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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention for pregnant and post-partum women: a descriptive study. Lancet 2021; 398 Suppl 1:S18. [PMID: 34227949 DOI: 10.1016/s0140-6736(21)01504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Targeted client communication using text messages can inform, motivate, and remind pregnant and postpartum women to use care in a timely way. The mixed results of previous studies of the effectiveness of targeted client communication highlight the importance of theory-based co-design with users. We planned, developed, and tested a theory-based intervention tailored to pregnant and postpartum women, to be automatically distributed via an electronic maternal and child health registry in occupied Palestinian territory. METHODS We did 26 in-depth interviews with pregnant women and health-care providers in seven purposively selected public primary health-care clinics in the West Bank and Gaza to include clinics with different profiles. An interview guide was developed using the Health Belief Model to explore women's perceptions of high-risk conditions (anaemia, hypertension, diabetes, and fetal growth restriction) and timely attendance for antenatal care, as predefined by a national expert panel. We did thematic analyses of the interview data. Based on the results, we composed messages for a targeted client communication intervention, applying concepts from the Model of Actionable Feedback, social nudging, and enhanced active choice. We assessed the acceptability and understandability of the messages through unstructured interviews with local health promotion experts, health-care providers, and pregnant women. FINDINGS The recurring themes indicated that most women were aware of the health consequences of anaemia, hypertension, and diabetes, but that they seldom associated these conditions with pregnancy. We identified knowledge gaps and low awareness of susceptibility to and severity of these complications and the benefits of timely antenatal care. The actionable messages were iteratively improved with stakeholder and end-user feedback after presenting the initial draft, and the messages deemed were understandable and acceptable based on reflections during unstructured assessment. INTERPRETATION Following a stepwise iterative process by a theory-based approach and co-designing the intervention with users, we revealed elements critical to an efficacious targeted client communication intervention. A potential limitation of our study is that conducting in-depth interviews on several health conditions simultaneously might have reduced the depth of information we could have obtained. The strength of our study was that we assessed for, developed, and refined the intervention following recommended theoretical frameworks and best practices. The effectiveness of this intervention is under evaluation in a cluster-randomised trial (ISRCTN10520687). FUNDING European Research Council and Research Council of Norway.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Itimad Abu Ward
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Taghreed Hijaz
- Palestinian Ministry of Health, Ramallah, occupied Palestinian territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Yousef Rabah
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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Mørkrid K, Bogale B, Abbas E, Abu Khader K, Abu Ward I, Attalh A, Awwad T, Baniode M, Frost KS, Frost MJ, Ghanem B, Hijaz T, Isbeih M, Issawi S, Nazzal ZAS, O’Donnell B, Qaddomi SE, Rabah Y, Venkateswaran M, Frøen JF. eRegCom-Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial. Trials 2021; 22:47. [PMID: 33430935 PMCID: PMC7802344 DOI: 10.1186/s13063-020-04980-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women. METHODS This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat. DISCUSSION This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach. TRIAL REGISTRATION ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018.
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Affiliation(s)
- Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
| | - Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | | | - Itimad Abu Ward
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Amjad Attalh
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Tamara Awwad
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Kimberly Suzanne Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Michael James Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Taghreed Hijaz
- Palestinian National Institute of Public Health, Ramallah, Palestine
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Sally Issawi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Brian O’Donnell
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Sharif E. Qaddomi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Yousef Rabah
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Mahima Venkateswaran
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study. BMC Med Inform Decis Mak 2020; 20:1. [PMID: 31906929 PMCID: PMC6945530 DOI: 10.1186/s12911-019-1002-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. METHODS We used the Health Belief Model to develop interview guides to explore women's perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. RESULTS We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. CONCLUSIONS We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Khadija Abu Khader
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Mervett Isbeih
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - Tamara Awwad
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Yousef Rabah
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
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