This study investigates whether training Community Health Workers (CHW) to use a smartphone-based prenatal counseling application as a "job aid" instead of the existing paper based standard is associated with increased women's use of maternal health services in Singida region, Tanzania.
In low-income countries, frontline community health workers (CHWs) have potential to improve women's access to maternal health services through prenatal counseling and referral. However, CHW performance can often be enhanced with sufficient training, incentives, supportive supervision and job aids. Smartphone-based applications designed to assist CHWs with referrals, health education and client counseling may improve the quality of care delivered during household visits. There is a need for rigorous scientific studies on the impact of such interventions. This study investigates whether CHWs' use of a smartphone-based application increases women's use of maternal health services in Singida region, Tanzania. It is hypothesized that smartphone-assisted counselling by CHWs can increase use of health facility-based delivery services compared to a control group of CHWs using standard paper-based protocols. This study is conducted within the context of larger project - SUSTAIN-MNCH Project (Supporting Systems to Improve Nutrition, Maternal, Newborn and Child Health), implemented by World Vision through multiple partners.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
572
Intervention (Smart phone assisted): During prenatal household visits, the smart phone based application guides CHW through electronic "decision tree" protocols, directing them to specific health/nutrition counseling topics and messages based on each woman's gestational age, and her answers to a specific series of diagnostic questions. Based on the client's gestational age, the tool directs CHW to lessons in an accompanying photo book, and reminds them to counsel on the importance of accessing timed and targeted maternal health services at health facilities. The application also assists CHW to identify danger signs during pregnancy, flags clients who require immediate referral to health facilities, and reminds CHW to follow-up with clients who were previously referred to clinics.
SUSTAIN Paperbased training of CHW (SOC): During prenatal household visits, the CHW asks a specific series of diagnostic questions based on the client's gestational age, offers counsel on the importance of accessing appropriate maternal health services at health facilities and uses lessons in an accompanying photo book to deliver messages on a variety of maternal and newborn health and nutrition topics. CHW are trained to identify danger signs during pregnancy, flag clients who require immediate referral to health facilities, and follow-up with clients who were previously referred to clinics.
Delivery in a facility
Participant delivered at or on the way to a health facility, measured by retrospective report at time of interview, after delivery
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Antenatal care attendance
Whether participant attended 4 ANC visits or more during their most recent pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Gestational age at first contact/ANC
Number of months into pregnancy the participant had first ANC visit
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Iron supplementation during pregnancy
Whether participant received 100 IFA tablets during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
HIV screening HIV Screening
Whether the participant was screened for HIV during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
De-worming treatment during pregnancy
Whether the participant reported during interview taking any listed de-worming medication during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
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Bednet use
Whether the participant slept under an insecticide treated bed net during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Malaria prophylaxis during pregnancy
Whether the participant reported during interview receiving two doses of IPTp during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Tetanus Toxoid Vaccination
Whether the participant received two TT vaccinations during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Referrals
Whether the participant was referred to a clinic during pregnancy by a CHW
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Referral uptake
Whether a referred participant went to the facility during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Presence of partner at ANC
Whether the participant's husband/spouse accompanied her to at least one ANC visit
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Birth plan
Whether the participant developed a birth plan during pregnancy
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Early initiation of breastfeeding
Whether the participant initiated breastfeeding within 1 hour after birth
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Exclusive breastfeeding at 7 days
Whether the participant breastfed exclusively for the first week after birth
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
BCG vaccination
Whether the participant's child received BCG vaccination within the first week of life
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Maternal knowledge of danger signs during pregnancy
Number of pregnancy danger signs listed by participant
Time frame: Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)