Effects of Mobile Health Technologies on Uptake of Routine Growth Monitoring among Caregivers of Children Aged 9 to 18 Months in Kenya

Journal of Primary Care and Community Health, Volume 12, Year 2021

Interpretation

This study aimed at finding out the effects of mobile health (mhealth) technologies on uptake of Routine Growth Monitoring (RGM) among caregivers of children aged above 9 months in Kenya. This was a quasi-experimental study. The experiment groups received Short Text Message (STM) and Voice Call (VC). The analysis demonstrates that in month 1, caregivers who received STM were 6.875 times more likely to take their children for RGM compared to control (OR = 6.875; 95 CI: 3.591-13.164); caregivers who received VC were 6.750 times more likely to take their children for RGM compared to those in control arm (OR = 6.750; 95 CI: 3.522-12.938). Policy makers and implementers in the health will find these study findings useful in deciding whether or not to adopt STM or VC in improving uptake of RGM for children above 9 months. This was a quasi-experimental study design. Study participants were recruited from 6 selected health facilities. Health facilities were purposively selected based on the high population of children visiting Maternal neonatal and child health clinics compared to the unselected health facilities.14 Randomization was done by use of simple random sampling to assign 2 health facilities for each of the 3 study arms. Upon randomization, the first experimental arm comprised Nyamira County Referral Hospital and Tinga Sub-County Hospital; the second experimental arm had Borabu Sub-County Hospital and Nyamusi Sub-County Hospital while the third had Keroka Sub-County Hospital and Ekeronyo Sub-County Hospital. Recruitment of the study subjects was done during their nineth month visit to clinic. During the recruitment period, all the caregivers with children aged 9 months visiting for measles vaccine were recruited until the correct sample was arrived at. The sample size (n = 180) was arrived at using a formula by Charan and Biswas.17 Those caregivers who had taken the selected health facilities as their regular child welfare centers and had access to a mobile phone within their household were included in the study. The selected caregivers in the intervention arm were asked to state the language in which STM and VC could be communicated. For the first experimental arm, caregivers received a Short Text Message (STM). A text message of about 15 words was designed by the study. STM was sent once to the participants before the next clinic it (a day prior to appointment day). For the second experimental arm, caregivers received Voice Call (VC). VC that lasted for not more than 2 min served as a reminder for next clinic visit. The voice call was also done once before the next appointment (a day prior to appointment day). Both the STM and VC were done simultaneously before appointment. The study considered suggestions given by health care providers in Maternal, Neonatal, and Child Health (MNCH) sections on the content of the text message as a reminder to the caregivers for clinic visit. The content of the STM and VC included; the name of the child, appointment date and time, and name of the health facility. Caregivers in the control arm did not receive STM nor VC. All caregivers in both intervention and control arms received usual care including health education. The researcher then followed up the intervention arms from the 10th month for a period of 9 months while the control arm was not followed up. Questionnaires with both closed and open-ended questions were used to obtain information from the 180 caregivers involved in the study. Key Informant Interview guide was used to collect information from 6 key informants. Statistical Package for Social Sciences (SPSS) version 23 was used for the analysis of the quantitative data collected. Chi-square test and Odds Ratio were used to test the association between the dependent and independent variables and the association was deemed significant when P-value was less than .05 at 95% confidence level. Approval to conduct the study was obtained from Kenyatta University Graduate School. Ethical clearance was obtained from Kenyatta University Ethics and Review Committee. Research permit was sought from National Commission for Science, Technology and Innovation (NACOSTI). Further approval was sought from ethics and review committee in the County. The study sought informed consent from the respondents before proceeding with the research.

AI Digest

Study Justification:

This study aimed to investigate the effects of mobile health (mhealth) technologies, specifically Short Text Message (STM) and Voice Call (VC), on the uptake of Routine Growth Monitoring (RGM) among caregivers of children aged 9 to 18 months in Kenya. The study findings provide valuable insights for policy makers and implementers in the health sector, helping them make informed decisions about adopting STM or VC to improve the uptake of RGM for children above 9 months.

Highlights:

– The study used a quasi-experimental design and recruited participants from 6 selected health facilities in Kenya.
– Caregivers who received STM were 6.875 times more likely to take their children for RGM compared to the control group.
– Caregivers who received VC were 6.750 times more likely to take their children for RGM compared to the control group.
– The study findings suggest that both STM and VC can effectively increase the uptake of RGM among caregivers.

Recommendations:

Based on the study findings, the following recommendations are made:

1. Policy makers should consider adopting STM or VC as part of routine health interventions to improve the uptake of RGM for children aged 9 to 18 months.
2. Implementers in the health sector should explore the feasibility of integrating mobile health technologies into existing healthcare systems to enhance caregiver engagement and adherence to RGM.
3. Further research should be conducted to assess the long-term impact of mobile health technologies on child health outcomes and caregiver behavior.

Key Role Players:

1. Policy makers in the health sector
2. Implementers of healthcare programs
3. Health facility administrators
4. Healthcare providers
5. Mobile network operators
6. Researchers and academics

Cost Items for Planning Recommendations:

1. Development and implementation of mobile health technology platforms
2. Training and capacity building for healthcare providers and caregivers
3. Mobile network connectivity and data plans
4. Monitoring and evaluation of the intervention
5. Research and data analysis
6. Stakeholder engagement and coordination efforts
7. Dissemination of findings and knowledge translation activities

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a quasi-experimental study design and includes odds ratios and confidence intervals. However, there are some areas for improvement. The abstract could provide more details on the sample size calculation and the recruitment process. Additionally, it would be helpful to include information on the response rate and any potential limitations of the study. Finally, the abstract could benefit from a clearer statement of the study’s implications and recommendations for policy makers and implementers in the health sector.

Abstract

This was a quasi-experimental study design. Study participants were recruited from 6 selected health facilities. Health facilities were purposively selected based on the high population of children visiting Maternal neonatal and child health clinics compared to the unselected health facilities.14 Randomization was done by use of simple random sampling to assign 2 health facilities for each of the 3 study arms. Upon randomization, the first experimental arm comprised Nyamira County Referral Hospital and Tinga Sub-County Hospital; the second experimental arm had Borabu Sub-County Hospital and Nyamusi Sub-County Hospital while the third had Keroka Sub-County Hospital and Ekeronyo Sub-County Hospital. Recruitment of the study subjects was done during their nineth month visit to clinic. During the recruitment period, all the caregivers with children aged 9 months visiting for measles vaccine were recruited until the correct sample was arrived at. The sample size (n = 180) was arrived at using a formula by Charan and Biswas.17 Those caregivers who had taken the selected health facilities as their regular child welfare centers and had access to a mobile phone within their household were included in the study. The selected caregivers in the intervention arm were asked to state the language in which STM and VC could be communicated. For the first experimental arm, caregivers received a Short Text Message (STM). A text message of about 15 words was designed by the study. STM was sent once to the participants before the next clinic it (a day prior to appointment day). For the second experimental arm, caregivers received Voice Call (VC). VC that lasted for not more than 2 min served as a reminder for next clinic visit. The voice call was also done once before the next appointment (a day prior to appointment day). Both the STM and VC were done simultaneously before appointment. The study considered suggestions given by health care providers in Maternal, Neonatal, and Child Health (MNCH) sections on the content of the text message as a reminder to the caregivers for clinic visit. The content of the STM and VC included; the name of the child, appointment date and time, and name of the health facility. Caregivers in the control arm did not receive STM nor VC. All caregivers in both intervention and control arms received usual care including health education. The researcher then followed up the intervention arms from the 10th month for a period of 9 months while the control arm was not followed up. Questionnaires with both closed and open-ended questions were used to obtain information from the 180 caregivers involved in the study. Key Informant Interview guide was used to collect information from 6 key informants. Statistical Package for Social Sciences (SPSS) version 23 was used for the analysis of the quantitative data collected. Chi-square test and Odds Ratio were used to test the association between the dependent and independent variables and the association was deemed significant when P-value was less than .05 at 95% confidence level. Approval to conduct the study was obtained from Kenyatta University Graduate School. Ethical clearance was obtained from Kenyatta University Ethics and Review Committee. Research permit was sought from National Commission for Science, Technology and Innovation (NACOSTI). Further approval was sought from ethics and review committee in the County. The study sought informed consent from the respondents before proceeding with the research.

Materials

N/A

Innovations

Based on the provided study, the following innovations can be recommended to improve access to maternal health:

1. Mobile Health Technologies (mHealth): The study found that the use of Short Text Messages (STM) and Voice Calls (VC) significantly increased the likelihood of caregivers taking their children for Routine Growth Monitoring (RGM). Implementing mHealth technologies can be an effective way to remind and educate caregivers about maternal health appointments and important information.

2. Quasi-Experimental Study Design: The study utilized a quasi-experimental design to evaluate the effects of mHealth technologies on RGM uptake. This design can be replicated in other settings to assess the impact of different interventions on maternal health outcomes.

3. Purposive Selection of Health Facilities: The study selected health facilities based on the high population of children visiting Maternal neonatal and child health clinics. This approach can be used to identify facilities with high demand for maternal health services and prioritize resource allocation accordingly.

4. Randomization: Simple random sampling was used to assign health facilities to different study arms. Randomization helps ensure that the groups being compared are similar, reducing bias and increasing the validity of the study results.

5. Language Preference: Caregivers in the intervention arm were asked to state the language in which STM and VC could be communicated. Considering language preferences can improve communication and understanding, leading to better engagement with maternal health services.

6. Content of STM and VC: The study considered suggestions from healthcare providers to design the content of the text message and voice call reminders. Involving healthcare providers in developing the content can ensure that the reminders are relevant, clear, and effective in encouraging caregivers to attend appointments.

7. Follow-up and Data Collection: The researcher followed up with the intervention arms for a period of 9 months to assess the long-term effects of the interventions. Using questionnaires and key informant interviews, data was collected to evaluate the impact of the interventions on RGM uptake.

8. Ethical Considerations: The study obtained ethical clearance and informed consent from participants, ensuring that the research was conducted in an ethical manner and respecting the rights and privacy of the caregivers.

These innovations can be considered when designing interventions to improve access to maternal health in other contexts.

AI Innovations Description

The recommendation from this study is to use mobile health (mhealth) technologies, specifically Short Text Messages (STM) and Voice Calls (VC), to improve the uptake of Routine Growth Monitoring (RGM) among caregivers of children aged 9 to 18 months in Kenya. The study found that caregivers who received STM were 6.875 times more likely to take their children for RGM compared to the control group, and caregivers who received VC were 6.750 times more likely to take their children for RGM compared to the control group.

To implement this recommendation, policy makers and implementers in the health sector can consider adopting STM or VC as a means to remind caregivers about their child’s clinic appointments for RGM. The content of the messages or calls should include the child’s name, appointment date and time, and the name of the health facility. Caregivers who regularly visit selected health facilities and have access to a mobile phone within their household should be included in the intervention.

It is important to note that this recommendation is based on a quasi-experimental study design conducted in six selected health facilities in Kenya. The study participants were recruited during their ninth-month visit to the clinic, and the sample size was determined using a formula by Charan and Biswas. The intervention arms received either STM or VC, while the control arm did not receive any messages or calls. The study followed up with the intervention arms for nine months, while the control arm was not followed up.

Ethical clearance and research permits were obtained before conducting the study, and informed consent was obtained from the respondents. The data collected was analyzed using statistical methods such as chi-square test and odds ratio.

Overall, the recommendation to use mhealth technologies, specifically STM and VC, can be a promising innovation to improve access to maternal health by increasing the uptake of Routine Growth Monitoring among caregivers of children aged 9 to 18 months in Kenya.

AI Innovations Methodology

Based on the provided description, the study aimed to investigate the effects of mobile health (mhealth) technologies on the uptake of Routine Growth Monitoring (RGM) among caregivers of children aged 9 to 18 months in Kenya. The study utilized a quasi-experimental design, with participants recruited from six selected health facilities. The participants were randomly assigned to three study arms: two experimental arms receiving either Short Text Message (STM) or Voice Call (VC), and a control arm that did not receive any intervention.

The methodology involved recruiting caregivers with children aged 9 months visiting for measles vaccine until the desired sample size of 180 was reached. The selected caregivers in the intervention arms were asked to state the language in which STM and VC could be communicated. For the first experimental arm, caregivers received a text message containing appointment details a day prior to their clinic visit. For the second experimental arm, caregivers received a voice call reminder lasting no more than 2 minutes before their appointment. Caregivers in the control arm did not receive any intervention but received usual care, including health education.

Data was collected using questionnaires with closed and open-ended questions from the 180 caregivers involved in the study. Key informant interviews were also conducted with six key informants. The collected quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Chi-square tests and Odds Ratios were used to test the association between dependent and independent variables, with statistical significance set at a p-value of less than 0.05 at a 95% confidence level.

To simulate the impact of these recommendations on improving access to maternal health, a similar methodology could be employed. The study could recruit a larger sample size from a wider range of health facilities to ensure representativeness. The intervention arms could be expanded to include additional mhealth technologies such as mobile apps or interactive voice response systems. The impact of these recommendations could be assessed by comparing the uptake of maternal health services among caregivers who receive the interventions versus those who do not. Data could be collected through questionnaires, interviews, and possibly through the use of electronic health records. Statistical analysis could be conducted to determine the association between the interventions and the uptake of maternal health services, using appropriate statistical tests and measures such as Odds Ratios. Ethical considerations and approvals would need to be obtained before conducting such a study.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1177/21501327211010995

ISSN: 21501319

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Technology and Innovations

Study Countries:

Kenya

Study Design:

Case-Control Study, Cross Sectional Study, Quasi Experimental Study, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative