Integration of a patient-centered mobile health intervention (Support-Moms) into routine antenatal care to improve maternal health in Uganda

将以患者为中心的移动健康干预措施（Support-Moms）纳入常规产前护理，以改善乌干达的孕产妇健康

• 批准号: 10641272
• 负责人: Esther Cathyln Atukunda
• 金额: $ 48.84万
• 依托单位: MBARARA UNIVERSITY/SCIENCE/ TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-05 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641272
• 关键词: Adopted; Africa South of the Sahara; Anxiety; Appointment; Behavioral; Birth; Birth Weight; Cessation of life; Child; Childbirth; Communication; Consolidated Framework for Implementation Research; Cost Analysis; Data; Decision Making; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Enrollment; Environment; Evaluation; Fostering; Friends; Future; Health; Health Benefit; Health Personnel; Health Policy; Health Services; Health Services Accessibility; Health care facility; Health system; Individual; Infant; Institution; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning; Maternal Health; Maternal Mortality; Mental Depression; Morbidity - disease rate; National Institute of Child Health and Human Development; Newborn Infant; Notification; Outcome; Participant; Perinatal; Perinatal mortality demographics; Pilot Projects; Positioning Attribute; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Proctor framework; Public Health; Quality of life; Quality-Adjusted Life Years; Questionnaires; Randomized; Randomized, Controlled Trials; Readiness; Records; Research Personnel; Resource Allocation; Risk; Rural; Schedule; Scientist; Services; Social Network; Social support; Taxonomy; Techniques; Telephone; Testing; Trust; Uganda; United States National Institutes of Health; Visit; Voice; Woman; Women' s Health; antenatal care; arm; care systems; coping; coping mechanism; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; cost-effectiveness ratio; effectiveness measure; effectiveness outcome; effectiveness testing; effectiveness/implementation trial; empowerment; experience; fetal; implementation intervention; implementation outcomes; implementation strategy; improved; incremental cost; incremental cost-effectiveness; intervention delivery; mHealth; maternal morbidity; multidisciplinary; obstetrical complication; patient oriented; perinatal morbidity; perinatal outcomes; post pregnancy; prevent; primary outcome; public health relevance; routine care; scale up; secondary outcome; service utilization; skills; social; social engagement; standard of care; success; uptake

PROJECT SUMMARY/Abstract Antenatal care (ANC) and skilled births are mainstays of preventing maternal and perinatal morbidity and mortality. Despite expanded availability of skilled birth attendants and referral health systems, Ugandan women have low ANC use and skilled births, resulting in one of the highest maternal mortality ratios and perinatal mortality rates in the world. Mobile health (mHealth) interventions can support individuals to internalize risks, need, and benefits of health services with high intervention delivery success. Provision of multiple messaging approaches—such as scheduled SMS, telephone voice messages and social support engagement—can empower individuals to seek and access care, and improve health outcomes. However, despite successes in pilot studies, there is little data on effectiveness, appropriateness, feasibility, fidelity and incremental costs needed to adopt, or scale up such strategies in sub–Saharan Africa, where the public health impact of such interventions is likely to be the greatest. As part of a K43 career development award (PI Atukunda), we used behavioral frameworks to develop a user-centered mHealth-based, audio-SMS messaging application to support pregnant women to use maternity care services in rural Uganda (Support-Moms app). The app shared health-related information and engaged social support networks via scheduled SMS/audio reminders and upcoming ANC appointment notifications. In a randomized 3-arm pilot study (n=120) comparing standard of care (SOC), scheduled messaging (SM), and scheduled messaging plus social supporter engagement (SS), we observed high intervention uptake, acceptability, and feasibility. All women whose social supporters were engaged on the app attended ≥4 ANC visits, compared to 83% and 50% of women receiving only messages and SOC, respectively. Nearly all women in the SS arm (98%) had a skilled delivery compared to 78% and 70% in SM and SOC groups, respectively. We now propose a type 2 hybrid implementation-effectiveness trial to evaluate and implement the Support-Moms intervention into routine care. We will test the effectiveness of the intervention in a randomized controlled trial (N=824); our primary outcome will be the proportion of healthcare provider-led skilled births (Aim 1). We will apply Proctor’s implementation outcomes framework to evaluate acceptability, feasibility, appropriateness, and fidelity, and conduct in-depth interviews with users and key stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) to refine implementation strategies for future scale-up (Aim 2). We will assess costs and cost-effectiveness of implementing Support-Moms into routine care (Aim 3). We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service utilization. This proposal directly responds to NIH and NICHD priorities described in PAR-22-105 and PAR-22-132 to reduce preventable causes of maternal deaths and improve health for women during and after pregnancy.

项目摘要/摘要 产前护理（ANC）和熟练的出生是预防母亲和围产期病态的支柱 尽管熟练的亲生服务员和推荐卫生系统的可用性扩大了 妇女的ANC使用量和熟练的出生较少，导致一个一个一个一个一个一个一个一个一个一个somelamaramitality Ratis的比例和 世界上的围产期荒原率（MHealth）可以支持个人 以高干预措施的成功提供了卫生服务的风险，需求和益处 多种消息传递方法 - 例如计划的SMS，电话语音消息和社交支持 参与 - 可以使个人能够寻求和获得护理，并改善健康成果。 尽管在试点研究方面取得了成功，但关于有效，拨款，可行性，忠诚，忠诚的有效数据很少 在萨哈拉非洲次级非洲采用或扩大此类策略所需的增量成本 搜索干预措施的健康影响可能是最大的。 作为K43职业发展奖（PI Atukunda）的一部分，我们使用了稳定的框架来开发 以用户为中心的MHealth，Audio-SMS消息传递应用程序，以支持孕妇使用 乌干达农村的孕妇护理服务（支持MOMS应用程序）。 和英语社会支持网络通过计划的SMS/音频提醒和即将进行的ANC任命 通知。 消息传递（SM）和计划的消息传递以及社交支持者参与（SS），我们观察到很高 干预，可接受性和饱和性。 ACP≥4次ANC访问的应用程序，仅收到消息和SOC的女性中有83％和50％ 敏感的几乎所有女性（98％）的熟练分娩是熟练的 和SOC群体，我们现在提出2型混合实施效应试验 评估和实施支持-MOMS INTERTENTINTO的常规护理。 一项随机对照试验的干预（n = 824）； 医疗保健提供者主导的熟练分娩（AIM 1）。 评估可接受性，可行性，拨款和保真度，并与 由合并框架启发的用户和钥匙持有人（CFIR）告知 为了完善未来规模的实施策略（AIM 2），我们将评估成本和成本效益 将支持 - 莫姆斯纳入常规护理（AIM 3）。 有效且成本效益的策略来改善该提案的效果。 在PAR-22-105和PAR-22-132中描述的NIH和NICHD优先级，以减少可预防的原因 孕产妇死亡并改善怀孕期间妇女的健康。