title: Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda.
abstract: BACKGROUND
  Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice.
  
  
  METHODS
  A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques.
  
  
  RESULTS
  Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns.
  
  
  CONCLUSIONS
  Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of combining home visits with phone consultations between VHTs and professional health workers. However, the challenge of attitudinal change among VHTs towards certain strongly culturally-embedded behavioural post-partum practices, resistance from part of the professional health workforce to collaborate with VHTs and the problematic availability of professional health workers are important systemic problems that need to be addressed.
  
  
  BACKGROUND
  Current Controlled Trials NCT02084680. Registered 14 March 2014.
authors.affiliation: Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda. mangwirichard@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Mangwi Ayiasi
authors.affiliation: Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda. atuyambe@musph.ac.ug.
authors.forename: Lynn Muhimbuura
authors.initials: LM
authors.lastname: Atuyambe
authors.affiliation: Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda. jkiguli@musph.ac.ug.
authors.forename: Juliet
authors.initials: J
authors.lastname: Kiguli
authors.affiliation: Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda. cgorach@musph.ac.ug.
authors.forename: Christopher
authors.initials: C
authors.lastname: Garimoi Orach
authors.affiliation: Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium. pkolsteren@itg.be.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.affiliation: Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium. bcriel@itg.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
mesh_terms: D040421:Cell Phone; D003150:Community Health Workers; D005190:Family; D005260:Female; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services; D011247:Pregnancy; D036301:Qualitative Research; D019114:Remote Consultation; D014454:Uganda