Recognising & supporting informal mhealth in Africa through grassroots interventions (REIMAGINE)

认识

• 批准号: MR/Y015614/1
• 负责人: Kate Hampshire
• 金额: $ 79.23万
• 依托单位: Durham University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY015614%2F1
• 关键词: Recognising; supporting; informal; mhealth; Africa

The potential for mobile devices to expand access to healthcare (mHealth) has been widely lauded, especially in rural areas of Low- and Middle-Income Countries (LMICs). However, the practice has not yet lived up to the hype: heavy reliance on donor funding and poor integration into national health systems means that projects often fizzle out when the funding dries up. Meanwhile, Community Health Workers (CHWs) are taking matters into their own hands, using personal devices on their own initiative in their work: a phenomenon we call "informal mhealth." Of 3000 CHWs we surveyed in Ghana, Ethiopia and Malawi, over 97% reported using a personal mobile device for work-related purposes on a daily basis, calling/messaging patients, organising logistics, calculating medicine dosages, and even using the torch function to deliver babies (compared with only 15% using "formal" mhealth phones or applications).These developments were viewed positively by CHWs and service users, facilitating communication, logistics and patient care, and even saving lives. However, they also brought costs and challenges, especially for CHWs working in more remote communities, including financial hardship in managing phone costs, increased stress and burn-out from 24/7 availability, risks to patient confidentiality, and lack of digital literacy in assessing online information. These give cause for concern: informal mhealth is happening at scale but the costs are borne by the lowest-paid cadre of health-workers, most of whom are women.In discussions with CHWs and policy-makers, we identified three possible low-cost interventions to recognise and support CHWs' existing practices: (1) providing basic training on digital literacy, online safety and use of relevant open-access applications; (2) developing and implementing locally-appropriate guidelines on use of personal mobile devices in healthcare; and (3) compensating CHWs for work-related phone expenditure.We now seek to develop and trial a participatory intervention incorporating all three elements (training, guideline development and financial compensation) in 6 contrasting rural ("hard-to-reach") sites across Ghana, Ethiopia and Malawi (2 sites per country). In each site, we will engage a cluster of c.106 CHWs to receive the intervention, alongside service users (community members) and local managers/supervisors. Crucially, while the framework is common to all sites, the content and delivery of the training and guidelines will be co-designed with CHWs and community representatives and will be specific to each location, building on and supporting existing good practice.In order to assess feasibility and acceptability of the intervention, and to assess possible impacts on CHWs, service users and managers, we will collect relevant data at baseline and post-intervention. All participating CHWs (minimum 212 per country) will complete questionnaires to measure changes in working practices and work-related wellbeing (including burn-out and retention intentions). Follow-up focus group discussions will be conducted with CHWs, service users and local supervisors/managers in each site (minimum 16 groups per country), to obtain a more detailed understanding of the concerns and priorities of these different groups, and to help elucidate potential causal pathways and mechanisms for changes observed.Ongoing engagement of national and local stake-holders is core to the project. Building on strong working relationships developed during our previous study, we will convene a National Stakeholder Group (NSG) in each country to help oversee the project, provide input and plan for subsequent scale-up. In each study location, we will form a Local Steering Group (LSG), comprising CHW and community representatives, and local managers. LSGs will meet regularly to coordinate each stage of the project, and deliver the intervention to Community User Groups (CUGs) at each participating health post

移动设备扩大医疗保健覆盖范围（移动医疗）的潜力受到广泛赞誉，尤其是在中低收入国家 (LMIC) 的农村地区。然而，这种做法尚未达到宣传的效果：严重依赖捐助资金并且与国家卫生系统的融合不善，这意味着当资金枯竭时，项目往往会失败。与此同时，社区卫生工作者 (CHW) 正在将事情掌握在自己手中，在工作中主动使用个人设备：我们将这种现象称为“非正式移动医疗”。在我们对加纳、埃塞俄比亚和马拉维的 3000 名社区卫生工作者进行的调查中，超过 97% 的人表示每天使用个人移动设备进行工作相关的用途，例如给患者打电话/发消息、组织后勤、计算药物剂量，甚至使用手电筒功能来进行工作。接生婴儿（相比之下，只有 15% 的人使用“正规”移动医疗电话或应用程序）。社区卫生工作者和服务用户对这些发展持积极态度，促进了沟通、后勤和患者护理，甚至节省了成本生活。然而，它们也带来了成本和挑战，特别是对于在较偏远社区工作的社区卫生工作者来说，包括管理电话费用方面的财务困难、24/7 可用性增加的压力和倦怠、患者保密风险以及评估时缺乏数字素养在线信息。这些令人担忧：非正式的移动医疗正在大规模发生，但成本由收入最低的卫生工作者骨干承担，其中大多数是女性。在与社区卫生工作者和政策制定者的讨论中，我们确定了三种可能的低成本方法认可和支持社区卫生工作者现有做法的干预措施：(1) 提供有关数字素养、在线安全和相关开放获取应用程序使用的基本培训； (2) 制定并实施适合当地的医疗保健中个人移动设备使用指南； (3) 补偿社区卫生工作者与工作相关的电话支出。我们现在寻求在 6 个对比鲜明的农村（“难以到达”）地点开发和试验一种包含所有三个要素（培训、指南制定和经济补偿）的参与式干预措施横跨加纳、埃塞俄比亚和马拉维（每个国家 2 个站点）。在每个站点，我们将聘请大约 106 名社区卫生工作者以及服务使用者（社区成员）和当地经理/主管来接受干预。至关重要的是，虽然该框架对所有地点都是通用的，但培训和指南的内容和交付将与社区卫生工作者和社区代表共同设计，并将针对每个地点，建立在现有良好实践的基础上并支持现有的良好实践。干预的可行性和可接受性，并评估对社区卫生工作者、服务使用者和管理者可能产生的影响，我们将收集基线和干预后的相关数据。所有参与的社区卫生工作者（每个国家至少 212 名）将完成调查问卷，以衡量工作实践和与工作相关的福祉（包括倦怠和保留意愿）的变化。后续焦点小组讨论将与每个地点的社区卫生工作者、服务使用者和当地主管/经理（每个国家至少 16 个小组）进行，以更详细地了解这些不同群体的关切和优先事项，并帮助阐明观察到的变化的潜在因果路径和机制。国家和地方利益相关者的持续参与是该项目的核心。基于我们之前研究中建立的牢固工作关系，我们将在每个国家召集一个国家利益相关者小组 (NSG)，以帮助监督该项目，为后续扩大规模提供投入和计划。在每个研究地点，我们将组建一个当地指导小组 (LSG)，由 CHW 和社区代表以及当地管理人员组成。 LSG 将定期召开会议，协调项目的每个阶段，并向每个参与卫生站的社区用户组 (CUG) 提供干预措施