Background: With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal. Objective: This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions. Methods: We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos. Results: The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers. Conclusions: A text message–based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message–based mHealth intervention design in under-resourced settings.

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中文翻译：

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探索使用移动医疗来改善尼泊尔山区社区健康和营养服务的利用：定性研究。


背景：随着移动电话覆盖率和拥有量在全球范围内不断扩大，移动医疗（mHealth）干预措施越来越多地用于提高健康和营养服务的覆盖范围和质量。然而，在尼泊尔等低收入和中等收入国家，有关移动医疗干预可行性和方案设计过程中需要考虑的因素的证据有限。目的：本研究旨在通过探索手机拥有和共享来检验使用短信改善健康和营养服务的潜力；手机的使用和技巧；有关移动医疗干预措施的兴趣、偏好和限制。方法：我们对 1000 天妇女（从受孕到孩子两岁生日期间）、医疗机构工作人员和女性社区卫生志愿者 (FCHV) 进行了 35 次深度访谈，并与医疗机构工作人员进行了 8 次焦点小组讨论、FCHV 和 1000 天家庭决策者（即丈夫、岳母和岳父）。我们还进行了手机技能测试。我们使用框架矩阵和分析备忘录进行主题分析。结果：该研究包括 70 名研究参与者，其中 68 人（97%）拥有手机，并且手机共享并不常见。与家庭决策者和 FCHV 相比，千日妇女和医疗机构工作人员最常报告使用短信。超过十分之八的参与者（54/64，84%）可以拨打号码，大多数 1000 天女性、医疗机构工作人员和男性决策者（28/34，82%）也可以阅读和书写文本消息。我们发现，千日妇女更喜欢教育和提醒信息，而医疗机构工作人员和 FCHV 则希望获得教育和激励信息。 参与者建议向千日妇女、家庭、FCHV 和医疗机构工作人员发送不同类型的短信，并表示从未知电话号码收到的短信价值较低。结论：基于短信的移动医疗干预措施在尼泊尔山区是可以接受的，并且有可能改善社区健康和营养服务的利用，特别是通过发送会议提醒和提供信息。我们的研究结果有助于资源贫乏地区基于短信的移动医疗干预设计。


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