Understanding women’s, caregivers’, and providers’ experiences with home-based records: A systematic review of qualitative studies

Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants’ reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records’ potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems.

全球163个国家的母亲、照护者与医疗保健从业者均已使用纸质与电子家庭健康记录（Home-Based Records, HBRs）以辅助初级保健问诊。此类标准化记录具备赋能女性、提升母婴照护质量并缩小健康不公平性的潜力。本综述梳理了妇幼保健领域中母亲、照护者及从业者使用家庭健康记录的实践经验，并旨在探究此类干预措施的可行性、可接受性、可负担性与公平性。我们系统检索了1992年1月至2017年12月期间发表于MEDLINE、MEDLINE In-Process、MEDLINE Ahead of Print、Embase、CINAHL、ERIC及PsycINFO的相关文献，采用CASP量表评估研究质量，使用框架分析法开展证据合成，并通过GRADE-CERQual工具评价关键研究结论的置信度。在检索得到的7904条引文中，共有19项研究符合本综述的纳入标准。在上述研究中，母亲、照护者与儿童均分享了妇幼保健场景下使用家庭健康记录的相关经验，该记录有助于免疫接种监测及儿童生长发育评估。受试者提及家庭健康记录可作为医患双方的沟通纽带，这也解释了为何他们认为该工具能改善沟通、提升以患者为中心的照护质量，并增强孕期与育儿阶段的参与感与赋能效果。医疗保健从业者与护士均表示，家庭健康记录强化了他们与患者之间的联结感。尽管存在针对电子记录保密性的担忧，但并未有针对纸质记录的明确顾虑被报道。母亲与其他照护者均认为，家庭健康记录在辅助初级保健问诊及优化家庭医疗照护方面发挥着关键作用。但用户对电子家庭健康记录保密性的担忧，或是其设计存在的缺陷，可能会限制此类记录的应用潜力。医疗体系应抓住家庭健康记录赋能女性的契机，尤其是在识字率较低、医疗服务供给体系薄弱的地区。