Building consensus on common features and interoperability use cases for community health information systems: a Delphi study.

INTRODUCTION: Information systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and middle-income countries. This study aimed to establish consensus regarding key features and interoperability priorities for community health information systems (CHISs). METHODS: A Delphi study was conducted among a systematically selected panel of CHIS experts. This impressive pool of experts represented a range of leading global health institutions, with gender and regional balance as well as diversity in their areas of expertise. Through five rounds of iterative surveys and follow-up interviews, the experts established a high degree of consensus. We supplemented the Delphi study findings with a series of focus group discussions with 10 community health worker (CHW) leaders. RESULTS: CHISs today are expected to adapt to a wide range of local contextual requirements and to support and improve care delivery. While once associated with a single role type (CHWs), these systems are now expected to engage other end users, including patients, supervisors, clinicians and data managers. Of 30 WHO-classified digital health interventions for care providers, experts identified 23 (77%) as being important for CHISs. Case management and care coordination features accounted for more than one-third (14 of 37, 38%) of the core features expected of CHISs today, a higher proportion than any other category. The highest priority use cases for interoperability include CHIS to health management information system monthly reporting and CHIS to electronic medical record referrals. CONCLUSION: CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. Future interoperability efforts, such as CHISs in general, are expected not only to move data efficiently but to strengthen community health systems in ways that measurably improve care.

Using a Responsive Feedback Approach to Develop and Pilot a Counseling Chatbot to Strengthen Child Nutrition in Rural India.

INTRODUCTION: Nearly half of all deaths in children in India aged younger than 5 years are attributable to undernutrition. Reinforcing the caregiver's positive behaviors through multiple channels can lead to improved child nutrition outcomes. We describe the development and piloting of a chatbot to improve nutrition outcomes for children aged 0-12 months. POSHAN DIDI CHATBOT DEVELOPMENT PROCESS: We engaged key stakeholders to understand existing interventions to improve nutrition outcomes and developed a theory of change that included an intervention that provides nutrition-related information directly to beneficiaries. A chatbot, Poshan Didi, was developed to provide individual counseling to mothers with children aged 0-12 months on age-appropriate, nutrition-related topics. The chatbot was piloted in Katni district from February 2019 to October 2019 in 2 phases to investigate the acceptability and feasibility of the chatbot (Phase 1, n=10 mothers) and to assess whether users would continue to be engaged and would engage with both the automated content as well as through free form questions (Phase 2, n=100 mothers). Quantitative and qualitative data were collected in focus group discussions with health care workers and mothers (n=4) and interviews with mothers (n=26). RESULTS: Mothers viewed the chatbot as being a private channel to discuss topics and referred to Poshan Didi's persona as being knowledgeable. Eighty percent of users replied at least once to a chatbot-generated message. Sixty-four percent engaged beyond the standard chatbot content by discussing at least 1 issue with a nurse who responded to escalated messages. CONCLUSION: This work demonstrates how chatbots could create multiple interaction touchpoints between caregivers and health care workers to increase caregivers' access to age-appropriate nutrition counseling and information. The study shows the value of using the responsive feedback approach in the chatbot design and implementation to improve the efficacy of the digital tool.

Evaluation of mHealth strategies to optimize adherence and efficacy of Option B+ prevention of mother-to-child HIV transmission: Rationale, design and methods of a 3-armed randomized controlled trial.

BACKGROUND: Lifelong antiretroviral therapy (ART) (Option B+) is recommended for all HIV-infected pregnant/postpartum women, but high adherence is required to maximize HIV prevention potential and maintain maternal health. Mobile health (mHealth) interventions may provide treatment adherence support for women during, and beyond, the pregnancy and postpartum periods. METHODS AND DESIGN: We are conducting an unblinded, triple-arm randomized clinical trial (Mobile WACh X) of one-way short message service (SMS) vs. two-way SMS vs. control (no SMS) to improve maternal ART adherence and retention in care by 2years postpartum. We will enroll 825 women from Nairobi and Western Kenya. Women in the intervention arms receive weekly, semi-automated motivational and educational SMS and visit reminders via an interactive, human-computer hybrid communication system. Participants in the two-way SMS arm are also asked to respond to a question related to the message. SMS are based in behavioral theory, are tailored to participant characteristics through SMS tracks, and are timed along the pregnancy/postpartum continuum. After enrollment, follow-up visits are scheduled at 6weeks; 6, 12, 18, and 24months postpartum. The primary outcomes, virological failure (HIV viral load ≥1000copies/mL), maternal retention in care, and infant HIV infection or death, will be compared in an intent to treat analysis. We will also measure ART adherence and drug resistance. DISCUSSION: Personalized and tailored SMS to support HIV-infected women during and after pregnancy may be an effective strategy to motivate women to adhere to ART and remain in care and improve maternal and infant outcomes.

Mobile phone tools for field-based health care workers in low-income countries.

In low-income regions, mobile phone-based tools can improve the scope and efficiency of field health workers. They can also address challenges in monitoring and supervising a large number of geographically distributed health workers. Several tools have been built and deployed in the field, but little comparison has been done to help understand their effectiveness. This is largely because no framework exists in which to analyze the different ways in which the tools help strengthen existing health systems. In this article we highlight 6 key functions that health systems currently perform where mobile tools can provide the most benefit. Using these 6 health system functions, we compare existing applications for community health workers, an important class of field health workers who use these technologies, and discuss common challenges and lessons learned about deploying mobile tools.