Using community health workers to refer pregnant women and young children to health care facilities in rural West Bengal, India: A prospective cohort study.

BACKGROUND: Community health workers (CHWs) have been placed in many rural areas in India to increase villagers' connections to basic preventive health care. In this study, we describe how pregnant women and mothers of young children react when CHWs inform them that they, or their child, are at high risk of pregnancy-related complications or early childhood developmental delays, and further screening and health care from a physician is recommended. METHODS: In this longitudinal study in rural villages in West Bengal, India, pregnant mothers, as well as mothers of children aged 12-24 months, were screened for high risk complications. They were re-contacted and asked questions regarding how and to what extent did visits by the CHWs improve their household's overall health behavior, along with details about what additional care, if any, they sought. These responses are presented by different demographic and medical characteristics. RESULTS: Of the 231 pregnant women, all said they had sought additional care in response to the CHW visit, and all stated that feedback from the CHW resulted in improvement to their health behaviors. Most (90%) pregnant women gave birth at an institution. Among the 213 mothers of young children who were followed up, all sought additional care in response to the CHW's visit. Most (67%) mentioned that they had a significant improvement in their health behaviors following feedback from the CHW, and the rest stated that they had some improvement. CONCLUSIONS: With the proper training, CHWs can be partners in health care to improve the health of vulnerable populations, not only in rural areas of India, but also in other developing countries. CHWs can promote positive health outcomes in their villages of residence.

Risk Factors During Pregnancy and Early Childhood in Rural West Bengal, India: A Feasibility Study Implemented via Trained Community Health Workers Using Mobile Data Collection Devices.

Objectives This study measures the prevalence of risk factors among pregnant women and young children aged 12-24 months in a rural community in West Bengal, India. Methods Community health workers (CHWs) enrolled women and children into this 2015 cross-sectional study. Pregnant women were evaluated for underweight, anemia, and abnormal blood pressure. Children were evaluated for underweight, abnormal head and upper arm circumferences, and low scores from the Ages and Stages Questionnaire (ASQ). Data were collected on smartphones and tablets or by paper. Results More than half of the 279 women (59.9%) had a risk factor during pregnancy: 48.7% were anemic, 35.1% had low blood pressure, and 7.5% were underweight. Among the 366 children, 59.3% had a risk factor, including 24.0% with low ASQ scores and 49.7% who had abnormal anthropometric measures. Conclusions for Practice Vulnerable populations, such as pregnant women and young children, needed a greater connection to doctors in this rural community. This study demonstrated the feasibility of CHWs to listen to health concerns and connect underserved populations with health care services.

Mobile devices and weak ties: a study of vision impairments and workplace access in Bangalore.

PURPOSE: To explore ways in which social and economic interactions are changed by access to mobile telephony. METHOD: This is a mixed-methods study of mobile phone use among 52 urban professionals with vision impairments in Bangalore, India. RESULTS: Interviews and survey results indicated that mobile devices, specifically those with adaptive technology software, play a vital role as multi-purpose devices that enable people with disabilities to navigate economically and socially in an environment where accessibility remains a significant challenge. CONCLUSIONS: We found that mobile devices play a central role in enabling and sustaining weak ties, but also that these weak ties have important gender-specific implications. We found that women have less access to weak ties than men, which impacts women's access to assistive technology (AT). This has potential implications for women's sense of safety and independence, both of which are strongly related to AT access. Implications for Rehabilitation Adaptive technologies increase individuals' ability to keep in contact with casual connections or weak ties through phone calls or social media. Men tend to have stronger access to weak ties than women in India due to cultural impediments to independent access to public spaces. Weak ties are an important source of assistive technology (AT) due to the high rate of resale of used AT, typically through informal networks.

The "voice" has it: screen reader adoption and switching behavior among vision impaired persons in India.

We present results from a mixed methods study of screen reader use and switching behavior among people with vision impairments in India. We examine loyalty and experimentation with screen readers and find that the main drivers of adoption for early users differ significantly from the factors that drive continued use by advanced users. We discuss the factor that emerges as one of the strongest stated drivers of early adoption, text-to-speech "voice" quality, particularly a "human-sounding voice" as one of the key features differentiating free/open source products from more expensive proprietary products. While the initial preferences are driven by voice quality, application support becomes more important over time as users speed up their sound settings and become more comfortable with the resultant non-human-sounding speech. We discuss these findings from two theoretical perspectives--first, through the application of the economics of behavior switching, and second, vis-à-vis novice and expert approaches toward new product adoption. We argue that these findings further our understanding of initial user comfort related to assistive technology adoption, and the impact of early technology choices on long-term technology switching behavior.