Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: A feasibility study

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Study Justification:
– The study aims to assess the reliability of phone surveys as an alternative to face-to-face surveys in measuring reproductive, maternal, and child health knowledge among pregnant women in rural India.
– Increasing access to mobile phones has made phone surveys a potential rapid and low-cost method for data collection in low-resource settings.
– Understanding the factors influencing the uptake of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services is crucial for improving healthcare delivery in these settings.
Study Highlights:
– The study found that knowledge scores among pregnant women regarding maternal nutrition, pregnancy danger signs, family planning, essential newborn care, infant and young child feeding, and infant and young child care were generally low.
– Higher knowledge was associated with factors such as older age, higher levels of education and literacy, living in a nuclear family, primary health decision-making, greater attendance in antenatal care, and satisfaction with accredited social health activist services.
– The study also revealed that phone surveys can generate reliable population-level estimates of pregnant women’s knowledge, but they should not be used for individual-level tracking.
Study Recommendations:
– Improve access to education and literacy programs for pregnant women to enhance their knowledge on RMNCH&N topics.
– Strengthen antenatal care services and ensure the satisfaction of pregnant women with the services provided.
– Enhance the training of enumerators conducting phone surveys to improve reliability and minimize biases.
– Consider using a combination of face-to-face surveys and phone surveys for comprehensive data collection on reproductive, maternal, and child health knowledge.
Key Role Players:
– Researchers and data analysts to analyze the survey data and draw conclusions.
– Healthcare providers and policymakers to implement the study recommendations.
– Educators and literacy program coordinators to develop and deliver educational programs for pregnant women.
– Antenatal care service providers to improve the quality and accessibility of services.
– Enumerators and survey administrators to conduct phone surveys and ensure accurate data collection.
Cost Items for Planning Recommendations:
– Training programs for healthcare providers, enumerators, and educators.
– Development and implementation of educational materials and programs.
– Improvement of infrastructure and resources for antenatal care services.
– Monitoring and evaluation of the implementation of study recommendations.
– Research and data analysis expenses.
– Communication and coordination costs between key role players.

Objectives Efforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery. Participants Women 5-7 months pregnant with access to a phone. Setting Four districts of Madhya Pradesh, India. Design Cross-sectional surveys administered face-to-face and within 2 weeks, the same surveys were repeated among two random subsamples of the original sample: face-to-face (n=205) and caller-attended telephone interviews (n=375). Bivariate analyses, multivariable linear regression, and prevalence and bias-adjusted kappa scores are presented. Results Knowledge scores were low across domains: 52% for maternal nutrition and pregnancy danger signs, 58% for family planning, 47% for essential newborn care, 56% infant and young child feeding, and 58% for infant and young child care. Higher knowledge (≥1 composite score) was associated with older age; higher levels of education and literacy; living in a nuclear family; primary health decision-making; greater attendance in antenatal care and satisfaction with accredited social health activist services. Survey questions had low inter-rater and intermodal reliability (kappa<0.70) with a few exceptions. Questions with the lowest reliability included true/false questions and those with unprompted, multiple response options. Reliability may have been hampered by the sensitivity of the content, lack of privacy, enumerators' and respondents' profile differences, rapport, social desirability bias, and/or enumerator's ability to adequately convey concepts or probe. Conclusions Phone surveys are a reliable modality for generating population-level estimates data about pregnant women's knowledge, however, should not be used for individual-level tracking. Trial registration number NCT03576157.

Based on the description provided, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile phone surveys: The study highlights the use of phone surveys as a rapid and low-cost alternative to face-to-face surveys. This innovation allows for remote data collection, making it easier to reach pregnant women in rural areas who may have limited access to healthcare facilities.

2. Assessing determinants of knowledge: The study aims to assess the determinants of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) knowledge among pregnant women with access to phones. This innovation helps identify the factors that influence knowledge levels, allowing for targeted interventions and education programs to improve maternal health outcomes.

3. Reliability assessment of survey delivery: The study examines the reliability of alternative modalities of survey delivery, specifically face-to-face surveys and caller-attended telephone interviews. This innovation helps ensure that the data collected through phone surveys are accurate and reliable, providing valuable insights into the knowledge levels of pregnant women.

4. Identifying factors associated with higher knowledge: The study identifies factors associated with higher knowledge scores, such as age, education, literacy, family structure, health decision-making, and utilization of antenatal care services. This innovation helps in understanding the socio-demographic factors that contribute to better maternal health knowledge, enabling targeted interventions for vulnerable populations.

5. Highlighting areas of low knowledge: The study reveals low knowledge scores across various domains, including maternal nutrition, family planning, newborn care, infant feeding, and child care. This innovation helps prioritize areas for improvement and develop targeted educational campaigns and interventions to address these gaps in knowledge.

Overall, these innovations contribute to improving access to maternal health by utilizing mobile phone surveys, assessing knowledge determinants, ensuring survey reliability, identifying factors associated with higher knowledge, and addressing areas of low knowledge.
AI Innovations Description
The recommendation based on the study is to use phone surveys as a reliable and low-cost alternative to face-to-face surveys in order to improve access to maternal health. The study found that phone surveys can effectively measure reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) knowledge among pregnant women with access to phones. However, it is important to note that phone surveys should be used for generating population-level estimates and not for individual-level tracking. The study also highlighted some factors that may affect the reliability of phone surveys, such as the sensitivity of the content, lack of privacy, differences in profiles between enumerators and respondents, rapport, social desirability bias, and the ability of enumerators to convey concepts or probe effectively. Overall, using phone surveys can be an innovative approach to improve access to maternal health by providing a rapid and cost-effective means of gathering data on knowledge and understanding of RMNCH&N services among pregnant women.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and promote mobile applications that provide pregnant women with access to reliable and accurate information about reproductive, maternal, newborn, child health, and nutrition (RMNCH&N). These applications can include features such as educational content, appointment reminders, and access to healthcare providers through teleconsultations.

2. Telemedicine Services: Expand telemedicine services to rural areas, allowing pregnant women to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide timely advice and guidance during pregnancy.

3. Community Health Workers: Train and equip community health workers to provide essential maternal health services in rural areas. These workers can conduct home visits, provide education, and facilitate access to healthcare facilities for pregnant women.

4. Mobile Clinics: Establish mobile clinics that travel to remote areas, providing comprehensive maternal health services including prenatal care, vaccinations, and health screenings. This can help overcome transportation barriers and bring healthcare services closer to pregnant women in underserved areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific group of pregnant women in rural areas who would benefit from improved access to maternal health services.

2. Collect baseline data: Gather information on the current state of access to maternal health services in the target population, including factors such as distance to healthcare facilities, availability of healthcare providers, and knowledge levels of pregnant women regarding RMNCH&N.

3. Introduce the recommendations: Implement the recommended innovations, such as mHealth applications, telemedicine services, community health worker programs, and mobile clinics, in the target population.

4. Monitor and evaluate: Track the implementation of the recommendations and collect data on key indicators, such as the number of pregnant women utilizing the innovations, changes in knowledge levels, and improvements in access to maternal health services.

5. Analyze the data: Use statistical analysis techniques to assess the impact of the recommendations on improving access to maternal health. This can include comparing pre- and post-intervention data, conducting regression analyses to identify factors influencing access, and calculating indicators such as the increase in the number of pregnant women receiving prenatal care.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any challenges or limitations encountered during the implementation and suggest further improvements or modifications to enhance the impact.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health and provide evidence-based insights for future interventions.

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