Online Program

Acceptability of mHealth tools by auxiliary midwives in Myanmar: A qualitative study

Tuesday, November 3, 2015

Ran van der Wal, LL.M., MPH (cand.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
Marie Hatem, PhD, M.sC., École de santé publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
Christina Zarowsky, PhD, M.sC., M.D., Global Health, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
Zin Ko Ko Lynn, MBBS, Première Urgence -Aide Médicale Internationale, Yangon, Myanmar/Burma
Myanmar’s fragile health system and suboptimal health workforce negatively affect quality of care. An NGO pilots Myanmar’s first point-of-care mHealth-project, providing smartphones to auxiliary midwives (AMWs) with patient registration and algorithm-based decision-making applications. Behavioural theories suggest that external stimuli increase clinical compliance, thereby improving quality of care, ultimately contributing to reduced maternal and neonatal mortality. With (inter)national evidence being scarce, this first known study of mHealth in Myanmar provides formative feedback to the implementing organization.

Operationalizing a conceptual framework based on Davis’ (1989) Technology Acceptance Model (TAM), acceptability, use and contextual barriers/facilitators were assessed through in-depth-interviews and focus groups with all AMWs (n=20). TAM’s premise: if mHealth tools are perceived as useful, easy to use, and important others in AMWs' social environment support its use, AMWs will accept mHealth tools (acceptance predictor for use), whereas contextual barriers/facilitators influence use of tools directly.

Acceptability was very high: smartphone and electronic applications were perceived as useful, easy to use, and AMWs’ social environment as supportive. All AMWs reported using the voice option; the majority used the applications. Organizational support (training, technical, material, financial), economic advantages (electronic reporting cheaper than paper) and political interest (MOH announced all reporting to be electronic soon) were contextual facilitators to use. Technical problems with applications and Internet network problems represented the main contextual barriers.

As mHealth was believed to be the future norm and its tools perceived as superior to the traditional system, AMWs were determined to use the mHealth tools despite important barriers, of which notably the technical need improvement.

Learning Areas:

Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
Identify perceived factors influencing acceptability and use of mHealth tools by auxiliary midwives in Myanmar Identify perceived barriers and facilitators to introducing mHealth tools in the implementation context in Myanmar Explain how qualitative research of a public health intervention can inform the implementing organization (knowledge transfer).

Keyword(s): International Health, Communication Technology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have co-developed the design, conceptual framework, and instruments. I have collected, analyzed and interpreted the data. My work for medical NGO's (Doctors without borders and Première Urgence -Aide Médicale Internationale) since 2000 and a consultancy I performed in Myanmar in 2013, have made me familiar with the implementing organization as well as the context in which the mHealth project is implemented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.