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HEALTH CARE IMPROVEMENT PROJECT Use of mHealth for Quality Improvement in Guatemala Background Method n In June 2010, the Guatemalan n Five focus group discussions (FGDs) Ministry of Health (MOH), with assessed the acceptability of mHealth, technical support from the USAID type of message desired, frequency, Health Care Improvement Project, and time of day preferred to inform managed by URC, tested the use the campaign design. Findings: of text messages to health workers – Messages should be motivational to promote quality improvement and promote quality performance as part of a larger intervention to – Participants should be informed implement a quality management and educated on the SMS system in the health sector. campaign in advance n Target populations were: – SMS should be sent no more than administrative staff from MOH 3 times a week in the morning Guatemala City (n=371, approximately before work or during lunch time 43% of central level administrative – There should be no cost to receive staff) and administrative staff and SMS health care providers (n=677, – The sender should be the MOH approximately 17% of total staff) in the San Marcos Health Area, one of – Confidentiality of phone numbers 29 health areas in the country. should be ensured Promotional posters were placed in health n This is the first experience in using n Messages for health workers were facilities to publicize the cell phone campaign. pre-tested in FGDs Photo by Elena Hurtado, URC. Poster design cell phones to promote improved by Monica Gonzalez, URC. quality of public sector health n A promotional campaign during services in Guatemala. the four weeks prior to sending SMS informed health workers n Mid-campaign FGDs assessed oBjectives of the purpose of the campaign coverage, recall and acceptability The cell phone campaign addressed the and encouraged staff to enroll by of SMS; and reported changes in following questions: submitting a form to the MOH attitudes and practices Health Promotion Coordinator 1. Are Short Messaging Services n An end-of-campaign random (SMS—or text messages) an n SMS were sent to enrolled staff three sample telephone survey assessed acceptable communication medium times a week for approximately six health workers’ receipt of SMS and to public health workers? weeks (July–September 2010). 19 reactions to the messages. messages were sent in all, grouped 2. What are the options for establishing in five message themes (see Table 1); a SMS system for public health total SMS sent=18,864 workers? noveMBer 2010 This work was supported by the American people through the United States Agency for International Development (USAID) and its Health Care Improvement (HCI) Project. The HCI Project is managed by University Research Co., LLC (URC) under the terms of Contract Number GHN-I-03-07-00003-00. For more information on the HCI’s work, please visit www.hciproject.org. For more information on the use of mhealth for quality improvement in Guatemala, please contact Nancy Newton at firstname.lastname@example.org. resuLts – 80% health workers reacted n Continue sending SMS to health positively to the messages workers, by monthly theme, and Focus Group Discussions: – 82% found the messages helpful expand to other Health Areas n SMS are an acceptable communication – 39% shared them with co-workers, n Test the feasibility of more tailored medium to public sector health family members, friends and messaging managed by the MOH at workers, if measures are taken to community residents the Health Area level gain their trust before and during the period of sending messages – Most often remembered messages n Conduct further evaluation to were those related to quality or measure the effects on health worker n SMS helped to create a sense of were motivational in nature (see practices connection between public-sector Table 1) health workers and their institution (the MOH): health workers felt like Lessons Learned and the MOH remembered them recoMMendations n Health workers want to continue n Public-private partnerships are receiving SMS regularly and to necessary for large-scale SMS include topics such as information campaigns to secure a mutually on events, more health topics, beneficial agreement for free air time emergency alerts, and MOH norms with a large national carrier. Random sample telephone survey n The MOH or other trusted sources (n=105): must manage the cell phone number n Of the 105 health workers database and be the originator of telephoned, 5 (5%) had not SMS for health workers; MOH received the SMS, and 40 (38%) and USAID logos on promotional did not respond to the survey. Of materials helped to create trust the 60 (57%) health workers who n To sustain SMS campaigns, a responded to the survey: mechanism to update the cell phone – 78% remembered the MOH as database regularly is needed, as the source turnover of cell phone numbers is high Table 1: Message Content and Recall Message Number of messages Number (%) who recalled theme (% of total) this type of message (n=60) Sample message The MOH informs: We are all the MOH. If we work with Quality 7 (37%) 45 (39%) quality, the institution will get better every day. The MOH requests: During Reproductive Health Month, help Reproductive 4 (21%) 17 (15%) people to choose freely the family planning method that they Health want to use. The MOH requests: Let’s work to guarantee breastfeeding in Breastfeeding 3 (16%) 18 (16%) the first half hour after childbirth. World Breastfeeding Week. The MOH informs: Today is Monday. Develop a work plan for Informational 3 (16%) 11 (10%) the week and you will obtain better results. The MOH wishes you a very happy Public Health Worker Day. Motivational 2 (11%) 25 (22%) We thank you for doing a job with quality and cordiality for the Guatemalan people every day. totaL 19 (100%) University Research Co., LLC • 7200 Wisconsin Avenue • Bethesda, MD 20814-4811 • USA • 301-654-8338 The contractor team for the USAID Health Care Improvement Project includes URC (prime contractor), EnCompass LLC, Family Health International, Health Research Inc., Initiatives Inc., Institute for Healthcare Improvement, and Johns Hopkins University Center for Communication Programs (CCP). For more information on HCI’s work, please visit www.hciproject.org or contact email@example.com.
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