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Background: mHealth has increasingly been touted as having the potential to help Sub-Saharan Africa achieve their health-related sustainable development goals by reducing maternal mortality rates. Such interventions are implemented as one-way or two-way systems where maternal clients receive pregnancy related information via SMS. While such technologies often view the users (the maternal health client) as having agency to adopt, we know from pregnancy literature that the pregnancy experience in Africa and other developing countries is often more collective. In addition to the maternal health client, other members of the community have high stakes in the pregnancy, and this often affects maternal healthcare-seeking behavior. Objective: The aim of this paper, therefore, is to understand the pathways through which these other members of the community affect mHealth use. Methods: The study used a qualitative approach and a case study research design. We analyzed two mHealth cases from Kenya and Malawi. In the Kenyan case, maternal health clients had mobile phones to receive pregnancy-related messages, while in the Malawi case, maternal health clients did not have mobile phones. Data were collected through interviews and focus group discussions. The study used an inductive thematic analysis to analyze the data. Results: The findings show that maternal stakeholders form a community of purpose (CoP) that plays a crucial role in the implementation, uptake, and use of mHealth. The CoP influences maternal health clients through a diverse range of mechanisms ranging from sensitization, bridging the digital literacy gap and legitimization of the intervention. The nature of influence is largely dependent on the contextual socio-cultural nuances. Conclusion: Our results provide useful insights to mHealth implementers to know how best to leverage the CoP for better mHealth uptake and usage. For example, engaging healthcare providers could champion adoption and use, while engaging other family-related stakeholders will ensure better usage and compliance, encourage behavior change, and reduce mHealth attrition. [ABSTRACT FROM AUTHOR]

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Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths. [ABSTRACT FROM AUTHOR]

Establishing and proving methodological rigor has long been a challenge for qualitative researchers where quantitative methods prevail, but much published literature on qualitative analysis assumes a relatively small number of researchers working in relative proximity. This is particularly true for research conducted with a grounded theory approach. Different versions of grounded theory are commonly used, but this methodology was originally developed for a single researcher collecting and analyzing data in isolation. Although grounded theory has evolved since its development, little has been done to reconcile this approach with the changing nature and composition of international research teams. Advances in technology and an increased emphasis on transnational collaboration have facilitated a shift wherein qualitative datasets have been getting larger and the teams collecting and analyzing them more diverse and diffuse. New processes and systems are therefore required to respond to these conditions. Data for this article are drawn from the experiences of the Innovations for Choice and Autonomy (ICAN) Research Consortium. ICAN aims to understand how self-injectable contraceptives can be implemented in ways that best meet women's needs in Kenya, Uganda, Malawi, and Nigeria. We found that taking a structured approach to analysis was important for maintaining consistency and making the process more manageable across countries. However, it was equally important to allow for flexibility within this structured approach so that teams could adapt more easily to local conditions, making data collection and accompanying analysis more feasible. Meaningfully including all interested researchers in the analysis process and providing support for learning also increased rigor. However, competing priorities in a complex study made it difficult to adhere to planned timelines. We conclude with recommendations for both funders and study teams to design and conduct global health studies that ensure more equitable contributions to analysis while remaining logistically feasible and methodologically sound., (© Suchman et al.)