Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis
| dc.contributor.author | Kabongo, Eveline M. | |
| dc.contributor.author | Mukumbang, Ferdinand C. | |
| dc.contributor.author | Delobelle, Peter | |
| dc.contributor.author | Nicol, Edward | |
| dc.date.accessioned | 2021-10-11T17:29:57Z | |
| dc.date.available | 2021-10-11T17:29:57Z | |
| dc.date.issued | 2021-03-09 | |
| dc.date.updated | 2021-03-14T04:11:59Z | |
| dc.description.abstract | Background Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers. Method We undertook a realist synthesis. An electronic search of five online databases (PubMed/Medline, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories. Results We formulated two configurational models illustrating how and why mHealth impacts implementation and uptake of maternal and child health care. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation and perceived ease of use and usefulness. These mechanisms are influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms are influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity and awareness. Conclusion Models developed in this study provide a detailed understanding of implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required. | en_US |
| dc.identifier.apacitation | Kabongo, Eveline M., Mukumbang, Ferdinand C., Delobelle, P., & Nicol, E. (2021). Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis. <i>BMC Pregnancy and Childbirth</i>, 21(Article number: 196), http://hdl.handle.net/11427/35169 | en_ZA |
| dc.identifier.chicagocitation | Kabongo, Eveline M., Ferdinand C. Mukumbang, Peter Delobelle, and Edward Nicol "Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis." <i>BMC Pregnancy and Childbirth</i> 21, Article number: 196. (2021) http://hdl.handle.net/11427/35169 | en_ZA |
| dc.identifier.citation | Kabongo, Eveline M., Mukumbang, Ferdinand C., Delobelle, P. & Nicol, E. 2021. Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis. <i>BMC Pregnancy and Childbirth.</i> 21(Article number: 196) http://hdl.handle.net/11427/35169 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Kabongo, Eveline M. AU - Mukumbang, Ferdinand C. AU - Delobelle, Peter AU - Nicol, Edward AB - Background Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers. Method We undertook a realist synthesis. An electronic search of five online databases (PubMed/Medline, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories. Results We formulated two configurational models illustrating how and why mHealth impacts implementation and uptake of maternal and child health care. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation and perceived ease of use and usefulness. These mechanisms are influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms are influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity and awareness. Conclusion Models developed in this study provide a detailed understanding of implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required. DA - 2021-03-09 DB - OpenUCT DP - University of Cape Town IS - Article number: 196 J1 - BMC Pregnancy and Childbirth KW - mHealth KW - Mobile phone KW - Maternal health KW - Child health KW - Low- and middle-income countries KW - Realist synthesis LK - https://open.uct.ac.za PY - 2021 T1 - Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis TI - Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis UR - http://hdl.handle.net/11427/35169 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12884-021-03684-x | |
| dc.identifier.uri | http://hdl.handle.net/11427/35169 | |
| dc.identifier.vancouvercitation | Kabongo Eveline M, Mukumbang Ferdinand C, Delobelle P, Nicol E. Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis. BMC Pregnancy and Childbirth. 2021;21(Article number: 196) http://hdl.handle.net/11427/35169. | en_ZA |
| dc.language.iso | en | en_US |
| dc.language.rfc3066 | en | |
| dc.publisher.department | Division of Endocrinology and Diabetology | en_US |
| dc.publisher.faculty | Faculty of Health Sciences | en_US |
| dc.rights.holder | The Author(s) | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_US |
| dc.source | BMC Pregnancy and Childbirth | en_US |
| dc.source.journalissue | Article number: 196 | en_US |
| dc.source.journalvolume | 21 | en_US |
| dc.source.uri | https://bmcpregnancychildbirth.biomedcentral.com/ | |
| dc.subject | mHealth | en_US |
| dc.subject | Mobile phone | en_US |
| dc.subject | Maternal health | en_US |
| dc.subject | Child health | en_US |
| dc.subject | Low- and middle-income countries | en_US |
| dc.subject | Realist synthesis | en_US |
| dc.title | Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis | en_US |
| dc.type | Journal Article | en_US |