Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study
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Abstract
Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries.
Methods
We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country.
Results
We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms ( n = 5–17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported – for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices.
Conclusions
There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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SciScore for 10.1101/2020.11.12.20229955: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: All participants provided informed consent. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable In each country, there are gender and location differences in mobile phone ownership and internet usage, indicating less independent access for women and rural residents. 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:Strengths and Limitations: Our …
SciScore for 10.1101/2020.11.12.20229955: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: All participants provided informed consent. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable In each country, there are gender and location differences in mobile phone ownership and internet usage, indicating less independent access for women and rural residents. 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:Strengths and Limitations: Our methodological approach, grounded in complexity theory and systems’ thinking7, 8, has afforded comparative insights into multiple perspectives (people, organisations, policies) within and across mConsulting systems. Located in five urban slums and two remote rural contexts in five LMIC countries, our study presents diversity of context, increasing the transferability of our findings to similar low-resource settings. Using a mixed method study design has enabled us to identify the extent of mConsulting within the urban slum sites and to understand reasons for this. Furthermore, we have been able to draw in lessons from our review of current evidence to contextualise the findings of our scoping study in urban and rural settings, thereby providing a more comprehensive picture than would be possible with quantitative or qualitative methods alone89. Many community residents and health workers engaged enthusiastically with the ‘idea’ of mConsulting without first-hand experience, especially of formal provider platforms. We expect that unanticipated challenges and benefits will emerge as mConsulting is further introduced and adopted within low resource settings. However, perceptions and willingness are important drivers of usage intention in telemedicine101, as well as of health-seeking behaviour, community trust and service acceptability10. Implications for policy and practice: Our study findings suggest various policy avenues for strengthening and sup...
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.
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