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Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting?
BACKGROUND: This study assessed health workers’ adherence to neonatal health protocols before and during the implementation of a mobile health (mHealth) clinical decision-making support system (mCDMSS) that sought to bridge access to neonatal health protocol gap in a low-resource setting. METHODS: W...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694934/ https://www.ncbi.nlm.nih.gov/pubmed/33243172 http://dx.doi.org/10.1186/s12887-020-02378-1 |
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author | Amoakoh, Hannah Brown Klipstein-Grobusch, Kerstin Agyepong, Irene Akua Amoakoh-Coleman, Mary Kayode, Gbenga A. Reitsma, J. B. Grobbee, Diederick E. Ansah, Evelyn K. |
author_facet | Amoakoh, Hannah Brown Klipstein-Grobusch, Kerstin Agyepong, Irene Akua Amoakoh-Coleman, Mary Kayode, Gbenga A. Reitsma, J. B. Grobbee, Diederick E. Ansah, Evelyn K. |
author_sort | Amoakoh, Hannah Brown |
collection | PubMed |
description | BACKGROUND: This study assessed health workers’ adherence to neonatal health protocols before and during the implementation of a mobile health (mHealth) clinical decision-making support system (mCDMSS) that sought to bridge access to neonatal health protocol gap in a low-resource setting. METHODS: We performed a cross-sectional document review within two purposively selected clusters (one poorly-resourced and one well-resourced), from each arm of a cluster-randomized trial at two different time points: before and during the trial. The total trial consisted of 16 clusters randomized into 8 intervention and 8 control clusters to assess the impact of an mCDMSS on neonatal mortality in Ghana. We evaluated health workers’ adherence (expressed as percentages) to birth asphyxia, neonatal jaundice and cord sepsis protocols by reviewing medical records of neonatal in-patients using a checklist. Differences in adherence to neonatal health protocols within and between the study arms were assessed using Wilcoxon rank-sum and permutation tests for each morbidity type. In addition, we tracked concurrent neonatal health improvement activities in the clusters during the 18-month intervention period. RESULTS: In the intervention arm, mean adherence was 35.2% (SD = 5.8%) and 43.6% (SD = 27.5%) for asphyxia; 25.0% (SD = 14.8%) and 39.3% (SD = 27.7%) for jaundice; 52.0% (SD = 11.0%) and 75.0% (SD = 21.2%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. In the control arm, mean adherence was 52.9% (SD = 16.4%) and 74.5% (SD = 14.7%) for asphyxia; 45.1% (SD = 12.8%) and 64.6% (SD = 8.2%) for jaundice; 53.8% (SD = 16.0%) and 60.8% (SD = 11.7%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. We observed nonsignificant improvement in protocol adherence in the intervention clusters but significant improvement in protocol adherence in the control clusters. There were 2 concurrent neonatal health improvement activities in the intervention clusters and over 12 in the control clusters during the intervention period. CONCLUSION: Whether mHealth interventions can improve adherence to neonatal health protocols in low-resource settings cannot be ascertained by this study. Neonatal health improvement activities are however likely to improve protocol adherence. Future mHealth evaluations of protocol adherence must account for other concurrent interventions in study contexts. |
format | Online Article Text |
id | pubmed-7694934 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76949342020-11-30 Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? Amoakoh, Hannah Brown Klipstein-Grobusch, Kerstin Agyepong, Irene Akua Amoakoh-Coleman, Mary Kayode, Gbenga A. Reitsma, J. B. Grobbee, Diederick E. Ansah, Evelyn K. BMC Pediatr Research Article BACKGROUND: This study assessed health workers’ adherence to neonatal health protocols before and during the implementation of a mobile health (mHealth) clinical decision-making support system (mCDMSS) that sought to bridge access to neonatal health protocol gap in a low-resource setting. METHODS: We performed a cross-sectional document review within two purposively selected clusters (one poorly-resourced and one well-resourced), from each arm of a cluster-randomized trial at two different time points: before and during the trial. The total trial consisted of 16 clusters randomized into 8 intervention and 8 control clusters to assess the impact of an mCDMSS on neonatal mortality in Ghana. We evaluated health workers’ adherence (expressed as percentages) to birth asphyxia, neonatal jaundice and cord sepsis protocols by reviewing medical records of neonatal in-patients using a checklist. Differences in adherence to neonatal health protocols within and between the study arms were assessed using Wilcoxon rank-sum and permutation tests for each morbidity type. In addition, we tracked concurrent neonatal health improvement activities in the clusters during the 18-month intervention period. RESULTS: In the intervention arm, mean adherence was 35.2% (SD = 5.8%) and 43.6% (SD = 27.5%) for asphyxia; 25.0% (SD = 14.8%) and 39.3% (SD = 27.7%) for jaundice; 52.0% (SD = 11.0%) and 75.0% (SD = 21.2%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. In the control arm, mean adherence was 52.9% (SD = 16.4%) and 74.5% (SD = 14.7%) for asphyxia; 45.1% (SD = 12.8%) and 64.6% (SD = 8.2%) for jaundice; 53.8% (SD = 16.0%) and 60.8% (SD = 11.7%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. We observed nonsignificant improvement in protocol adherence in the intervention clusters but significant improvement in protocol adherence in the control clusters. There were 2 concurrent neonatal health improvement activities in the intervention clusters and over 12 in the control clusters during the intervention period. CONCLUSION: Whether mHealth interventions can improve adherence to neonatal health protocols in low-resource settings cannot be ascertained by this study. Neonatal health improvement activities are however likely to improve protocol adherence. Future mHealth evaluations of protocol adherence must account for other concurrent interventions in study contexts. BioMed Central 2020-11-27 /pmc/articles/PMC7694934/ /pubmed/33243172 http://dx.doi.org/10.1186/s12887-020-02378-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Amoakoh, Hannah Brown Klipstein-Grobusch, Kerstin Agyepong, Irene Akua Amoakoh-Coleman, Mary Kayode, Gbenga A. Reitsma, J. B. Grobbee, Diederick E. Ansah, Evelyn K. Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title | Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title_full | Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title_fullStr | Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title_full_unstemmed | Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title_short | Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
title_sort | can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694934/ https://www.ncbi.nlm.nih.gov/pubmed/33243172 http://dx.doi.org/10.1186/s12887-020-02378-1 |
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