Evaluating the Adoption of mHealth Technologies by CommunityHealth Workers to Improve the Use of Maternal Health Servicesin Sub-Saharan Africa:Systematic Review

Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs)on improving the use of maternal health services in sub-Saharan Africa (SSA). Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care(ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth useby CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical systemapproach. Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa IndexMedicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection,2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software(Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, weperformed a narrative synthesis of the outcomes. Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwentdata extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes,43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births,89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increasedPNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors relatedto the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships,digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very fewstudies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, andequipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA.Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealthprograms. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364