Nthabi in Lesotho - Implementation
Condition: Preconception Care
Study type: Interventional

Summary: 
      This project will determine how well the mobile health (mHealth) Nthabi application is
      introduced and used at district hospitals in Lesotho. This will help with measuring the
      effectiveness of an evidence-based mHealth application in a low-income country. Three factors
      will be studied when assessing the mHealth application's overall impact: 1) end-user content
      knowledge 2) pre and post stage of change and 3) system usage. This data will be collected by
      the mHealth application. End-users will use the mHealth application over a period of two
      months. Results will be shared with the clinical, health services research, information
      technology, and policy communities.
    

Detailed description: 
      Lesotho has second-highest HIV and fifth-highest tuberculosis prevalence rates worldwide, and
      a maternal mortality rate (1024/100,000) that is among the highest in Africa. As there are
      only 6.2 nurses and 0.5 physicians per 10,000 people, both about one-third of the African
      average, there is an enormous need for eHealth systems to assist the clinical care system.

      Preconception care is an effort to focus on engaging young women in their health before they
      become pregnant since many women enter pregnancy at risk for poor outcomes because of
      preexisting medical conditions or not following evidence-based preventive action. In 2013,
      the WHO prioritized research that focuses on developing, delivering, and scaling
      preconception women's health interventions in low and middle-income countries to optimize
      health and birth outcomes. The WHO emphasized implementation research as the key step in
      helping to maximize the coverage and uptake of preconception care to enhance the long-term
      health outcomes for women and their children.

      The existing "Gabby" system is a patient-facing, user-friendly, evidence-based, scalable,
      culturally adaptive, health communication system designed to improve women's health. The
      investigator's team has developed and tested several Embodied Conversational Agents (ECAs),
      which are virtual characters designed using expertise from health communication,
      psychotherapy, social psychology, sociolinguistics, linguistics, and communication theory.

      For this project, the investigators will first adapt the existing "Gabby" system to a
      culturally appropriate mHealth application, called "Nthabi", and second, study the impact of
      the Nthabi application into district hospitals in Lesotho in partnership with the Lesotho
      Boston Health Alliance (LeBoHA) using the existing educational infrastructure. The research
      team will assess the effectiveness of Nthabi based on the periodic stage of change
      assessments over the two-month implementation, end-user content knowledge, and system usage.
    

Intervention name(s): mHealth Application
Intervention type(s): Behavioral
Intervention description(s): Nthabi mHealth Application delivers educational content and recommendations to minimize or eliminate health risks. The content is delivered via the Nthabi application downloaded on an Android phone smartphone. End-users can select from a list of topics relevant to the Lesotho population to engage with the conversational agent, Nthabi, and discuss conditions such as tuberculosis, HIV testing, healthy diet, and family planning.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: mHealth; Lesotho