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Systematic Review
To assess the effects of Targeted Client Communication (TCC) via mobile devices (MD) on health behaviour, service use, health, and well‐being for MNCH.
"Only two studies in this review met the inclusion criteria of this evidence map (Yudin et al. 2017; Lund et al. 2012):
'Based on pooled analyses of the trial and another conducted in Canada, TCC via mobile devices may increase attendance for antenatal vaccinations (influenza and tetanus) (OR 1.36, 95% CI 0.90 to 2.06; n = 714; low-certainty evidence – downgraded due to risk of bias and imprecision (Lund 2012; Yudin 2017).'
In regards to the findings from the wider review, the authors state:
We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls.
Pregnant and postpartum women
TCCMD versus standard care
For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low‐certainty evidence), but have little or no effect in settings where almost all women breastfeed (low‐certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low‐certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low‐certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low.
TCCMD versus non‐digital TCC (e.g. pamphlets)
TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low‐certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low‐certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies.
TCCMD versus digital non‐targeted communication
No studies reported behavioural, health, or well‐being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low‐certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence).
Pregnant and postpartum women living with HIV
TCCMD versus standard care
For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low‐certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI –0.36 to 3.36; low‐certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low‐certainty evidence. For health and well‐being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low‐certainty evidence. No studies reported on maternal mortality or morbidity.
TCCMD versus non‐digital TCC
The effect is unknown due to lack of studies reporting this comparison.
TCCMD versus digital non‐targeted communication
TCCMD may increase infant ARV/prevention of mother‐to‐child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low‐certainty evidence). The effect on other outcomes is unknown due to lack of studies."
The authors state:
"The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."