Evaluation of a mHealth Data Quality Intervention to Improve Documentation of Pregnancy Outcomes by Health Surveillance Assistants in Malawi: A Cluster Randomized Trial

BackgroundWhile community health workers are being recognized as an integral work force with growing responsibilities, increased demands can potentially affect motivation and performance. The ubiquity of mobile phones, even in hard-to-reach communities, has facilitated the pursuit of novel approaches to support community health workers beyond traditional modes of supervision, job aids, in-service training, and material compensation. We tested whether supportive short message services (SMS) could improve reporting of pregnancies and pregnancy outcomes among community health workers (Health Surveillance Assistants, or HSAs) in Malawi.Methods and FindingsWe designed a set of one-way SMS that were sent to HSAs on a regular basis during a 12-month period. We tested the effectiveness of the cluster-randomized intervention in improving the complete documentation of a pregnancy. We defined complete documentation as a pregnancy for which a specific outcome was recorded. HSAs in the treatment group received motivational and data quality SMS. HSAs in the control group received only motivational SMS. During baseline and intervention periods, we matched reported pregnancies to reported outcomes to determine if reporting of matched pregnancies differed between groups and by period. The trial is registered as ISCTRN24785657.ConclusionsStudy results show that the mHealth intervention improved the documentation of matched pregnancies in both the treatment (OR 1.31, 95% CI: 1.10–1.55, p

背景 尽管社区卫生工作者正被视为肩负日益繁重职责的不可或缺的工作队伍，但不断攀升的工作需求可能会对其工作动机与绩效产生潜在负面影响。即便在难以抵达的偏远社区，移动电话的普及也为探索创新支持路径提供了便利，得以赋能社区卫生工作者，而非仅局限于传统的监督模式、工作辅助工具、在职培训以及物质补偿手段。我们开展了测试，旨在探究支持性短消息服务（Short Message Service, SMS）能否改善马拉维境内社区卫生工作者（健康监测助理，Health Surveillance Assistants，简称HSAs）对妊娠及妊娠结局的上报工作。
方法与结果 我们设计了一组单向短消息服务内容，在12个月的周期内定期发送给HSAs。我们测试了整群随机干预试验在提升妊娠完整记录率方面的有效性，其中完整记录被定义为已明确记录妊娠结局的妊娠病例。干预组的HSAs会收到兼具激励性与数据质量提示的短消息服务信息，对照组的HSAs仅收到激励性短消息服务信息。在基线期与干预期内，我们将上报的妊娠病例与上报的结局信息进行匹配，以对比两组间以及不同时期内匹配妊娠病例的上报情况是否存在差异。本试验已注册为ISCTRN24785657。
结论 研究结果显示，此项移动健康（mobile health, mHealth）干预措施提升了匹配妊娠病例的记录率，其中干预组的比值比（Odds Ratio, OR）为1.31，95%置信区间（95% Confidence Interval, 95% CI）为1.10–1.55，P值