A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

  1. Anna Galle
  2. Aline Semaan
  3. Elise Huysmans
  4. Constance Audet
  5. Anteneh Asefa
  6. Therese Delvaux
  7. Bosede Bukola Afolabi
  8. Alison Marie El Ayadi
  9. Lenka Benova

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Abstract

The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally.

Methods

The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.

Results

Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.

Conclusions

Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.

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  1. Version published to 10.1136/bmjgh-2020-004575
  2. ScreenIT

    SciScore for 10.1101/2020.11.25.20238535: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: This study was approved by the Institutional Review Board at the Institute of Tropical Medicine in Antwerp Belgium under the number 1372/20.
    Consent: Respondents provided informed consent online by checking a box affirming that they voluntarily agreed to participate in the survey.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableParticularly relevant to this analysis, we added a section on the use of telemedicine, whereby we asked participants whether they used technology to counsel or provide care to women or their babies remotely, and if so, what type of services were being provided remotely and whether they had received any guidelines on telemedicine provision.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Limitations of our study are the sample bias and lack of representativeness, due to the convenience sampling approach. We received few responses from professionals working in lower-level facilities, particularly in LICs, which might itself be related to limited access to the internet in these settings. Our sample might over-represent higher qualified cadres of health professionals in settings with limited use of technology among lower cadres of staff, and under-represent overstretched staff, or those with limited access to internet connection. This is particularly relevant for the objective of this analysis, as we might overestimate the use of telehealth because of the sample that we reached. Another limitation is the over-representation of healthcare providers from Kazakhstan in our study. This was a result of the proactive dissemination of the survey by the Ministry of Health in Kazakhstan. A sensitivity analysis was conducted, showing Kazakhstan skewed the data from MICs regarding the use of telemedicine because they were overrepresented (in Kazakhstan 67% of respondents used telemedicine versus 52 % in other MICs). However, this mixed-methods analysis does not aim to make a generalisable statement about telemedicine use by country income levels. We rather use the quantitative findings to frame the qualitative data, which was analysed in-depth to explore healthcare providers’ personal experiences with telemedicine. We therefore do not apply any statistical cor...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.11.25.20238535v1 on medRxiv