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Abstract

Worldwide, concerted efforts are made to stimulate the use of information and communication technology (ICT) in health care. From online Personal Health Record (PHR), treatment and appointment reminders by SMS, to the e-mailing of confidential clinical data, healthcare systems are increasingly using technologies to provide better services with less financial and human resources. Among ICTs for health, eHealth -i.e. health on the Internet - has been extensively studied whereas the use of mobile technologies for health called « mhealth » or mobile Health has been less documented so far. In 2013, almost 6.8 billion people were mobile phone users, mobile-cellular penetration rates stand at 96% globally (89% in developing countries). Access to the Internet, by comparison, is a reality for only 39% of the world population (77% of the developed world population is online). During the last three years, many health stakeholders and mobile technology providers have understood the high potential of mHealth and launched more than 600 operational projects in developing countries. In this article we are discussing this issue first by assessing the current state of knowledge on mobile health in developing countries, as well as the issues and challenges raised by mobile health. We then focus our discussion on maternal health to discuss the potential applications of these new techniques in this specific field. Finally we suggest several avenues for further analysis on the implications of using mobile phones as a tool for women's health.
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Available online at www.sciencedirect.com
LITERATURE REVIEW
Mobile health and maternal care: A winning
combination for healthcare in the developing
world?
Marine Al Dahdah
a,
n
, Annabel Desgrées Du Loû
b
, Cécile Méadel
c
a
Center for Population and Development, University Paris Descartes Sorbonne Paris Cité-IRD-INED, Paris
b
Institute of Research for Development (France), Center for Population and Development, University Paris
Descartes Sorbonne Paris Cité-IRD-INED, Paris
c
Researcher at Centre de sociologie de l'innovation, Mines Paritech-CNRS, Paris
Available online 16 April 2015
KEYWORDS
Mobile health;
MHealth;
Mobile phone;
Maternal care;
ICT;
Developing countries
Abstract
Worldwide, concerted efforts are made to stimulate the use of information and communication
technology (ICT) in health care. From online Personal Health Record (PHR), treatment and
appointment reminders by SMS, to the e-mailing of condential clinical data, healthcare
systems are increasingly using technologies to provide better services with less nancial and
human resources. Among ICTs for health, eHealth i.e. health on the Internet has been
extensively studied whereas the use of mobile technologies for health called mhealthor
mobile Health has been less documented so far. In 2013, almost 6.8 billion people were mobile
phone users, mobile-cellular penetration rates stand at 96% globally (89% in developing
countries). Access to the Internet, by comparison, is a reality for only 39% of the world
population (77% of the developed world population is online). During the last three years, many
health stakeholders and mobile technology providers have understood the high potential of
mHealth and launched more than 600 operational projects in developing countries. In this
article we are discussing this issue rst by assessing the current state of knowledge on mobile
health in developing countries, as well as the issues and challenges raised by mobile health. We
then focus our discussion on maternal health to discuss the potential applications of these new
techniques in this speciceld. Finally we suggest several avenues for further analysis on the
implications of using mobile phones as a tool for women's health.
&2015 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.hlpt.2015.04.002
2211-8837/&2015 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
n
Corresponding author. Tel.: +33674336699.
E-mail address: marine.aldahdah@gmail.com (M. Al Dahdah).
Health Policy and Technology (2015) 4, 225231
Contents
Introduction.................................................................. 226
Mobile health: a growing phenomenon in developing countries .................................. 226
Maternal health, a productive sector for mHealth applications .................................. 226
Challenges of mHealth ........................................................... 227
Research on mHealth is only beginning ................................................. 228
The lack of cross-national studies .................................................... 228
Shaping future research .......................................................... 228
Author statements .............................................................. 229
Conict of interest ........................................................... 229
Ethical approval............................................................. 229
Funding .................................................................. 229
Competing interests .......................................................... 229
References .................................................................. 229
Introduction
There are many potential applications of digital technologies
in the health sector. Whether online patient records,clinical
data digitalized and transmitted electronically, or appoint-
ment reminders by SMS, health systems around the world are
increasingly using these technologies in the context of reduced
health resources and expenditure but also of increased
involvement of patients and lay personnel. Substantial
research has been conducted on eHealth health on the
Internet, mainly regarding the nature and the value of health
information on the web [1,17], the redenition of the roles of
lay and expert in health [2,83,84], the subsequent transforma-
tion of the patientcaregiver relationship [3,7]orthecon-
sequences of eHealth on work organisation. The use of mobile
phone and wireless technology within health programs, called
mHealthor mobile health, is more recent and has been less
studied. And yet mHealth is likely to change how health is
dened, to modify the relationship between caregivers and
patients, to inuence medical information, etc. These issues
are particularly acute in developing countries in the context of
increased access to mobile phones, which has been shown to
be associated with great invention in use and a certain number
of technological innovations (Chéneau-Loquay, [11];Hahnet
Kibora, [33]). In this paper, we address these transformations
rst by assessing the current state of knowledge on mobile
health in developing countries, as well as the issues and
challenges raised by mobile health. We then focus our
discussion on maternal health to discuss the potential applica-
tions of these new techniques in this speciceld. Finally we
suggest several avenues for further analysis on the implica-
tions of using mobile phones as a tool for women's health.
Mobile health: a growing phenomenon in
developing countries
Access to mobile phones is becoming increasingly common
in developing countries, and is increasing much faster than
access to the Internet: in 2013, there are almost 6.8 billion
mobile phone lines worldwide, with 128 lines per 100
inhabitants in developed countries and 89 lines per 100
inhabitants in developing countries, where only 37 out of
100 people have access to the Internet [40]. Over the past
three years, many actors in the health (NGOs, pharmaceu-
tical companies, hospitals) and telecom sectors throughout
the world have understood the potential of mobile technol-
ogy in the eld of health and have launched hundreds of
health projects involving mobile phones. The GSM Associa-
tion (GSMA) of mobile operators and mobile technology
providers has estimated up to nearly 1000 the number of
such projects in 2013, 65% of which are taking place in
developing countries [31].
Aware of the growing deployments of mobile technology,
health policy makers aim to better characterize this phenom-
enon.TheWorldHealthOrganization(WHO)rst described
and analyzed the concept of mHealth in a report published in
2011 [80].Itisdened as the practice of medicine and public
health assisted by mobile technologies, such as mobile phones,
patient monitoring monitors, personal digital assistants
(PDAs) and other wireless technologies. mHealth capitalizes
on the core functions of mobile phones (voice and SMS) but
also on the more complex features and applications of new
generations of mobile phones. WHO segments mHealth
according to a typology of projects that include: communica-
tion from individuals to health services (call centres, helpline
or hotline), communication from health services to individuals
(appointment or treatment reminders, awareness and mobili-
zation campaigns on health issues) and communication
between health professionals (mobile telemedicine, manage-
ment of intersectoral emergencies, patient monitoring,
patient data collection and creation of patient records, aid
to diagnosis and decision-making).
Maternal health, a productive sector for
mHealth applications
Half a million women die each year worldwide as a result of
pregnancy or childbirth, almost all (99%) in developing
countries. Millions of women experience pregnancy-related
morbidity, sometimes with severe consequences (infertility,
stula, incontinence) that could be avoided through better
information and better monitoring of pregnant women [78].
Clinicians report that postpartum hemorrhage is the main
causeofdeathforwomeninlabor,thatcanbelinkedto
nonattendance or late arrival in a health service [47,54].
Among the multiple reasons for this delayed care are:
M. Al Dahdah et al.226
distance,lackoftransport,poorqualityofprimaryhealthcare
services, poverty, lack of information or education, women's
social status [69]. Large disparities remain worldwide in terms
of prenatal care coverage and skilled attendance during
childbirth [81].Poorwomenlivinginremoteareasareless
likely to receive adequate care. This is especially true in areas
where the number of qualied health workers is low [29],
especially in sub-Saharan Africa, Southeast Asia and Oceania.
Improving maternal health is one of the objectives of the
Millennium Development Goals set by the United Nations
(MDG5).Theobjectiveofreducingmaternalmortalityrates
by three quarters, between 1990 and 2015, is yet unattained
[38,49] and some actors are seeking new dynamics to reach
this goal. The private sector (telephone operators, pharma-
ceutical companies, foundations) has been massively invest-
ing in mHealth projects involving women and several recent
international initiatives suggest using mobile phones to catch
up on improving maternal health [50].
The U.S. government launched in May 2011 a $10 million
partnership called Mobile Alliance for Maternal Action
(MAMA), devoted exclusively to providing health informa-
tion to future or young mothers using mobile phones. The 3-
year partnership is supported by USAID and the Johnson &
Johnson pharmaceutical company. Three pilot countries
were targeted to implement mHealth activities: India,
Bangladesh and South Africa. This publicprivate partner-
ship is an example of how mHealth projects tend to mix
general and commercial interests, especially in developing
countries. Maternal follow-up mobilizes most mHealth fund-
ing [77], representing near to one out of ve mHealth
projects in developing countries.
The rapid development of mobile health projects addres-
sing maternal health can be explained in part by the wide-
spread access of women to mobile phones; gender
differences in accessing new technologies are much less for
mobile phone access. Several gender studies have shown that
access to ICT is (or has been for a long time in developed
countries) in general more difcult for women, who are less
equipped for example, the computer remains the property
of the spouse and therefore less accustomed to ICT [82].
The male presence and dominant position in the construction
of ICT technologies may also explain why women hardly nd
their place in those same technologies [32,36]. Mobile phones
however hold a special place in the world of ICT: women are
21% less likely than men to own a mobile phone, so gender
difference do exist, but mobile phones are a more egalitar-
ian technologythan the computer or Internet access
because its cost is lower and its handling requires little
training. Sociology, particularly feminist, has provided ample
work to understand the distribution of social roles within ICT,
gender inequalities in professional practices, the impact of
ICT on socialization (or on the contrary on the dissolution of
the social bond), or the dominance effects, etc ([9,35];
Gardey, [26]). Certain studies have focused specically on
Internet applications [74,79]. This research has contributed
to understand gender relations in the context of mobile tools
developed specically for women's health. This, in order to
study both how mobile technologies shape gendered
relationships and how gender relationships have an impact
on the actual construction of technological projects.
The eld of maternal health is therefore particularly
relevant to explore the development of mHealth and the
associated public health transformations (institutional over-
haul, transnationalization, increasing role of communica-
tion technologies, gender relationships and expertise), but
has been little researched so far. The available articles on
the subject consist in literature reviews of existing projects
[57,76], or reports on the use of mobile phones by a group of
midwives in Northern Indonesia [10] and on Thai border
areas [44] or the use of persuasive messages addressed to
women in rural India [68].
Challenges of mHealth
The use of this mobiletechnology in the eld of health
raises a number of issues that should not be hidden by the
apparent simplicity of the mobile phonetool.
mHealth indeed redenes the roles of different public
health actors, may contribute to give them new roles and
redistribute powers and responsibilities. We see for example
pharmaceutical companies channeling public health infor-
mation through SMS.
mhealth contributes to the emergence of new actors that
have been little involved in the eld of public health so far,
such as mobile phone operators in charge of mobile phone
networks and connectivity (Orange, Telenor)ortechnical
private operators in charge of development platforms,
mobile applications and interfaces as well as data storage
(Intel, Voxiva). These rms act in their best commercial
interests and marketing developments, without necessarily
feeling obliged to endorse the objectives of equality and
access to health for all [56]. In addition, mobile health can
reshape health nancing; on the one hand, because it
contributes to the emergence of new funders such as private
foundations born from Information and Communication Tech-
nology (ICT) companies (Vodafone Foundation or Bill and
Melinda Gates Foundation), who embrace the notion of
philanthrocapitalism[5] dened as the combination of
generosity and commercial interests, or as the development
of new markets justied by a good cause. On the other hand,
because some health projects' funders (governments, foun-
dations, mutual funds, insurance companies, NGOs, etc.)
may reallocate funds previously devoted to building care
infrastructure towards innovative technologies such as those
involving mobile phones, to the detriment of more tradi-
tionalhealthcare services [77].
Mobile health raises major issues in terms of data security
and anonymity. In most countries, laws on condentiality of
health data and their transmission are very strict, however
they only partially apply to the new uses and new systems
implemented via mobile phones. These issues are all the
more problematic that mobile phones facilitate the transfer
and storage of data. Some doctors are questioning the
safety of the platforms used by mHealth projects, that do
not seem to protect the anonymity and condentiality of
patient health data [60]. Questioning the access and use of
health data collected by mobile applications as well as the
medical credibility and intentions of the different stake-
holders involved in mHealth projects, seems all the more
essential that the main mHealth project partners are from
the private sector and have clear business imperatives.
Finally, the development of mobile health projects raises
the issue of equity in partnerships, when projects are
227Mobile health and maternal care
implemented in developing countries and technology is
controlled by developed countries. Within the MOTECH
project for maternal follow-up in Ghana for example, project
stakeholders are numerous: the Bill and Melinda Gates
Foundation, the U.S. Agency for International Development
(USAID), the Johnson & Johnson laboratory, the Grameen
Foundation and the Norwegian government fund the project;
the Public Health Department of Columbia University in New
York and the Department of Computer Sciences of the
University of Southern Maine in Portland are responsible for
the scientic coordination of the project; the U.S. companies
Dimagi, Thoughtworks, Instedd and Reach Village are respon-
sible for developing the platform and for its local use; and
nally the Ministry of Health of Ghana collaborates to the
project and contributes to its implementation country-wide
[30]. The American technical operators and funders are
largely dominant within this Africanproject, and this is
facilitated by the ability to remotely develop, manage and
maintain these technical tools.
This new wave of mobile technology applied to health
thus raises complex issues in terms of economic organiza-
tion, governance, distribution of power and control. It calls
for anthropological and geopolitical questioning on the
implementation in developing countries of studies that are
sometimes entirely designed and funded by developed
countries, studies within which the types of collaboration
of developing countries, that is more or less voluntary, more
or less committed, deserve to be further studied. These
mobile technologies point out important issues in terms of
data safety, condentiality and privacyin the context of
collection and analysis of health data that is globalized and
deterritorialized. They also highlight the dynamics of how
foreign ethical and nancial practices adapt to local eco-
nomic and political contexts, customs and traditions, health
organizations and health professionals. mHealth thus parti-
cipates to the economic and technological recongurations
of transnational public health. It raises major issues at the
intersection of research on ICT, sociology of health and
research on science and technology.
Research on mHealth is only beginning
The rst academic studies focused on mHealth were con-
ducted within the past six years. Several papers have pre-
sented the results of pilot projects on: aid or emergency lines
[14,41,66], appointment reminders by SMS [18,15,28,55],
reminders to take anti-malarial [59] or antiretroviral medica-
tion [64], support to stop smoking or improve physical activity
[39,46], prevention of risk behaviors among youth [45,53,75],
follow-up of diabetic [12,23,34,65] or asthmatic patients
[37,72], or mobile telemedicine and mobile phone support in
collecting health data [4,6,52,61]. Most of these results
consist in descriptive analyses of mHealth pilot projects.
Unlike studies on eHealth, the overall consequences of these
technologies on care practices and on patientpractitioner
relationships, as their overall impact on health, are still poorly
studied.
The rst scientic papers analyzing the impact of
mHealth are very recent. These papers have focused on
reviewing the local mHealth trials and their consequences
on health care professionals and care practices on the one
hand [25] and on patient beneciaries on the other hand
[27]. Very few papers provide impact data. Free et al. have
identied just about forty articles reporting on mHealth
projects dedicated to health professionals and 75 articles on
mHealth projects with patients. Almost all of these papers
relate to projects conducted in developed countries only,
while more than 650 mHealth projects are currently under-
way in developing countries [31]. The very construction of
these projects remains poorly documented: Who pays? What
technical infrastructure is deployed? Who produces the
information? What is the involvement of public and private
actors? Even though these essential questions remain unan-
swered, millions of dollars are being invested in mHealth
projects, particularly in developing countries where poor
health systems are failing to meet the needs of the
population and where the absence of legal framework may
leave the door open to experiments [62,70].
The lack of cross-national studies
The studies on mHealth mentioned above are implemented
within single observation geographical spaces and relate to
single applications of mHealth. Yet multi-or transnational
research on this issue would be relevant for several reasons.
Multi-site analysis, that encouraged eld research in multi-
ple and heterogeneous spaces championed by anthropol-
ogist GE Marcus [51] and adopted by many researchers such
as Fischer [22], Jasanoff [42], Fassin [20] and Rajan [67] is
particularly suitable for the study of ICT in a global context.
It meets the new methodological requirements of research
on contemporary social recongurations since, by deni-
tion, this type of study focuses on moving objects such as
mobile phones, symbol of mobility. The idea is not to simply
compare two similar research objects but to draw links,
juxtapositions, connections between different places and
objects. The aim is also to study the people, objects, ideas,
symbols, signs, tensions and conicts embedded in these
projects and this is only possible by diversifying the elds of
research. mHealth raises international issues because its
nancing, its technical implementation, infrastructure and
areas of implementation are supported by different actors
across the world. The transnational mechanisms underlying
these various applications can only be highlighted through
studies involving different cultural areas, different socio-
economic contexts, different situations in terms of maternal
care and public/private healthcare sectors articulations.
Shaping future research
The recent multiplication of mHealth projects worldwide
illustrates the overall trend towards the globalization and
technologization of biomedicine. The idea that ICT contri-
butes to improving care, reducing health disparities and
optimizing health systems has taken shape in recent years in
a diverse set of technical devices: eHealth,mHealth,
telemedicine, big data, etc. mHealth or mobile Health is
a particular vector of this global movement, which goes
beyond the use of mobile phones, and shows how technol-
ogies contribute to the emergence of new powers, to the
reorganization of roles and the globalization of devices in
M. Al Dahdah et al.228
the eld of health. In order to move away from the sterile
opposition between euphoric technophiles who see ICT, and
among them mobiles phones, as sources of empowerment
and reduction of health inequalities, and technophobes who
emphasize the risks of market domination and increasing
inequalities, space needs to be made for research without
prejudice, capable of analyzing the modalities and issues
raised by the development of mHealth activities in the
context of an evolving public health sector, especially in
developing countries.
Three research areas seem particularly interesting.
The reorganization of roles and the emergence of new
actors in the public health sector
The implementation of a socio-technical system such as
mHealth is giving way to a new approach to public
health. Mobile health is multidisciplinary and multisec-
toral, and is building specic issues that were once
outside the eld of health. Research on the reorganiza-
tion and redistribution of powers between private and
public actors, on the changes in balance between
historical (health facilities, clinics, governments, phar-
maceutical companies, etc) and emerging actors (mobile
networks operators, technology developers, donors and
ICT philanthropists) involved in mHealth projects has
been poorly explored so far. Questioning the notion of
Global Health [8,21] with regard to Mobile Health
issues also seems to be an interesting research issue to
investigate.
Processing techniques for administering health and care
practices.
While in developed countries, research has been con-
ducted on the impact of PDAs and smartphones on care
practices [19,58,71], in developing countries, in spite of
a multiplication in the number of mobile health projects,
the issues and consequences of mobile technologies on
health care and management practices are still poorly
documented [10]. Issues of condentiality and security of
health data collected via mobile, the technical condi-
tions of storage and dissemination, and the evaluation of
these specic health programmes also remain to be
explored.
The transformation of health uses and practices for
beneciaries.
The observation of mobile phone uses, that is, what
people actually do with these objects and technical
devices, should be carefully studied. The impact of
objects on society was formalized by Coneinet al. [13],
Proulx [63] or Jouët [43], among others, and investigated
regarding patient care and health in developed countries
[24,48,73]. The analysis of the individualized approach
allowed by mHealth and the mobility of health practices
associated with these projects are still to be further
explored in developing countries [16].
StudiesoninnovativeusesofmHealth (smart phones, PDAs
and tablets) apply to a limited group of professionals and
patients, mainly in developed countries, or to a very fortunate
population in developing countries. The identication of the
barriers to these technologies [82] should also be explored in
parallel with those uses.
Maternal health programmes using mobile phones are
particularly relevant to explore thanks to these three areas
of analysis: they grow rapidly due to the emergency of the
situation around maternal health, and they will provide the
basis for questioning how gender roles are articulated
within the roles of the actors and beneciaries of health
programmes, and possibly can be reshaped by the use of
new technologies.
Author statements
Conict of interest
The author assures that all data, models, or methodology
used in the research are proprietary.
The author certies that there is no conict of interest
with any nancial organization regarding the material
discussed in the manuscript.
Ethical approval
Not required.
Funding
Marine Al Dahdah benets from a doctoral scholarship from
the French National Agency for research on AIDS and viral
hepatitis.
Competing interests
None declared.
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231Mobile health and maternal care
... The main sectors of using this technology in health care can be state as online Personal Health Record (PHR), treatment and appointment reminders by SMS, e-mailing of confidential clinical data, doctor channeling etc. for all these systems a mobile phone is used to conduct, in recent society mobile phone is an important stuff that is needed for a person, a system called e health is conducted in the world which explains that by the use of internet the people are satisfying their medical requirements through internet base orders, and also another system that has been developed can be named as M-Health or mobile heath , this is a system that is similar as the e health system which the parties who are engage in the health sector are using a mobile phone to conduct their activities or it can be defined as the use of mobile phone and wireless technology within health programs. Mobile phone has become an important thing in today's society, people conduct so many activities using their mobile phone, according to the researches there are 6.8 billion people are mobile users worldwide and the cellular penetration rate is stands as 96% globally, the people who can access the internet is numbered as 39% globally (Al Dahdah, Desgrées Du LoÛ and Méadel, 2015). This means that there is a significant amount of people are using the smart phones and the mobile application that are used in the health care are successful to a certain extent. ...
... The main actors like NGOs s, pharmaceutical companies, hospitals have been identified the importance and potential of the mobile base technology and launched different kinds of innovations to increase the efficiency of the system. GSM association has introduced 1000 projects in 2013 which are taking place in the developing countries(Al Dahdah, Desgrées Du LoÛ and Méadel, 2015). the health policy makers are also aware about the use of the mobile technology in the health care sector and they also engage in different ways in the system. ...
... (Al Dahdah, Desgrées Du LoÛ and Méadel, 2015) Maternal health is one of the main challenge to the governments, according to the researches half a million child or the mother will die in a year due to the pregnancy-related morbidity, sometimes with severe consequences(Al Dahdah, Desgrées Du LoÛ and Méadel, 2015). Mobile application is a better solution for this kind of problem, by monitoring the pregnancy women and by collecting the information digitally will increase the efficiency and the moderators can gain a better monitoring of the pregnant women. ...
Chapter
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Due to the advancement in technology, it plays a major role in the healthcare industry. Health care is an industry where most businesses are engaged and in a high demand, the following health literature review will derive how the present and future health care is affected by the technology.
... (Talor, 2015) Covering an interdisciplinary and a multi-sector venue, m-health raises opportunities which have stayed out of the health care domain till now. Very recently, roles of diverse stakeholders who are responsible for health practice have been in transformation and reorganization, indicating more responsibility and empowerment for individuals (Dahdah, Du Loû, & Meadel, 2015). This surfaces distinctive ways about how and for what individuals actually interacts with m-health technologies, rather than the exact technological capabilities or limitations of these technologies. ...
... Sometimes voice-based interactions are preferred rather then textual interactions in m-health implementations due to language and literacy barriers (mHealth Alliance, n.d.). Moreover, basic m-health services are sometimes connected to a broader health informatics system and PHRs to collect data for measuring the effectiveness of m-health implementations, identifying prime development indicators, incorporating them in further decision making processes, and devising policies(Kaewkungwal et al., 2010;Labrique, Vasudevan, Kochi, Fabricant, & Mehl, 2013;Philbrick, 2012; Vital Wave Consulting, 2009).Understanding and acknowledging the significance of the global attention on and struggles for RMNCH in undeveloped and developing countries, diverse obstacles that pregnant women encounter in also developed countries while trying to reach m-health solutions have been discussed as being overlooked bethinking urban poverty, women's social status, gender differences, and other conditions(Dahdah, Du Loû, & Meadel, 2015; Jennings et al., 2015;mHEalth Alliance, 2012;UN Millennium Project, 2005;Peyton et al., 2014a; Urrutia et al., 2015). According to some researchers, pregnant women with low-income and low-literacy consult Internet resources less frequently because of not having access, enough skills, and self-confidence(Urrutia et al., 2015). ...
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...The results have shown that needs and expectations change according to different trimesters and pregnant women types. Correspondingly, positive user experience dimensions with mobile pregnancy technologies and their conceptual relationships, as well as content, interaction, appearance, and function related characteristics and scopes of mobile pregnancy technologies have been revealed paying attention to wellness dimensions during pregnancy. Moreover, feeding from the results of the study and positive psychology literature, design descriptions have been delivered that would focus on the wellness and happiness of different pregnant women.
... Furthermore, there is evidence of demonstrated positive outcomes from mHealth tools for pregnant women and future mothers, but also of the difficulties related to the routine integration of mHealth tools into established prenatal and newborn health services [13]. Nonetheless, it is worth pointing out that most of the research studies on mHealth interventions in the field of maternal, neonatal, and newborn care have been undertaken in low-and middle-income countries [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. ...
... First, there is scarce empirical evidence of the real potential of mHealth in improving women's access to care, their literacy and self-management skills, and quality of services along the maternal pathway [9]. This is particularly true for western countries because the literature focuses on the impact of technologies in developing countries [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In high-income countries, technology-supported interventions targeted at pregnant women and new mothers are often aimed at improving their lifestylerelated behaviors [9,51]. ...
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Background Mobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy). Objective The protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway. Methods A pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results Following study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway. Conclusions The study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application. International Registered Report Identifier (IRRID) DERR1-10.2196/19073
... In a mountainous area like Cao Bang, a northeast province of Vietnam with five minority ethnic groups living together, Mong people had the highest infant mortality rate in Vietnam at 46 per thousand live births (Knowles et al., 2009;United Nations Children's Fund, General Statistics Office of Vietnam, United Nations Population Fund, 2011). The main reasons for these difficulties can relate to low economic issues, lack of transportation, insufficient knowledge, and inaccessibility to health care services of rural residents (Al Dahdah et al., 2015;McBride et al., 2018). ...
Article
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Background Health education via DVD/video has been demonstrated as a novel method to encourage a positive change and improvement in patients’ health behaviors. A community health project was implemented in Cao Bang, a mountainous area of Vietnam, for health workers to use tablets, portable projectors, and television to disseminate health education messages via designed video clips. Method and Objectives A qualitative study using semi-structured individual and group interviews was conducted with 25 health workers in Trung Khanh district to explore their experience of using video in providing health education. Results The video was confirmed to be an accessible, interactive, and flexible tool supporting health education activities in this mountainous area. However, some health workers in the mountainous area struggled due to a lack of technological skills and responsibility for their work. Conclusions for Practice More training on using technology for health professionals and incorporating video-based health education activities into labor contract-based responsibilities can alleviate present obstacles.
... Notably, ICT diffusion and adoption in the healthcare sector generally take center stage in public health intervention programs, like Antenatal Care (ANC). For example, the improvement of maternal healthcare -as one crucial objective of the Millennium Development Objective (MDGs) -has been engendered through the use of ICTs (Ngabo et al., 2012;Mahapatra and Sahoo, 2015;Al Dahdah et al., 2015;Sondaal et al., 2016;Uneke et al., 2017;Abejirinde et al., 2018;Thobias and Kiwanuka, 2018;Borsari et al., 2018). Specifically, significant mortality rates related to pregnancy and childbirth can be avoided if the women receive adequate and timely ANC using ICT as a facilitator. ...
Chapter
Existing research on improving antenatal care—using information and communication technologies and related technology—has focused on mobile phones to support SMS alerts and the implementation of a tool for booking appointments. The SMS alert system is limited in many ways, especially in addressing the conflicts in schedule and time for appointment and visit. Even with the reported tool(s) implemented, activities in the software development process, especially the design specifications, were not correctly followed and documented to justify the solutions proposed. By means of a qualitative research approach, a face-to-face oral interview with both pregnant women and obstetricians and a brainstorming session with the obstetricians were achieved. The chapter approach harnesses course-plotting technology to determine the most suitable obstetrician based on proximity and route with Google Map's aid. The result is presented from both analytical and technical perspectives to prevent and reduce the high rate of maternal and neonatal loss.
... Following the emergent of m-health interventions in GDM, the development and evaluation of individual interventions have attracted more attention by the researchers. The previous systematic reviews either have focused on the effectiveness of m-health interventions [4,16,[27][28][29][30][31][32][33][34] or a single condition [35][36][37][38]. However, minimal evidence has been provided on healthcare utilization or cost analyses. ...
Article
Full-text available
This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.
... Philanthrocapitalism has also been explored in relation to several aspects of healthcare, including: the use of information and communication technology to provide healthcare services in developing countries (Al Dahdah et al., 2015); international drug donations by the pharmaceuticals industry (Guilbaud, 2018); and the corporate framing of surrogate pregnancy in India (Lewis, 2019). All other healthcare-focused articles within our sample examine the global healthcare agenda, a field dominated by the Gates and Rockefeller Foundations. ...
Article
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Philanthrocapitalism—the strategic application of market methods and motives for philanthropic purposes—plays increasingly prominent roles in policy design and implementation at national and international levels. Notwithstanding philanthrocapitalism's growing significance, relevant scholarly discourse remains limited and fragmented. Drawing together diverse debates, our paper systematically reviews and synthesizes academic literature on philanthrocapitalism. Alongside raising questions about the casting and practice of philanthropy, the 186 relevant publications included in our review indicate a strong emphasis of philanthrocapitalism in the areas of education, international development, healthcare and agriculture. Across these, we identify and discuss the importance of three cultural frames: (1) development challenges being framed as scientific problems; (2) beneficiaries being framed as productive entrepreneurs; and (3) philanthropy being framed as social investment. Outlining and critically examining these issues, this work contributes: a comprehensive analysis of key debates and issues; strengthened conceptual clarity and nuance through an evaluative exploration of the multiple interpretations of philanthrocapitalism; and a future research agenda to address persisting knowledge gaps and refine focus.
Chapter
Taboos and discrimination hinder women’s access to basic health care in Bangladesh. Young women in Bangladesh are active users of mobile phones, which suggests that they may find mobile health services useful. However, information on the usage of these services by women are missing in the literature. This research provides an insight into women’s use patterns of mHealth and its significance in their lives. Mobile technologies take the role of a peer support system that used to be dominated by older sisters and close friends. This research showed there is a serious need for improved digital and health literacy to create more awareness about the accuracy of information found online and also to avoid health complications in the future.
Article
Vital signs are a series of clinical measurements and important to health-related quality of life. To establish a method for self-monitoring and management of vital signs and diet, a self-monitoring method (SMM) including wireless body area network and mobile technology was proposed in this paper. The study population comprised a total of 180 participants. Differences between measurements taken using the SMM and traditional instruments were analyzed with respect to accuracy and reproducibility. Participant measurements before and after intervention were used to evaluate the validity of the SMM. There was no statistically significant difference between our SMM and traditional instruments for measuring vital signs (p>0.05). The relative standard deviation of the SMM (0.38%) indicated good repeatability. These findings suggest that the SMM had a clear effect of promoting improvement in health habits, health condition monitoring, and disease prevention (p<0.05). Statistical analysis indicated that our SMM contributed to improve monitoring of vital signs and diet, and improved the health-related quality of life among study participants to a certain degree.
Article
Objective The objective of this paper is to develop a framework for the planning and positioning of mHealth interventions in developing countries. Method The description of the framework uses an illustrative case from Enugu State, Nigeria. Planning and positioning for this case involved a number of interventions including workshops, training sessions, and other attempts to socialise mHealth tools and canvass for local and regional support. Results The planning and positioning differentiates between interventions at two levels. First, we differentiate between interventions targeting traits and states, the latter being situation-specific. Second, we differentiate between individual and social interventions, the latter being resilient to personnel change. This creates a simple 2 × 2 matrix to lay out the portfolio of interventions in an mHealth project. Conclusion The framework offers support to governments, decision makers, and developers as they design an assemblage of mHealth interventions. This added clarity means the framework also helps to analyse ‘as is’ structures and behaviours. The framework further provides support for reflecting on projects, as interdependent goals in different quadrants can be assessed against specific interventions.
Article
This paper discusses the implications of shortages of midwives, nurses and doctors for maternal health and health services in sub-Saharan Africa, and inequitable distribution of maternal health professionals between geographic areas and health facilities. Shortages of health professionals reduce the number of facilities equipped to offer emergency obstetric care 24 hours a day, and are significantly related to quality of care and maternal mortality rates. Some countries are experiencing depletion of their workforces due to emigration and HIV-related illness. Another feature is the movement from public to private health facilities, and to international health and development organisations. The availability of skilled birth attendants and emergency obstetric care may be reduced due to understaffing, particularly in rural, poor areas. The existing workforce may experience increased workloads and job dissatisfaction, and may have to undertake tasks for which they are not trained. If governments and development partners are serious about reaching the Millennium Development Goal on maternal health, substantial numbers of professionals with midwifery skills will be needed. Shortages of maternal health professionals should be addressed within overall human resources policy. A rethink of health sector reforms and macro-economic development policies is called for, to focus on equity and strengthening the role of the state. Résumé Cet article examine les conséquences du manque de sages-femmes, d'infirmières et de médecins pour les services de santé maternelle et de santé en Afrique sub-saharienne, et la répartition inégale des professionnels de santé maternelle entre zones géographiques et centres de santé. Ces pénuries réduisent le nombre d'installations capables d'offrir des soins obstétriques d'urgence 24 heures sur 24, et influent sur la qualité des soins et les taux de mortalité maternelle. Dans certains pays, la main-d'éuvre est appauvrie par l'émigration et les maladies liées au VIH. Une autre caractéristique est le mouvement du public vers le privé, et vers les organisations internationales de santé et de développement. Ce phénomène peut réduire la disponibilité d'accoucheuses formées et de soins obstétriques d'urgence, particulièrement dans les zones rurales pauvres. Le personnel connaît donc un surcroît de travail, ce qui crée un mécontentement, et doit parfois accomplir des tâches pour lesquels il n'a pas été formé. Si les gouvernements et les partenaires de développement veulent vraiment atteindre l'objectif du Millénaire pour le développement en matière de santé maternelle, il leur faudra former un nombre substantiel de professionnels en obstétrique. Les pénuries de personnel de santé maternelle doivent être corrigées dans le cadre de la politique globale des ressources humaines. Il convient de repenser les réformes du secteur de la santé et les politiques de développement macro-économique, afin de se centrer sur l'équité et renforcer le rôle de l'État. Resumen Este artículo trata de la escasez de obstetrices, enfermeras y médicos en salud materna y servicios de salud general en África sub-Sahariana, y la distribución no equitativa de profesionales de la salud materna entre zonas geográficas y los establecimientos de salud. La escasez de estos profesionales disminuye el número de establecimientos equipados para ofrecer cuidados obstétricos de emergencia las 24 horas del día y está relacionada en gran medida con la calidad de la atención y las tasas de mortalidad materna. Algunos países están experimentando una reducción de su población activa debido a la emigración y las enfermedades relacionadas con el VIH. Otro aspecto es la mudanza del sector público hacia el privado, y a las organizaciones de salud y desarrollo internacional. La disponibilidad de parteras capacitadas y de cuidados obstétricos de emergencia podría reducirse debido a la falta de personal, particularmente en las zonas rurales pobres. La actual población activa podría experimentar mayores cargas de trabajo e insatisfacción en el trabajo, y verse obligada a realizar tareas para las cuales no está capacitada. Si los gobiernos y los colaboradores de desarrollo están verdaderamente comprometidos a lograr el Objetivo de Desarrollo para el Milenio respecto a la salud materna, se necesitarán muchos profesionales con habilidades en obstetricia. La escasez aquí mencionada debe tratarse como parte de la política general de recursos humanos. Para garantizar equidad y fortalecer la función del Estado, será necesario reformular las reformas del sector salud y las políticas de desarrollo macroeconómico.
Article
In low-income countries, the coverage of institutional births is low. Using data from the two most recent Demographic and Health Surveys (1995–2001 and 2001–2006) for 25 low-income countries, this study examined trends in where women delivered their babies – public or private facilities or non-institutional settings. More than half of deliveries were in institutional settings in ten countries, mostly public facilities. In the other 15 countries, the majority of births were in women's homes, which was often their only option. Between the two survey periods, all five Asian countries studied (except Bangladesh) had an increase of 10–20 percentage points in institutional coverage, whereas none of the 19 sub-Saharan African countries saw an increase of more than 10 percentage points. More urban women and more in the richest (least poor) quintile gave birth in public or private facilities than rural and poorest quintile women. The rich–poor gap of institutional births was wider than the urban–rural gap. Inadequate public investment in health system infrastructure in rural areas and lack of skilled health professionals are major obstacles in reducing maternal mortality. Governments in low-income countries must invest more, especially in rural maternity services. Strengthening private, for-profit providers is not a policy choice for poor, rural communities. Résumé Dans les pays à faible revenu, la couverture des naissances institutionnelles est faible. Se fondant sur les données des deux plus récentes enquêtes démographiques et sanitaires (1995–2001 et 2001–2006) pour 25 pays à faible revenu, cette étude a examiné l'évolution des lieux d'accouchement : maternités publiques et privées ou sites non institutionnels. Dans dix pays, plus de la moitié des naissances se produisaient dans une institution, principalement publique. Dans les 15 autres pays, la majorité des accouchements avait lieu au domicile de la mère, souvent la seule option. Entre les deux périodes d'enquête, les cinq pays asiatiques étudiés (à l'exception du Bangladesh) ont enregistré une augmentation de 10–20 points de pourcentage de la couverture institutionnelle, alors qu'aucun des 19 pays d'Afrique subsaharienne n'a connu une hausse supérieure à 10 points de pourcentage. Les femmes urbaines et dans le quintile le plus riche accouchaient davantage dans des maternités publiques ou privées que les femmes rurales ou dans le quintile inférieur. Pour les naissances institutionnelles, l'écart entre riches et pauvres était plus large qu'entre zones urbaines et rurales. L'insuffisance des financements publics pour l'infrastructure sanitaire des zones rurales et le manque de professionnels qualifiés sont les principaux obstacles pour réduire la mortalité maternelle. Les gouvernements des pays à faible revenu doivent investir davantage, en particulier pour les services ruraux de maternité. Renforcer les prestataires privés et à but lucratif n'est pas un choix politique pour les communautés rurales pauvres. Resumen En países de bajos ingresos, la cobertura de nacimientos institucionales es baja. Utilizando los datos de las últimas dos Encuestas Demográficas y de Salud (1995–2001 y 2001–2006) realizadas en 25 países de bajos ingresos, este estudio examinó las tendencias en cuanto a los lugares donde las mujeres dan a luz: en unidades públicas o privadas, o en entornos no institucionales. Más de la mitad de los partos ocurrieron en ámbitos institucionales en diez países, principalmente en unidades públicas. En los otros 15 países, casi todos los partos fueron domiciliarios, a menudo la única opción. Entre los dos períodos de la encuesta, los cinco países asiáticos estudiados (excepto Bangladesh) vieron un aumento de 10 a 20 puntos porcentuales en cobertura institucional, mientras que en ninguno de los 19 países africanos subsaharianos hubo un aumento de más de 10 puntos porcentuales. Más mujeres urbanas y más en el quintil más rico dieron a luz en unidades públicas o privadas que mujeres rurales y del quintil más pobre. La brecha entre partos institucionales de ricas y pobres fue mayor que la brecha urbana-rural. Inadecuadas inversiones públicas en la infraestructura del sistema de salud en zonas rurales y la falta de profesionales de la salud calificados son los principales obstáculos para disminuir la mortalidad materna. Los gobiernos en países de bajos ingresos deben realizar mayores inversiones, especialmente en servicios rurales de maternidad. Fortalecer a prestadores de servicios particulares, con fines de lucro, no es una opción de políticas para las comunidades pobres rurales.
Article
The phenomenal growth of global pharmaceutical sales and the quest for innovation are driving an unprecedented search for human test subjects, particularly in middle- and low-income countries. Our hope for medical progress increasingly depends on the willingness of the world's poor to participate in clinical drug trials. While these experiments often provide those in need with vital and previously unattainable medical resources, the outsourcing and offshoring of trials also create new problems. In this groundbreaking book, anthropologist Adriana Petryna takes us deep into the clinical trials industry as it brings together players separated by vast economic and cultural differences. Moving between corporate and scientific offices in the United States and research and public health sites in Poland and Brazil, When Experiments Travel documents the complex ways that commercial medical science, with all its benefits and risks, is being integrated into local health systems and emerging drug markets. Providing a unique perspective on globalized clinical trials, When Experiments Travel raises central questions: Are such trials exploitative or are they social goods? How are experiments controlled and how is drug safety ensured? And do these experiments help or harm public health in the countries where they are conducted? Empirically rich and theoretically innovative, the book shows that neither the language of coercion nor that of rational choice fully captures the range of situations and value systems at work in medical experiments today. When Experiments Travel challenges conventional understandings of the ethics and politics of transnational science and changes the way we think about global medicine and the new infrastructures of our lives.
Article
Our CDSS was designed to provide the probability of pulmonary embolism at each stage of a diagnostic work-up by using the Bayes theorem, validated clinical probability scoring, and estimates of test characteristics from a recent meta-analysis (9, 12). It supplied the physician with this information in real time, whereas physicians in the paper guidelines group had to actively search for it. The CDSS thus improved the diagnostic management of suspected pulmonary embolism. Its first and main effect was to prompt physicians to assess the initial pretest probability, and the large difference in such assessments between the computer-based and paper guidelines groups explains some—but not all—of the CDSS's benefit. The system helped physicians to order appropriate testing by offering flexible choices on the basis of clinical situations, locally available tests, and previous diagnostic test results. The CDSS also advised physicians to stop investigations once a diagnosis of pulmonary embolism was excluded or confirmed; physicians in the computer guidelines group were less likely to stop investigations prematurely (such as after a positive d-dimer test result) and used fewer tests to reach a validated diagnostic decision than did physicians in the paper guidelines group. Our study has limitations. More patients were enrolled in the paper guidelines group than in the computer-based guidelines group. Center allocation depended on the frequency of appropriate management during the preintervention period, rather than the number of suspected cases of pulmonary embolism. Imbalances in patient numbers during preintervention and intervention are therefore more likely to be related to the centers than to the intervention, and the number of inclusions per center and patient-related risk factors for inappropriateness were taken into account in the statistical analysis. Use of CDSS was not associated with a significant decrease in the incidence of thromboembolic events during follow-up in patients in whom the diagnosis of pulmonary embolism was excluded and who were left untreated. However, our study was not designed to detect such a difference. The lower thromboembolic event rate than that in our previous observational study (3) may be related to improvements in test performance. Differences in patient characteristics or treatment may explain the imbalance between groups in the number of deaths among patients with confirmed pulmonary embolism. Finally, the frequency of handheld computer use in real time was low, about 40%. This raises questions about whether physicians will use such a decision aid in the long term. However, handheld devices were used much more frequently during the intervention phase in the computer-based guidelines group (80%), which suggests that a diagnostic aid is used by most physicians if it is available at the time of the clinical decision.