Mobile phone access and comfort: implications for HIV and tuberculosis care in India and South Africa

  • The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, Volume 23, No. 7, Year 2019

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Study Justification:
– India and South Africa have high burdens of tuberculosis (TB) and human immunodeficiency virus (HIV) infection, respectively.
– Care retention for TB and HIV is suboptimal in these countries.
– Mobile phone access and comfort could potentially improve care retention and outcomes.
– This study aimed to identify factors associated with mobile phone access and comfort and assess access patterns in India and South Africa.
Study Highlights:
– The study enrolled 261 participants, with 136 in India and 125 in South Africa.
– Over a period of 1 week to 6 months, participant contact decreased from 90% to 57% in India and from 93% to 70% in South Africa.
– In South Africa, clinic visits for HIV management were associated with lower odds of contact compared to other priorities.
– In India, 57% of participants reported discomfort with texting, with higher discomfort among the unemployed and those aged ≥35 years.
– In South Africa, 91% of participants reported comfort with texting.
Study Recommendations:
– Mobile phone contact for TB and HIV care needs improvement, as it was poor at 6 months.
– Alternative approaches may be necessary for certain subpopulations who experience discomfort with texting or have lower access to mobile phones.
– Further research and interventions are needed to optimize the use of mobile phones in TB-HIV care.
Key Role Players:
– Researchers and scientists in the field of TB and HIV care
– Healthcare providers and professionals
– Policy makers and government officials
– Non-governmental organizations (NGOs) and community-based organizations
– Mobile network operators and technology companies
Cost Items for Planning Recommendations:
– Research and data collection expenses
– Personnel costs for researchers, healthcare providers, and support staff
– Training and capacity-building programs for healthcare providers
– Development and implementation of mobile phone-based interventions
– Communication and outreach activities to raise awareness and promote mobile phone access
– Monitoring and evaluation of the interventions
– Collaboration and coordination efforts among stakeholders
– Infrastructure and technology costs for mobile phone access and support

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a cross-sectional and longitudinal assessment of mobile phone access and comfort in India and South Africa. The enrollment of 261 participants provides a decent sample size. The study identified factors associated with mobile phone access and comfort, and assessed access patterns over time. However, the abstract does not provide specific details about the methodology used or the statistical analysis performed. To improve the strength of the evidence, the abstract could include more information about the study design, sampling method, data collection process, and statistical tests used. Additionally, providing more specific results and effect sizes would enhance the clarity and robustness of the findings.

SETTING: India and South Africa shoulder the greatest burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection respectively, but care retention is suboptimal.OBJECTIVE: We conducted a study in Pune, India, and Matlosana, South Africa, 1) to identify the factors associated with mobile phone access and comfort of use, 2) to assess access patterns.DESIGN: A cross-sectional study assessed mobile phone access, and comfort; a longitudinal study assessed access patterns.RESULTS: We enrolled 261 participants: 136 in India and 125 in South Africa. Between 1 week and 6 months, participant contact decreased from 90% (n = 122) to 57% (n = 75) in India and from 93% (n = 116) to 70% (n = 88) in South Africa. In the latter, a reason for a clinic visit for HIV management was associated with 63% lower odds of contact than other priorities (e.g., diabetes mellitus, maternal health, TB). In India, 57% (n = 78) reported discomfort with texting; discomfort was higher in the unemployed (adjusted OR [aOR] 4.97, 95%CI 1.12-22.09) and those aged ≥35 years (aOR 1.10, 95%CI 1.04-1.16) participants, but lower in those with higher education (aOR 0.04, 95% CI 0.01-1.14). In South Africa, 91% (n = 114) reported comfort with texting.CONCLUSION: Mobile phone contact was poor at 6 months. While mHealth could transform TB-HIV care, alternative approaches may be needed for certain subpopulations.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile phone-based reminders and notifications: Utilizing mobile phones to send reminders and notifications to pregnant women about important prenatal care appointments, medication schedules, and health education information.

2. Mobile phone-based telemedicine: Implementing telemedicine services through mobile phones to allow pregnant women to consult with healthcare providers remotely, reducing the need for in-person visits and improving access to medical advice.

3. Mobile phone-based health education: Developing mobile phone applications or text messaging services that provide pregnant women with relevant and accurate health information, including prenatal care guidelines, nutrition advice, and warning signs to watch out for during pregnancy.

4. Mobile phone-based appointment scheduling: Creating mobile phone applications or platforms that allow pregnant women to easily schedule and manage their prenatal care appointments, reducing barriers to accessing healthcare services.

5. Mobile phone-based transportation assistance: Integrating mobile phone applications or services that provide pregnant women with information on available transportation options to healthcare facilities, helping them overcome transportation challenges and improve access to maternal health services.

6. Mobile phone-based support networks: Establishing mobile phone-based support networks or online communities where pregnant women can connect with each other, share experiences, and receive emotional support, fostering a sense of community and reducing feelings of isolation.

These innovations leverage the widespread use of mobile phones to improve access to maternal health services, enhance communication between healthcare providers and pregnant women, and empower women to take an active role in their own healthcare.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health could be to leverage mobile phone technology and mHealth (mobile health) interventions. The study conducted in India and South Africa highlights the potential of mobile phone access and comfort for improving healthcare outcomes.

Here are the key points to consider for developing an innovation:

1. Mobile phone access: The study found that a significant proportion of participants had access to mobile phones. This indicates that mobile phones can be utilized as a means of communication and information dissemination for maternal health services.

2. Comfort with texting: While discomfort with texting was reported by some participants in India, the majority in South Africa reported comfort with texting. This suggests that text-based interventions, such as SMS reminders and educational messages, can be effective in improving access to maternal health information and services.

3. Poor contact retention: The study revealed a decrease in participant contact over time. To address this, innovative strategies should be developed to ensure consistent and sustained engagement with pregnant women and new mothers. This could include personalized messaging, interactive voice response systems, or mobile applications specifically designed for maternal health.

4. Tailored interventions: The study also highlighted the need for alternative approaches for certain subpopulations. It is important to consider the specific needs and challenges faced by different groups, such as unemployed individuals or those with lower education levels, and develop targeted interventions that address their unique circumstances.

By leveraging mobile phone technology and mHealth interventions, such as SMS reminders, educational messages, and tailored interventions, access to maternal health can be improved. These innovations can help overcome barriers to healthcare access, enhance communication between healthcare providers and patients, and ultimately contribute to better maternal health outcomes.
AI Innovations Methodology
Based on the provided information, one potential innovation to improve access to maternal health could be the use of mobile phone technology for maternal health services. This innovation could involve developing mobile applications or text messaging services specifically designed to provide maternal health information, reminders, and support to pregnant women and new mothers.

To simulate the impact of this recommendation on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific group of pregnant women and new mothers who would benefit from improved access to maternal health services through mobile phone technology.

2. Collect baseline data: Gather information on the current access to maternal health services in the target population, including factors such as clinic visits, prenatal care utilization, and health outcomes.

3. Develop the mobile phone intervention: Design and implement the mobile phone application or text messaging service that provides maternal health information, reminders, and support. Ensure that the intervention is user-friendly, culturally appropriate, and accessible to the target population.

4. Implement the intervention: Roll out the mobile phone intervention to the target population and track its usage and engagement. Monitor the number of women who sign up for the service, the frequency of interaction, and the types of information and support accessed.

5. Evaluate the impact: Compare the access to maternal health services and health outcomes of the target population before and after the implementation of the mobile phone intervention. Use quantitative data, such as the number of clinic visits, prenatal care utilization rates, and maternal and infant health indicators, to assess the impact of the intervention.

6. Analyze the results: Analyze the data collected to determine the effectiveness of the mobile phone intervention in improving access to maternal health services. Identify any barriers or challenges faced by the target population in utilizing the intervention.

7. Refine and iterate: Based on the evaluation results, make any necessary adjustments or improvements to the mobile phone intervention. Continuously monitor and evaluate the impact of the intervention over time to ensure its effectiveness and sustainability.

By following this methodology, researchers and policymakers can assess the potential impact of using mobile phone technology to improve access to maternal health services and make informed decisions about its implementation and scalability.

Statistics:
Citations: 3
Authors: 14
Identifiers:
DOI: 10.5588/ijtld.18.0542
Research Areas:
Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Technology and Innovations
Study Countries:
South Africa
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
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