Safe+natal Sierra Leone: Opportunities and Challenges in Co-Designing a Maternal and Neonatal Health Intervention. Open Access

Abstract

Maternal health is a prominent focus of global health efforts in low- and middle-income countries (LMICs). Healthcare settings in LMICs often pose unique challenges such as limited resources, lack of highly skilled healthcare workers, and existing infrastructure that is not conducive to interventions that may be successful in high-income countries. Additionally, current interventions on the market often only target one or two aspects/stages of the pregnancy-related continuum of care. New approaches in maternal healthcare such as mobile health (mHealth) technology and co-design are needed to address these gaps to combat high rates of maternal and neonatal mortality. Safe+natal is a low-cost, low-tech maternal and neonatal monitoring kit that includes a mobile-phone programmed with an app to walk healthcare providers through pregnancy-related scenarios. The safe+natal pilot study uses the principles of co-design to actively engage end-users in the intervention design process while considering the cultural context of the intended use site. 

The aim of this thesis is to analyze the challenges and realities of conducting the safe+natal pilot study in Sierra Leone to better understand the opportunities for this intervention in LMICS, as well as potential challenges and barriers to success. Sierra Leone, a country in West Africa, has one of the highest rates of maternal mortality in Sub-Saharan Africa and is currently serving as the most recent pilot study site for safe+natal. Through analysis of training assessments conducted on community health workers (CHWs) and first-hand interview and meeting data with the Sierra Leone co-design team, my thesis will help inform future pilots of safe+natal and improve upon the co-design process to impact scalability of the intervention and bolster use of mHealth for global maternal health.

Table of Contents

Table of Contents

1. Background ….. 1

1.1 Introduction ….. 1

1.2 Global Maternal and Neonatal Health and Mortality ….. 2

1.3 Mobile Health Technology ….. 4

1.3.1 Rationale for use of mHealth technology ….. 5

1.3.2 Main approaches to mHealth ….. 6

1.3.3 Mobile internet usage ….. 8

1.4 Safe+natal ….. 9

1.4.1 Background of safe+natal ….. 9

1.4.2 The safe+natal toolkit materials and set up ….. 11

1.4.3 Evidence for the use of safe+natal to detect danger signs in mother and fetus ….. 13

1.4.4 Safe+natal in comparison to other mHealth Maternal Health interventions ….. 15

1.5 Sierra Leone ….. 16

1.5.1 Sierra Leone’s current efforts to improve maternal and neonatal health ….. 18

1.6 The Co-Design approach ….. 20

1.6.1 Benefits of Co-Design  ….. 22

1.6.2 Challenges of Co-Design ….. 23

2. Methods ….. 24

2.1 The safe+natal toolkit training process & quantitative data ….. 24

2.1.1 Training Participants ….. 28

2.1.2 Quantitative Procedures: Training Assessments ….. 31

2.2 Qualitative Procedures ….. 31

2.2.1 Weekly Observational Meetings with Emory & Sierra Leone Teams ….. 33

2.2.2 Semi-Structured Interviews ….. 34

2.2.3 Qualitative Data Codebook ….. 37

3. Results ….. 38

3.1 Quantitative Training Assessment Results ….. 38

3.2 Observational Meeting Data ….. 41

3.3 Qualitative Data Codebook Parent Codes ….. 43

3.3.1 Communication ….. 43

3.3.2 Delays ….. 44

3.3.3 Design ….. 45

3.3.4 Logistics ….. 46

3.3.5 Training ….. 47

3.3.6 Motivation ….. 48

3.3.7 Team Building ….. 49

4. Discussion ….. 50

4.1 The Co-Design Process for safe+natal ….. 51

4.1.1 Problem Identification with local partner ….. 52

4.1.2 Baseline needs assessment and local input ….. 53

4.1.3 Building an existing technology for prototype ….. 54

4.1.4 Refining technology based on context and local preferences ….. 55

4.1.5 End-user training ….. 59

4.1.6 Implementation and ongoing support and refining ….. 60

4.2 Other Opportunities & Challenges for safe+natal ….. 61

4.2.1 The Referral Process and Capacity Building for Health Workers ….. 64

4.2.2 Challenges in Communication and Building Relationships ….. 67

4.2.3 Delays in the Co-design Process ….. 68

5. Conclusion ….. 68

5.1 Limitations of this research ….. 69

5.2 Future Directions ….. 70

6. References ….. 72

7. Appendices ..... 81

 

About this Honors Thesis

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School	Emory College
Department	Human Health
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Anthropology, Medical and Forensic Health Sciences, General
Keyword	Co-design Maternal health Global health Sierra Leone Mobile health technology
Committee Chair / Thesis Advisor	Rachel Hall-Clifford, Emory University
Committee Members	Gari Clifford, Emory University Don Noble, Emory University

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