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Targeted client communication via mobile devices for improving maternal, neonatal, and child health.

Palmer MJ et al. (2020)

Cochrane Database of Systematic Reviews - 10.1002/14651858.CD013679

Evidence Categories

  • Care setting: Healthcare Setting
  • Care setting: Community setting
  • Care setting: Primary care
  • Population group: Under 5s
  • Intervention: Reminder/recall (patient)
  • Outcome: Changes to parent/patient attitudes or beliefs
  • Outcome: Service provision/process outcomes
  • Outcome: Patient Satisfaction
  • Outcome: Other

Type of Evidence

Systematic Review

Aims

This Cochrane review aimed to assess the effects of targeted client communication via mobile devices (TCCMD) on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).

Findings

The reviewers 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. Only results relevant to this evidence map have been extracted below.

 

Pregnant and postpartum women

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 [Risk ration (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58], though the CI encompasses both benefit and harm (low‐certainty evidence).

 

Parents of children aged less than five years

TCCMD versus standard care: Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low‐certainty evidence); however, the effect estimates varied widely between studies.

 

TCCMD versus non‐digital TCC: TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low‐certainty evidence), and may make little or no difference to oral hygiene practices (low‐certainty evidence).

 

TCCMD versus digital non‐targeted communication: TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low‐certainty evidence).

 

No trials in any population reported data on unintended consequences.

Conclusions

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.