Health workers’ experiences, barriers, preferences and motivating factors in using mHealth forms in Ethiopia

Human Resources for Health

Geert-Jan Dinant³  Roman Blanco⁴  Kidane Tadesse¹  Mark Spigt²  Henock Yebyo¹  Alex Little⁴  Araya Abrha Medhanyie¹ 

[1] Department of Public Health, College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia;General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway;Department of Family Medicine, CAPHRI, School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands;Digital Campus, Winchester, 21 North Drive, Littletown, Winchester S022 6QA, England, UK

关键词: Mobile technologies;    Smartphones;    Electronic forms;    mHealth;    Mobile health;    Maternal health care;    Primary health care;    Midwives;    Health extension workers;    Community health workers;   

Others  :  1133715
DOI  :  10.1186/1478-4491-13-2

 received in 2014-05-18, accepted in 2014-12-20,  发布年份 2015

【 摘 要 】

Background

Mobile health (mHealth) applications, such as innovative electronic forms on smartphones, could potentially improve the performance of health care workers and health systems in developing countries. However, contextual evidence on health workers’ barriers and motivating factors that may influence large-scale implementation of such interfaces for health care delivery is scarce.

Methods

A pretested semistructured questionnaire was used to assess health workers’ experiences, barriers, preferences, and motivating factors in using mobile health forms on smartphones in the context of maternal health care in Ethiopia. Twenty-five health extension workers (HEWs) and midwives, working in 13 primary health care facilities in Tigray region, Ethiopia, participated in this study.

Results

Over a 6-month period, a total of 2,893 electronic health records of 1,122 women were submitted to a central computer through the Internet. Sixteen (69.6%) workers believed the forms were good reminders on what to do and what questions needed to be asked. Twelve (52.2%) workers said electronic forms were comprehensive and 9 (39.1%) workers saw electronic forms as learning tools. All workers preferred unrestricted use of the smartphones and believed it helped them adapt to the smartphones and electronic forms for work purposes. With regards to language preference, 18 (78.3%) preferred using the local language (Tigrinya) version of the forms to English. Indentified barriers for not using electronic forms consistently include challenges related to electronic forms (for example, problem with username and password setting as reported by 5 (21.7%), smartphones (for example, smartphone froze or locked up as reported by 9 (39.1%) and health system (for example, frequent movement of health workers as reported by 19 (82.6%)).

Conclusions

Both HEWs and midwives found the electronic forms on smartphones useful for their day-to-day maternal health care services delivery. However, sustainable use and implementation of such work tools at scale would be daunting without providing technical support to health workers, securing mobile network airtime and improving key functions of the larger health system.

【 授权许可】

   
2015 Medhanyie et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Singh P, Sachs JD: 1 million community health workers in sub-Saharan Africa by 2015. Lancet 2013, 382(9889):363-5.
• [2]Federal Ministry of Health of Ethiopia: Health Extension Program in Ethiopia Profile. Addis Ababa: Health Extension and Education Center. Ministry of Health; 2007.
• [3]Federal Ministry of Health of Ethiopia: Health Sector Development Programme III, Annual performance report. Addis Ababa: Ministry of Health; 2010.
• [4]Federal Ministry of Health of Ethiopia: Health Sector Development Program IV (2010/11-2014/15). Addis Ababa: Federal Ministry of Health of Ethiopia Planning and Program Department; 2010.
• [5]Federal Ministry of Health (FMOH) of Ethiopia: Health and Health Related Indicators 2010/11. Addis Ababa: Ministry of Health; 2011.
• [6]Teklehaimanot HD, Teklehaimanot A: Human resource development for a community-based health extension program: a case study from Ethiopia. Hum Resour Health 2013, 11(1):39. BioMed Central Full Text
• [7]Federal Ministry of Health (FMOH) of Ethiopia: Health and Health Related Indicators 2003/04. Addis Ababa: Ministry of Health; 2004.
• [8]Medhanyie A, Spigt M, Kifle Y, Schaay N, Sanders D, Blanco R, et al.: The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Serv Res 2012, 12:352. BioMed Central Full Text
• [9]Karim AM, Admassu K, Schellenberg J, Alemu H, Getachew N, Ameha A, et al.: Effect of Ethiopia's health extension program on maternal and newborn health care practices in 101 rural districts: a dose-response study. PLoS One 2013, 8(6):e65160.
• [10]Central Statistical Agency [Ethiopia], ORC Macro: Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro; 2006.
• [11]Central Statistical Agency and ICF International: Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, MD, USA: Central Statistical Agency and ICF International; 2012.
• [12]Medhanyie A, Spigt M, Dinant G, Blanco R: Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study. Hum Resour Health 2012, 10(1):44. BioMed Central Full Text
• [13]Koblinsky M, Tain F, Gaym A, Karim A, Carnell M, Tesfaye S: Responding to the challenge - The Ethiopian Health Extension Programme and back up support for maternal health care. Ethiop J Health Dev 2010, 24(Special issue 1):105-9.
• [14]Teklehaimanot A, Kitaw Y, G/yohannes A, Girma S, Seyoum A, Desta H, et al.: Study of working conditions of Health Extension Workers in Ethiopia. Ethiop J Health Dev 2007, 21(3):246-59.
• [15]Sebastian MS, Lemma H: Efficiency of the health extension programme in Tigray. Ethiopia: a data envelopment analysis. BMC Int Health Hum Rights 2010, 10:16. BioMed Central Full Text
• [16]Institute E: Barriers and gaps affecting mHealth in low and middle income Countries: A Policy White Paper. Washington DC: mHealth Alliance; 2010.
• [17]Vital Wave Consulting: mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. Washington, D.C. and Berkshire, UK: UN Foundation-Vodafone Foundation Partnership; 2009.
• [18]World Health Organization: mHealth: New Horizons for Health through Mobile Technologies, Global Observatory for eHealth series, Volume 3. Geneva: WHO; 2011.
• [19]Marshall C, Lewis D, Whittaker M: mHealth Technologies in Developing Countries: A Feasibility Assessment and a Proposed Framework. Working paper. Herston Qld 4006, Australia: The University of Queensland; 2013.
• [20]Vital Wave Consulting: mHealth in Ethiopia: Strategies for a new Framework. mHealth Ethiopia Report. California, USA: Vital Wave Consulting; 2011.
• [21]Kallander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AH, et al.: Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review. J Med Internet Res 2013, 15(1):e17.
• [22]Tamrat T, Kachnowski S: Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Matern Child Health J 2012, 16(5):1092-101.
• [23]Mosa AS, Yoo I, Sheets L: A systemic review of healthcare applications for smartphones. BMC Med Inform Decis Mak 2012, 12:67. BioMed Central Full Text
• [24]Kaplan WA: Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Global Health 2006, 2:9. BioMed Central Full Text
• [25]Little A, Medhanyie A, Yebyo H, Spigt M, Dinant GJ, Blanco R: Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia. PLoS One 2013, 8(10):e77563.
• [26]Rajput ZA, Mbugua S, Amadi D, Chepngeno V, Saleem JJ, Anokwa Y, et al.: Evaluation of an Android-based mHealth system for population surveillance in developing countries. J Am Med Inform Assoc 2012, 19(4):655-9.
• [27]Callaghan-Koru JA, Seifu A, Tholandi M, de Graft-Johnson J, Daniel E, Rawlins B, et al.: Newborn care practices at home and in health facilities in 4 regions of Ethiopia. BMC Pediatr 2013, 13(1):198. BioMed Central Full Text
• [28]Patnaik S, Brunskill E, Thies W: Evaluating the Accuracy of Data Collection on Mobile Phones: A study of forms, SMS, and Voice. Proc IEEE/ACM Int'l Conf Information and Comm Technologies and Development (ICTD) 2009.