Integration Towards Sustainable Health in the Digital Era: A Meta-Analysis of Primary Care Services for Adolescent Pregnant Women
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Abstract
This mixed-method meta-analysis aimed to analyze the effectiveness of digital technology integration in primary care services for adolescent pregnant women, identify factors affecting sustainability, and develop policy recommendations. The sample comprised 38 research studies published between 2013-2024 that met the inclusion criteria. Research instruments included a study selection form, quality assessment tools (RoB 2 and ROBINS-I), and data extraction form. Data analysis employed pooled effect size calculation using a random-effects model, heterogeneity analysis, subgroup analysis, meta-regression, publication bias assessment, and inductive content analysis.
Results showed that digital technology integration was effective in increasing antenatal care utilization (RR = 1.72, 95% CI: 1.35, 2.18), improving health knowledge and behaviors, and positively affecting health outcomes. Mobile applications demonstrated the highest effectiveness (SMD = .64). Integration into existing systems and stakeholder involvement were significantly associated with effectiveness (p < .05). However, effectiveness decreased with longer follow-up periods and varied by country income levels. Factors affecting sustainability encompassed multiple levels, from individual to policy factors.
Key recommendations include promoting mobile application development, integrating technologies into existing systems, enhancing stakeholder participation, and providing continuous policy and budgetary support for long-term sustainability.
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References
Azevedo, J. P., Hasan, A., Goldemberg, D., Geven, K. & Iqbal, S. A. (2021). Simulating the potential impacts of COVID-19 school closures on schooling and learning outcomes: A set of global estimates. The World Bank Research Observer, 36(1), 1-40.
Berwick, D. M. (2020). The moral determinants of health. Journal of the American Medical Association, 324(3), 225-226.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.
Chen, H., Chai, Y., Dong, L., Niu, W. & Zhang, P. (2021). Effectiveness and appropriateness of mHealth interventions for maternal and child health: Systematic review. JMIR mHealth and uHealth, 9(1), e17216.
Daher, J., Vijh, R., Linthwaite, B., Dave, S., Kim, J., Dheda, K., Peter, T. & Pai, N. P. (2023). Do digital health technologies improve health outcomes in low- and middle-income countries? A systematic review. BMJ Global Health, 8(1), e009553.
Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319-340.
Department of Health, Ministry of Public Health. (2022). Thailand's situation of adolescent pregnancy 2022. Ministry of Public Health. (in Thai).
Fleming, N., O'Driscoll, T., Becker, G. & Spitzer, R. F. (2023). Adolescent pregnancy guidelines. Journal of Obstetrics and Gynaecology Canada, 45(1), 30-61.
Glass, G. V. (1976). Primary, secondary, and meta-analysis of research. Educational Researcher, 5(10), 3-8.
Golden, S. D. & Earp, J. A. L. (2020). Social ecological approaches to individuals and their contexts: Twenty years of health education & behavior health promotion interventions. Health Education & Behavior, 47(4), 554-568.
Kongrach, P., Wattanakul, B. & Kespichayawattana, J. (2021). Development of online counseling system for pregnant teenagers. Journal of Health Science Research, 15(2), 89-98. (in Thai).
Labrique, A. B., Wadhwani, C., Williams, K. A., Lamptey, P., Hesp, C., Luk, R. & Aerts, A. (2021). Best practices in scaling digital health in low and middle income countries. Globalization and Health, 17(1), 68.
Marcolino, M. S., Oliveira, J. A. Q., D'Agostino, M., Ribeiro, A. L., Alkmim, M. B. M. & Novillo-Ortiz, D. (2022). The impact of mHealth interventions: Systematic review of systematic reviews. JMIR mHealth and uHealth, 10(5), e35337.
Ministry of Public Health. (2020). Strategic plan for health service system development (Service Plan) in maternal and child health. Ministry of Public Health. (in Thai).
Patton, G. C., Raniti, M., Reavley, N., Sawyer, S. M., Patton, K. & Sanci, L. A. (2022). Promoting social inclusion in the early years to prevent depression: A systematic review. The Lancet. Public Health, 7(7), e628-e638.
Phoodaangau, B., Deoisres, W. & Chunuan, S. (2022). Effectiveness of using application "Pink Book" for promoting antenatal care attendance among teenage pregnant women. Thai Journal of Nursing Council, 37(2), 90-105. (in Thai).
Ramirez-Rubio, O., Daher, C., Fanjul, G., Gascon, M., Mueller, N., Pajín, L., Plasencia, A., Rojas-Rueda, D., Thondoo, M. & Nieuwenhuijsen, M. J. (2022). Urban health: An example of a "health in all policies" approach in the context of SDGs implementation. Globalization and Health, 18(1), 3.
Sameroff, A. (2022). Developmental systems and family functioning. In F. Walsh (Ed.), Normal family processes: Growing diversity and complexity (4th ed., pp. 35-54). The Guilford Press.
Scheirer, M. A. & Dearing, J. W. (2021). An agenda for research on the sustainability of public health programs. American Journal of Public Health, 111(3), 405-411.
Starfield, B., Shi, L. & Macinko, J. (2021). Contribution of primary care to health systems and health. The Milbank Quarterly, 99(2), 167-202.
United Nations. (2022). The sustainable development goals report 2022. United Nations.
Wang, Q., Su, M., Zhang, M. & Li, R. (2022). Integrating digital technologies and public health to fight Covid-19 pandemic: Key technologies, applications, challenges and outlook of digital healthcare. International Journal of Environmental Research and Public Health, 19(4), 1910.
Whittaker, R., Umali, E., & Tanielu, H. (2021). Mobile health: Scaling digital health solutions to reach the primary healthcare level in low-and middle-income countries. BMJ Global Health, 6(Suppl 5), e004752.
World Health Organization. (2020). Adolescent pregnancy. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy
Yamey, G. (2011). Scaling up global health interventions: A proposed framework for success. PLoS Medicine, 8(6), e1001049.
