BACKGROUND Although considerable progress has been made in reducing maternal mortality over the past 25 years in Senegal, the national maternal mortality ratio (MMR), at 315 deaths per 100,000 live births, is still unacceptably high. In recent years a mobile health (mHealth) intervention to enhance maternal health care has been introduced in rural and remote areas of the country. CommCare is an application that runs on cell phones distributed to community health workers known as matrones who enroll and track women throughout pregnancy, birth and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers. METHODS An ethnographic study of the CommCare intervention and the larger maternal health program into which it fits was conducted in order to identify key social and cultural contextual factors that contribute to the uptake and functioning of this mHealth intervention in Senegal. Ethnographic methods and semi-structured interviews were used with participants drawn from four categories: NGO field staff (n = 16), trained health care providers (including physicians, nurses, and midwives) (n = 19), community level health care providers (n = 13); and women belonging to a community intervention known as the Care Group (n = 14). Data were analyzed using interpretive analysis informed by critical medical anthropology theory. RESULTS The study identified five socio-cultural factors that work in concert to encourage the uptake and use of CommCare: convening women in the community Care Group; a cultural mechanism for enabling pregnancy disclosure; constituting authoritative knowledge amongst women; harnessing the roles of older women; and adding value to community health worker roles. We argue that, while CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care. CONCLUSIONS In Senegal, mHealth has the potential not only to bridge the gaps of distance and expertise, but to engage local people productively in the goal of enhancing maternal health care. Successful mHealth interventions do not work as 'magic bullets' but are part of 'assemblages' - people and things that are brought together to accomplish particular goals. Attention to the social and cultural elements of the global health assemblage within which CommCare functions is critically important to understand and develop this mHealth technology to its full potential.

中文翻译：

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社会文化背景因素有助于采用移动卫生干预措施，以加强塞内加尔农村地区的孕产妇保健。

背景尽管过去25年来塞内加尔在降低孕产妇死亡率方面取得了相当大的进展，但全国孕产妇死亡率（MMR）为每10万活产中有315人死亡，仍然高得令人无法接受。近年来，该国农村和偏远地区引入了移动医疗（mHealth）干预措施，以加强孕产妇保健。CommCare 是一款在手机上运行的应用程序，分发给被称为护士长的社区卫生工作者，她们在怀孕、分娩和产后期间登记和跟踪妇女，提供健康信息、道德支持、预约提醒以及转介到正规医疗保健提供者。方法 对 CommCare 干预措施及其所适用的更大的孕产妇保健计划进行了人种学研究，以确定有助于在塞内加尔采用和发挥这一移动医疗干预措施的关键社会和文化背景因素。采用人种学方法和半结构化访谈，对来自四类的参与者进行了调查：非政府组织现场工作人员（n = 16）、经过培训的医疗保健提供者（包括医生、护士和助产士）（n = 19）、社区级医疗保健提供者（ n = 13); 以及属于称为“护理小组”的社区干预的妇女 (n = 14)。使用以批判医学人类学理论为基础的解释分析来分析数据。结果 该研究确定了五个共同作用以鼓励人们接受和使用 CommCare 的社会文化因素： 在社区护理小组中召集妇女；允许披露怀孕情况的文化机制；在妇女中构成权威知识；利用老年妇女的角色；并增加社区卫生工作者角色的价值。我们认为，虽然 CommCare 是一种强大的信息、临床支持、监测和数据收集工具，但它也是一种社交技术，可以联系和激励人们，改变关系，从而优化其改善孕产妇保健的潜力。结论 在塞内加尔，移动医疗不仅有可能缩小距离和专业知识的差距，而且可以有效地吸引当地人参与加强孕产妇保健的目标。成功的移动医疗干预措施并不是“灵丹妙药”，而是“组合”的一部分——将人和事物聚集在一起以实现特定目标。关注 CommCare 发挥作用的全球健康组合的社会和文化元素对于理解和开发这项移动医疗技术的全部潜力至关重要。