Dissemination and implementation of the  e-MCH Handbook , UNRWA’s newly released maternal and child health mobile application: a cross-sectional study

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Abstract

Objectives

In April 2017, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) released the electronic Maternal and Child Health Handbook, the e-MCH Handbook application. One of the first mobile health (m-Health) interventions in a refugee setting, the application gives pregnant women and mothers access to educational information and health records on smartphones. This study investigated factors associated with the dissemination and implementation of m-Health in the refugee setting.

Setting and participants

A cross-sectional study was conducted in 9 of 25 UNRWA health centres for Palestine refugees in Jordan. Self-administered questionnaires were distributed for 1 week to pregnant women and mothers with children aged 0–5 years.

Outcome measures

The outcomes were whether participants knew about, downloaded or used the application. Multiple regression analyses were conducted to determine factors associated with application download and usage.

Results

1042 participants were included in the analysis. 979 (95.5%) had a mobile phone and 862 (86.9%) had a smartphone. 499 (51.3%) knew about, 235 (23.8%) downloaded and 172 (17.4%) used the application. Having other mobile applications (OR 6.17, p<0.01), staff knowledge of the application (OR 11.82, p<0.01), using the internet as a source of medical information (OR 1.63, p=0.01) and having internet access at home (OR 1.46, p=0.05) were associated with application download. The age of the husband was associated with application usage (OR 1.04, p=0.11).

Conclusions

Though m-Health may be a promising means of promoting health in refugees, multiple barriers may exist to its dissemination and implementation. Those who regularly use mobile applications and get medical information from the internet are potential targets of m-Health dissemination. For successful implementation of a m-Health intervention, health staff should have thorough knowledge of the application and users should have access to the internet. Husband-related factors may also play a role.

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Most cited references 18

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How Many Subjects Does It Take To Do A Regression Analysis.

S Green (1991)

Numerous rules-of-thumb have been suggested for determining the minimum number of subjects required to conduct multiple regression analyses. These rules-of-thumb are evaluated by comparing their results against those based on power analyses for tests of hypotheses of multiple and partial correlations. The results did not support the use of rules-of-thumb that simply specify some constant (e.g., 100 subjects) as the minimum number of subjects or a minimum ratio of number of subjects (N) to number of predictors (m). Some support was obtained for a rule-of-thumb that N ≥ 50 + 8 m for the multiple correlation and N ≥104 + m for the partial correlation. However, the rule-of-thumb for the multiple correlation yields values too large for N when m ≥ 7, and both rules-of-thumb assume all studies have a medium-size relationship between criterion and predictors. Accordingly, a slightly more complex rule-of thumb is introduced that estimates minimum sample size as function of effect size as well as the number of predictors. It is argued that researchers should use methods to determine sample size that incorporate effect size.

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Mapping mHealth Research: A Decade of Evolution

Maddalena Fiordelli, Nicola Diviani, Peter J. Schulz (2013)

Background For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments.

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A qualitative study of user perceptions of mobile health apps

Wei-Wei Peng, Shaheen Kanthawala, Shupei Yuan … (2016)

Background Mobile apps for health exist in large numbers today, but oftentimes, consumers do not continue to use them after a brief period of initial usage, are averse toward using them at all, or are unaware that such apps even exist. The purpose of our study was to examine and qualitatively determine the design and content elements of health apps that facilitate or impede usage from the users’ perceptive. Methods In 2014, six focus groups and five individual interviews were conducted in the Midwest region of the U.S. with a mixture of 44 smartphone owners of various social economic status. The participants were asked about their general and health specific mobile app usage. They were then shown specific features of exemplar health apps and prompted to discuss their perceptions. The focus groups and interviews were audio recorded, transcribed verbatim, and coded using the software NVivo. Results Inductive thematic analysis was adopted to analyze the data and nine themes were identified: 1) barriers to adoption of health apps, 2) barriers to continued use of health apps, 3) motivators, 4) information and personalized guidance, 5) tracking for awareness and progress, 6) credibility, 7) goal setting, 8) reminders, and 9) sharing personal information. The themes were mapped to theories for interpretation of the results. Conclusions This qualitative research with a diverse pool of participants extended previous research on challenges and opportunities of health apps. The findings provide researchers, app designers, and health care providers insights on how to develop and evaluate health apps from the users’ perspective. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3808-0) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2020

Publication date (Electronic): 9 March 2020

Volume: 10

Issue: 3

Electronic Location Identifier: e034885

Affiliations

[1 ]University of Nebraska Medical Center , Omaha, Nebraska, USA

[2 ]departmentHealth Department , United Nations Relief and Works Agency for Palestine Refugees in the Near East , Amman, Jordan

[3 ]departmentDepartment of Pediatrics , The University of Tokyo Hospital , Bunkyo-ku, Tokyo, Japan

[4 ]World Bank , Washington, District of Columbia, USA

[5 ]departmentDepartment of Community and Global Health , The University of Tokyo, Graduate School of Medicine, Faculty of Medicine , Bunkyo-ku, Tokyo, Japan

Author notes

[Correspondence to ] Dr Ryunosuke Goto; ryunosukegoto@ 123456gmail.com

SN and RG are joint first authors.

Author information

Ryunosuke Goto http://orcid.org/0000-0002-4164-0990

Akiko Kitamura http://orcid.org/0000-0003-1954-6954

Article

Publisher ID: bmjopen-2019-034885

DOI: 10.1136/bmjopen-2019-034885

PMC ID: 7064073

PubMed ID: 32156767

SO-VID: 70a6f8c9-c64f-47e5-acf0-1dc27f1b5e80

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 12 October 2019

Date revision received : 03 February 2020

Date accepted : 04 February 2020

Funding

Funded by: United Nations Relief and Works Agency for Palestine Refugees in the Near East;

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ScienceOpen disciplines: Medicine

Keywords: mobile health,e-health,dissemination and implementation,refugee,unrwa,palestine refugees,maternal and child health

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ScienceOpen disciplines: Medicine

Keywords: mobile health, e-health, dissemination and implementation, refugee, unrwa, palestine refugees, maternal and child health

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Dissemination and implementation of the e-MCH Handbook, UNRWA’s newly released maternal and child health mobile application: a cross-sectional study

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Abstract

Objectives

Setting and participants

Outcome measures

Results

Conclusions

Related collections

The Covid-19 Lessons: How Telemedicine Helps

Most cited references 18

How Many Subjects Does It Take To Do A Regression Analysis.

Mapping mHealth Research: A Decade of Evolution

A qualitative study of user perceptions of mobile health apps

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Affiliations

Author notes

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History

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Cited by 13

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