Background: Antenatal care (ANC) is a mainstay of preventing maternal and perinatal morbidity and mortality but utilization of these services in Uganda remains low. Consequently, maternal and perinatal mortality rates are among the highest in the world. Short message service (SMS) and other mobile health (mHealth) interventions have been proposed to promote positive health behavior and strengthen informed decision- making for women in the perinatal period. Such interventions are hypothesized to improve outcomes through knowledge transfer and strengthened access to social support. However, few evaluations of mHealth interventions to improve maternal care have been conducted in sub-Saharan Africa, where social and contextual factors that drive successful interventions differ, and the public health impact of such interventions is likely to be great. Few studies have also examined theory-informed methods to develop interventions to maximize end-user acceptability. Candidate: I am a lecturer at Mbarara University of Science and Technology with basic training in epidemiology, research methods and data analysis, resulting in 12 publications (6 first- authored). I am applying for this K43 award to secure training and mentorship in developing and adopting low cost, context-specific novel interventions to improve maternal-child health in low resource settings.
To accomplish this goal, I have identified a strong mentorship team with expertise in reproductive health (Drs. Matthews & Mugyenyi), mHealth, methodology and epidemiology (Dr. Siedner), qualitative methods (Dr. Ware), career development and project implementation (Professor. Obua). Leveraging this strong team of multidisciplinary mentors and formal didactics in the identified focus areas of training will enable me to obtain requisite skills and hands-on experience to inform, design, adopt and test novel intervention strategies to improve maternal-child health in low resource settings. Training: I require additional experience, mentorship and training in: 1) qualitative methods to elicit end-user feedback for development of interventions, 2) technology acceptance for patient-centered intervention development and evaluation, and 3) experimental study designs to evaluate interventions in pregnant women. Research: I propose to 1) conduct a qualitative study to identify barriers and facilitators to women?s engagement in ANC, decisions to deliver in health facilities, and characterize their preferences for an mHealth-based, social support intervention; 2) develop and iteratively evaluate the intervention based on these qualitative results; 3) pilot test the intervention to assess feasibility, acceptability and preliminary efficacy to improve ANC utilization and skilled births. This training and results will position me to write an R01 application in year 5 of this award to evaluate the effectiveness of an mHealth-based social support intervention compared to routine care to improve maternal and child health outcomes in Uganda. My ultimate goal is to become an independent investigator, with expertise in development and evaluation of culturally informed solutions to reduce maternal-child mortality.
Ugandan women and their children suffer from high maternal mortality (360 for every 100,000 women) and perinatal mortality (41 deaths per 1000 births). Only 58% of pregnant women attend at least 4 ANC visits (of the recommended 8) and only 70% deliver with a skilled attendant. The proposed work will position me to become a regional expert in the design and evaluation of patient-centered, interventions to engage social support and improve utilization of ANC and skilled delivery services, with an overarching goal of improving maternal child health in lower-resourced settings.