The TRAction project is supporting research conducted at the International Center for Diarrheal Disease Research, Bangladesh (icddr,b) examining an innovative mobile health (“mhealth”) intervention that utilizes mobile phones to improve maternal and neonatal health outcomes. Termed “Aponjon,” the intervention package disseminates health messages aimed at changing maternal behavior to improve care practices and is administered by the Mobile Alliance for Maternal Action (“MAMA”).
Goals four and five of the millennium development goals focused on maternal and newborn health. Aimed at reducing child mortality by two-thirds and the maternal mortality ratio by three-quarters, Bangladesh was on track for improvements in these areas but trends showed that the country would fall short of meeting targets. Innovations in behavior change to assist with reaching populations at high-risk for poor maternal and newborn outcomes were prioritized, hopeful that new models could improve health.
Globally, the explosion of mobile phone technology presents great potential for information dissemination. With the growth of mobile apps that allow for innovation in areas such as instant money transfers and among farmers, harnessing mobile technology to improve health for growth within public health programming is an area for investment among public health practitioners. Even so, as the number and quality of information seemingly explodes, there is also a need to provide evidence to improve upon messaging and ensure that the hardest to reach are receptive to information received via their mobile.
Primary Objective: assess accessibility, acceptability and effectiveness of the “Aponjon” mobile phone based health messages for behavior change and improved health care practices among the end users of the service.
1. To explore the facilitating factors and barriers in relation to accessibility, acceptability, affordability and utility of the Aponjon intervention,
2. To test effectiveness of the intervention in improved knowledge in care giving and care seeking,
3. To test awareness to adopt appropriate care-giving and care-seeking behavior, and
4. To characterize facilitators to increased and utilization of services for MNH care.
The health belief model served as a guiding theory to framing the research questions and design. Researchers employed a mixed-methods, case-control approach, recruiting 14,720 pregnant or new mothers into the survey and 768 into the qualitative component from one of four areas: one in the iccddr,b’s Matlab, one slum in Dhaka City, and two sites from Brahmanbaria District. The quantitative survey utilized a retrospective observational quasi-experimental approach, employing propensity score matching to assign treatment (subscriber Aponjon) and control groups (not subscriber of Aponjon). Both the qualitative interviews and the survey on behaviors were conducted at three intervals (3, 12, and 18 months) during the intervention period. Qualitative methods included a combination of focus group discussions, key informant interviews, and semi-structured interviews.
The study’s results will be helpful for improving the design of mhealth programs for effective behavior change programming. This study will also provide evidence in the form of feedback to improve the operation of the MAMA program and toward improving the function of MCH activities.
The study found that the intervention package led to greater knowledge of maternal health care for those that were enrolled for 6 months or longer. For those that participated for shorter durations, the results were less conclusive. The intervention also had an impact on maternal health practices for those that participated for 6 months or longer. The intervention illustrated the efficacy of using mobile technology to encourage both knowledge dissemination and behavior change, but simply using mobile technology is not enough. The program must be specifically targeted and of significant enough frequency and duration to have an appreciable impact.
International Centre for Diarrheal Disease Research (icddr,b)