Improving health worker performance through text messaging: A mixed-methods evaluation of a pilot intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy in West Nile, Uganda

Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and...

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Bibliographic Details
Published in:PloS one 2018-09, Vol.13 (9), p.e0203554-e0203554
Main Authors: Rassi, Christian, Gore-Langton, Georgia R, Gidudu Walimbwa, Badru, Strachan, Clare E, King, Rebecca, Basharat, Sinwan, Christiansen-Jucht, Celine, Graham, Kirstie, Gudoi, Sam Siduda
Format: Article
Language:English
Subjects:
Acceptability
Analysis
Care and treatment
Cellular telephones
Classrooms
Consortia
Electronic devices
Employee performance
Engineering and Technology
Feasibility studies
Health aspects
Health care facilities
Information dissemination
Intervention
Low income groups
Malaria
Medical personnel
Medicine and Health Sciences
Messages
Mixed methods research
People and Places
Practice
Pregnancy
Prenatal care
Prevention
Short message service
Social Sciences
Text messaging
Training
Vector-borne diseases
Womens health
Workers
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Summary:Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and outcomes of an mHealth intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in two districts of West Nile, Uganda. In both districts, selected health workers (N = 48) received classroom training on malaria in pregnancy. All health workers in one district (N = 49) subsequently received 24 text messages reinforcing the training content. The intervention was evaluated using a mixed-methods approach, including four focus group discussions with health workers and three in-depth interviews with district health officials, health worker knowledge assessments one month (N = 90) and six months (N = 89) after the classroom training, and calculation of IPTp coverage from participating health facilities' (N = 16) antenatal care registers covering six months pre- and post-intervention. Complementing classroom training with text messaging was found to be a feasible, acceptable and inexpensive approach to improving health worker performance. The messages served as reminders to those who had attended the classroom training and helped spread information to those who had not. Health workers in the district where text messages were sent had significantly better knowledge of IPTp, achieving an increased composite knowledge score of 6.00 points (maximum score: 40) compared with those in the district where only classroom training was provided. Average facility coverage of three doses of IPTp was also significantly higher where text messages were sent (85.8%) compared with the district where only classroom training was provided (54.1%). This intervention shows promise for the improvement of health worker performance for delivery of IPTp, and could have significant broader application.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0203554