vaiheissa. Tutkimuksen tarkoituksena on selvittää kirjallisuuskatsauksen keinon, mitä sovelluksista ja niiden käytöstä tiedetään sekä millaisia toiminnallisuuksia ne sisältävät. Lisäksi pohditaan kulttuuristen erojen vaikutusta sovelluksiin ja sitä suosittelevatko viralliset tahot niiden käyttöä. Tutkimuksessa havaittiin, että erilaisia raskauteen liittyviä digitaalisia sovelluksia on tarjolla enemmän kuin mitään muita terveyteen liittyviä sovelluksia. Lisäksi esiin nousi sovellusten tavoittaman käyttäjäryhmän suuruus: USA:ssa jopa puolet odottavista äideistä. Myös huoli raskaussovellusten huonosta laadusta, sekä niiden kehittämiseen liittyvästä säännöstelyn ja valvonnan puutteesta korostui. Kulttuurin vaikusta raskaussovellusten sisältöön ei juurikaan havaittu, mutta tarve kulttuurisesti erikoistuneimmille sovelluksilla tunnistettiin. Huomio kiinnittyi myös sovellusten yksipuoliseen tapaan lähestyä raskautta niin sanotun normaalin raskauden näkökulmasta. Lisää tutkimusta puuttuvan sääntelyn ja valvonnan aiheuttamista seurauksista sovellusten laatuun tarvitaan, jotta ongelman laajuus tunnistetaan ja siihen voidaan reagoida riittävällä vakavuudella

Behavior Change Apps for Gestational Diabetes Management : Exploring Desirable Features

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.Gestational diabetes mellitus (GDM) has considerable and increasing health effects as it raises both the mother’s and offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and engaging insufficient physical activity. While telemedicine interventions requiring weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control amongst women with GDM, apps without extensive input from health care professionals are limited and have not shown to be effective. We aimed to improve the efficacy of GDM self-management apps by exploring desirable features in a review. We derived six desirable features from the multidisciplinary literature and we evaluated the state of implementation of these features in existing GDM apps. The results showed that features for increasing competence to manage GDM and for providing social support were largely lacking.Peer reviewe

Exploring mobile learning opportunities and challenges in Nepal: the potential of open-source platforms

With the increasing access to mobile devices in developing countries, the number of pilots and projects embracing mobile devices as learning tools is also growing. The important role it can play in improving education is also positively received within education communities. But, providing a successful mobile learning service is still significantly challenging. The considerable problems arise due to existing pedagogical, technological, political, social and cultural challenges and there has been a shortage of research concerning how to deploy and sustain this technology in a resource constrained educational environment. There are studies mainly conducted in sub-Saharan countries, India, and Latin America, which provide some guidelines for incorporating technology in the existing educational process. However, considering the contextual differences between these regions and other countries in Asia, such as Nepal, it requires a broader study in its own challenging socio-cultural context. In response to this difficulty, the aims of this exploratory research work are to study the distinct challenges of schools’ education in Nepal and evaluate the use of open-source devices to provide offline access to learning materials in order to recommend a sustainable mobile learning model. The developmental study was conducted in University of West London in order to assess the feasibility of these devices. The main study in Nepal explored i) the overall challenges to education in the challenging learning environment of schools with limited or no access to ICT, ii) how ICT might be helping teaching and learning in the rural public schools, and iii) how an offline mobile learning solution based on the open source platforms may facilitate English language teaching and learning. Data collection primarily involved interviews, questionnaires, observations and supplemented by other methods. This thesis presents the sustainable model for deploying and supporting mobile technology for education, which is based on the findings emerging from completed exploratory studies in Nepal. It highlights all the aspects that need to be addressed to ensure sustainability. However, to translate this understanding to a design is a complex challenge. For a mobile learning solution to be used in such challenging learning contexts, the need is to develop simple and innovative solutions that provide access to relevant digital learning resources and train teachers to embed technology in education. This thesis discusses these findings, limitations and presents implications for the design of future mobile learning in the context of Nepal

Designing a Multimedia Intervention for Illiterate and Semi-Illiterate Pregnant Women in Developing Countries: A Case of Uganda

Die hohe Müttersterblichkeit in Entwicklungsländern ist zum Teil auf indirekte Faktoren wie Analphabetismus und eingeschränkten Zugang zu Gesundheitsinformationen für Mütter zurückzuführen. Während gebildete Frauen auf Gesundheitsinformationen über Online-Plattformen und mHealth-Apps zugreifen können, müssen Analphabetinnen diese in Gesundheitseinrichtungen abrufen, was aufgrund der Transportkosten oft nicht möglich ist. Mobilfunktechnologie hat in der Gesundheitsversorgung Chancen für ressourcenarme Gemeinschaften eröffnet, die sonst nicht von den digitalen Technologien profitiert hätten. Obwohl Mobilfunktechnologie in der Müttergesundheit eingesetzt wird, können die meisten Maßnahmen nicht von Analphabeten genutzt werden, verwenden Sicherheitsmodelle die nicht auf den Kontext von Entwicklungsländern zugeschnitten sind, und wurden nicht auf ihre Auswirkungen auf die Müttergesundheit hin evaluiert. In dieser Arbeit wurden zwei (Web und Mobile) Apps entwickelt, die die Übermittlung von multimedialen Nachrichten zur Müttergesundheit, Terminerinnerungen und Anrufe/Chats erleichtern. Um die Anforderungen der Nutzer zu erfassen, wurde eine Feldstudie mit halbstrukturierten Interviews und Fokusgruppendiskussionen mit schwangeren Analphabetinnen, Gesundheitsexperten und Entwicklern durchgeführt. Es folgte die Entwicklung eines Sicherheitsmodells (T2RoL) zur Sicherung der Gesundheitsinformationen in den Apps, die dann nach einem nutzerzentrierten Designansatz entwickelt wurden. Eine zweite Feldstudie in Form von halbstrukturierten Interviews und Umfragen wurde durchgeführt, um die mobile App in einer randomisierten kontrollierten Studie mit 80 schwangeren Analphabetinnen über 9 Monate zu evaluieren. Die Auswertung zeigte, dass die App akzeptiert wurde sowie einfach zu erlernen und zu benutzen war. Das Wissen über Müttergesundheit in der Interventionsgruppe verbesserte sich, was sich positiv auf gesundheitsbezogene Entscheidungen und Gesundheitsmaßnahmen auswirkte.Maternal mortality is high in developing countries partly due to indirect factors such as illiteracy and limited access to maternal health information. While literate women can access health information from online platforms, and mHealth apps, illiterate women must get it from health facilities which is often not possible due to lack of transport fees. Mobile technology has opened opportunities in maternal health care for low resource communities that would otherwise not have benefited from digital technologies. Although used in maternal health, most interventions are not usable by the illiterate, use security models that are not tailored to the developing countries’ context, and have not been evaluated to assess their impact on maternal health care. In this thesis, two (web and mobile) apps that facilitate delivery of multimedia-based maternal health messages, appointment reminders, and calls/ chats were developed. To gather user requirements, a field study in form of semi-structured interviews and focus group discussions was conducted with illiterate pregnant women, health practitioners and developers. Development of a security model (T2RoL) to secure the health information in the apps followed. The apps were then developed following a user-centered design approach. A second field study in form of semi-structured interviews and surveys was conducted to evaluate the mobile app through a randomized controlled trial with 80 illiterate pregnant women that were followed for 9 months. Overall, results show that the app was acceptable, easy to learn and use. There was improved maternal health knowledge among the intervention group which positively influenced health related decision making and health practices

bump2bump: Designing and Evaluating Technology to Promote Maternal Wellbeing in the Transition to Motherhood

The notion of wellbeing is synonymous with feeling competent, supported and satisfied with one’s life. Understanding how to sustain one’s own wellbeing is important at times of significant life change. The transition to motherhood is characterised by major emotional and physiological changes, which can impact on maternal subjective wellbeing and affect pregnancy outcomes. While Human Computer Interaction (HCI) has begun to address some of the challenges in the prevention and treatment of affective disorders in vulnerable perinatal groups, approaches that promote holistic maternal wellbeing in the low-risk majority have received less attention. This thesis draws on the multidisciplinary legacy of digital intervention development, utilising best practice from eHealth and HCI. Six studies using quantitative and qualitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which proposed an integrated framework of factors involved in the successful development and evaluation of digital perinatal wellbeing resources. Study 2 used qualitative methods to explore the contextualised usage of digital resources by perinatal women. Studies 3, 4 and 5 involved the iterative development and formative evaluation of a prototype (bump2bump). Study 6 used mixed methods to explore the longitudinal, in-the-wild usage of bump2bump by a group of women as they became mothers. This thesis contributes to current discourse in HCI on how technology might be used positively and presents recommendations regarding the development and use of digital resources in first time pregnancy. Digital resources are increasingly relied upon when community services are lacking, and usage of such resources is particularly nuanced at the transition to motherhood. Design features that support users’ trust in content, facilitate face-to-face interaction with local similar others, and provide brief, practical information were found to be most important in meeting user needs. These findings can be used to inform the development and evaluation of digital perinatal wellbeing resources