Abstract
Quality antenatal care (ANC) is recognised as an opportunity for screening and early identification of pregnancy-related complications. In rural Ghana, challenges with access to diagnostic services demotivate women from ANC attendance and referral compliance, leading to absent or late identification and management of high-risk women. In 2016, an integrated diagnostic and clinical decision support system tagged ‘Bliss4Midwives’ (B4M), was piloted in Northern Ghana. The device facilitated non-invasive screening of pre-eclampsia, gestational diabetes and anaemia at the point-of-care. This study aimed to explore the experiences of pregnant women with B4M, and its influence on service utilisation (“pull effect”) and woman-provider relationships (“woman engagement”).
Methods
Through an embedded study design, qualitative methods including individual semi-structured interviews and non-participant observation were employed. Interviews were conducted with 20 pregnant women and 10 health workers, supplemented by ANC observations in intervention facilities. Secondary data on ANC registrations over a one-year period were extracted from health facility records to support findings on the perceived influence of B4M on service utilisation.
Results
Women’s first impressions of the device were mostly emotive (excitement, fear), but sometimes neutral. Although it is inconclusive whether B4M increased ANC registration, pregnant women generally valued the availability of diagnostic services at the point-of-care. Additionally, by fostering some level of engagement, the intervention made women feel listened to and cared for. Process outcomes of the B4M encounter also showed that it was perceived as improving the skills and knowledge of the health worker, which facilitated trust in diagnostic recommendations and was therefore believed to motivate referral compliance.
Conclusions
This study suggests that mHealth diagnostic and decision support devices enhance woman engagement and trust in health workers skills. There is need for further inquiry into how these interventions influence maternal health service utilization and women’s expectations of pregnancy care.
| Original language | English |
|---|---|
| Article number | 209 |
| Pages (from-to) | 1-11 |
| Number of pages | 11 |
| Journal | BMC Pregnancy and Childbirth |
| Volume | 18 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 5 Jun 2018 |
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Keywords
- Antenatal
- Clinical decision support
- Ghana
- MHealth
- Prenatal screening
- Woman-provider interaction
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Pregnant women's experiences with an integrated diagnostic and decision support device for antenatal care in Ghana. / Abejirinde, I.O.; Douwes, R.H.; Bardají, Azucena; Abugnaba-Abanga, Rudolf; Zweekhorst, M.B.M.; van Roosmalen, Jos; De Brouwere, Vincent.
In: BMC Pregnancy and Childbirth, Vol. 18, No. 1, 209, 05.06.2018, p. 1-11.Research output: Contribution to Journal › Article › Academic › peer-review
TY - JOUR
T1 - Pregnant women's experiences with an integrated diagnostic and decision support device for antenatal care in Ghana
AU - Abejirinde, I.O.
AU - Douwes, R.H.
AU - Bardají, Azucena
AU - Abugnaba-Abanga, Rudolf
AU - Zweekhorst, M.B.M.
AU - van Roosmalen, Jos
AU - De Brouwere, Vincent
PY - 2018/6/5
Y1 - 2018/6/5
N2 - BackgroundQuality antenatal care (ANC) is recognised as an opportunity for screening and early identification of pregnancy-related complications. In rural Ghana, challenges with access to diagnostic services demotivate women from ANC attendance and referral compliance, leading to absent or late identification and management of high-risk women. In 2016, an integrated diagnostic and clinical decision support system tagged ‘Bliss4Midwives’ (B4M), was piloted in Northern Ghana. The device facilitated non-invasive screening of pre-eclampsia, gestational diabetes and anaemia at the point-of-care. This study aimed to explore the experiences of pregnant women with B4M, and its influence on service utilisation (“pull effect”) and woman-provider relationships (“woman engagement”).MethodsThrough an embedded study design, qualitative methods including individual semi-structured interviews and non-participant observation were employed. Interviews were conducted with 20 pregnant women and 10 health workers, supplemented by ANC observations in intervention facilities. Secondary data on ANC registrations over a one-year period were extracted from health facility records to support findings on the perceived influence of B4M on service utilisation.ResultsWomen’s first impressions of the device were mostly emotive (excitement, fear), but sometimes neutral. Although it is inconclusive whether B4M increased ANC registration, pregnant women generally valued the availability of diagnostic services at the point-of-care. Additionally, by fostering some level of engagement, the intervention made women feel listened to and cared for. Process outcomes of the B4M encounter also showed that it was perceived as improving the skills and knowledge of the health worker, which facilitated trust in diagnostic recommendations and was therefore believed to motivate referral compliance.ConclusionsThis study suggests that mHealth diagnostic and decision support devices enhance woman engagement and trust in health workers skills. There is need for further inquiry into how these interventions influence maternal health service utilization and women’s expectations of pregnancy care.
AB - BackgroundQuality antenatal care (ANC) is recognised as an opportunity for screening and early identification of pregnancy-related complications. In rural Ghana, challenges with access to diagnostic services demotivate women from ANC attendance and referral compliance, leading to absent or late identification and management of high-risk women. In 2016, an integrated diagnostic and clinical decision support system tagged ‘Bliss4Midwives’ (B4M), was piloted in Northern Ghana. The device facilitated non-invasive screening of pre-eclampsia, gestational diabetes and anaemia at the point-of-care. This study aimed to explore the experiences of pregnant women with B4M, and its influence on service utilisation (“pull effect”) and woman-provider relationships (“woman engagement”).MethodsThrough an embedded study design, qualitative methods including individual semi-structured interviews and non-participant observation were employed. Interviews were conducted with 20 pregnant women and 10 health workers, supplemented by ANC observations in intervention facilities. Secondary data on ANC registrations over a one-year period were extracted from health facility records to support findings on the perceived influence of B4M on service utilisation.ResultsWomen’s first impressions of the device were mostly emotive (excitement, fear), but sometimes neutral. Although it is inconclusive whether B4M increased ANC registration, pregnant women generally valued the availability of diagnostic services at the point-of-care. Additionally, by fostering some level of engagement, the intervention made women feel listened to and cared for. Process outcomes of the B4M encounter also showed that it was perceived as improving the skills and knowledge of the health worker, which facilitated trust in diagnostic recommendations and was therefore believed to motivate referral compliance.ConclusionsThis study suggests that mHealth diagnostic and decision support devices enhance woman engagement and trust in health workers skills. There is need for further inquiry into how these interventions influence maternal health service utilization and women’s expectations of pregnancy care.
KW - Antenatal
KW - Clinical decision support
KW - Ghana
KW - MHealth
KW - Prenatal screening
KW - Woman-provider interaction
UR - http://www.scopus.com/inward/record.url?scp=85048095980&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048095980&partnerID=8YFLogxK
U2 - 10.1186/s12884-018-1853-7
DO - 10.1186/s12884-018-1853-7
M3 - Article
VL - 18
SP - 1
EP - 11
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
SN - 1471-2393
IS - 1
M1 - 209
ER -