A model for predicting utilization ofmHealth interventions in low-resourcesettings: case of maternal and newborncare in Kenya

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Mburu and Oboko BMC Medical Informatics and Decision Making(2018) 18:67

Abstract
Background:
In low-resource settings, there are numerous socioeconomic challenges such as poverty, inadequate facilities, shortage of skilled health workers, illiteracy and cultural barriers that contribute to high maternal and newborn deaths. To address these challenges, there are several mHealth projects particularly in Sub-Sahara Africa seeking to exploit opportunities provided by over 90% rate of mobile penetration. However, most of these interventions have failed to justify their value proposition to inspire utilization in low-resource settings.
Methods:
This study proposes a theoretical model named Technology, Individual, Process-Fit (TIPFit) suitable for user-centred evaluation of intervention designs to predict utilization of mHealth products in low-resource settings. To investigate the predictive power of TIPFit model, we operationalized its latent constructs into variables used to predict utilization of an mHealth prototype called mamacare. The study employed single- group repeated measures quasi-experiment in which a random sample of 79 antenatal and postnatal patients were recruited from a rural hospital. During the study cond ucted between May and October 2014, the treatment involved sending and receiving SMS alerts on vital signs, appointments,
safe delivery, danger signs, nutrition, preventive care and adherence to medication.
Results:
Measurements taken during the study were cleaned and coded for analysis using statistical models like PartialLeast Squares (PLS), Repeated Measures Analysis of Variance (RM-ANOVA), and Bonferroni tests. After analyzing 73 pretest responses, the model predicted 80.2% fit, and 63.9% likelihood ofutilization. However, results obtained from initial post-test taken after three months demonstrated 69.1% fit, and utilization of 50.5%. The variation between prediction and theactual outcome necessitated improvement of mamacare based on feedback obtained from users. Three months later, weconducted the second post-test that recorded further drop in fit from 69.1 to 60.3% but utilization marginally improved from 50.5 to 53.7%.
 
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