title: Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India.
abstract: BACKGROUND
  A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low.
  
  
  OBJECTIVE
  This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs.
  
  
  METHODS
  The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery.
  
  
  RESULTS
  Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff.
  
  
  CONCLUSIONS
  The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial.
authors.affiliation: Community Health Department, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Dhiren
authors.initials: D
authors.lastname: Modi
authors.affiliation: Argusoft India Ltd., Gandhinagar, Gujarat, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Gopalan
authors.affiliation: Community Health Department, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Shobha
authors.initials: S
authors.lastname: Shah
authors.affiliation: Argusoft India Ltd., Gandhinagar, Gujarat, India.
authors.forename: Sethuraman
authors.initials: S
authors.lastname: Venkatraman
authors.affiliation: Community Health Department, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Desai
authors.affiliation: Community Health Department, SEWA Rural, Bharuch, Gujarat, India; sdesai1977@yahoo.com.
authors.forename: Shrey
authors.initials: S
authors.lastname: Desai
authors.affiliation: Community Health Department, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Shah
mesh_terms: D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D003906:Developing Countries; D015438:Health Behavior; D006266:Health Education; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007318:Inservice Training; D008427:Maternal Health Services / Q000458:organization & administration*; D063731:Mobile Applications; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*
keywords: ASHAs; acceptability; complex intervention; implementation research; mHealth; uptake