伊拉克北部的卫生系统因冲突和300多万人的国内流离失所而受到削弱。基于手机的干预措施(mHealth)可以通过启用紧急转诊来改善孕产妇和新生儿的健康结果,促进患者和提供者之间的沟通,改善患者数据管理;然而,在受冲突影响的环境中,它们没有得到充分的研究。我们探讨了利益相关者对产科转诊挑战的看法,以及基于手机的应用程序的可行性和可接受性,以减少到达紧急产科护理的延迟,从而为其发展提供信息。我们于五月至七月在伊拉克北部库尔德斯坦地区进行了定性研究,2018.使用有目的的采样,我们对包括医疗管理人员在内的协调行为者进行了15次半结构化访谈,政府卫生官员,非政府卫生计划经理和救护人员。访谈探讨了产科护理的提供,转介流程,手机使用和移动健康实施策略。十一个焦点小组讨论,其中纳入了类似主题的参与性活动,是和救护车司机一起进行的,医院和基层卫生中心的工作人员。录音,转录和翻译的数据被迭代地编码以识别新出现的概念,并按主题进行分析。68个利益攸关方(36名女性和32名男性)参加了会议。有关转诊系统的挑战包括资源限制,安全问题,费用和妇女不愿乘坐男性救护车。在产科护理和决策方面,与会者注意到卫生保健提供者之间在与当前纸质系统的服务沟通和协调方面存在差距,救护车司机,医院工作人员。救护车司机报告由于缺乏患者信息而导致延误,路况差,和安全问题。一个原型手机应用程序被认为是可以接受的,基于感知到的有用性,以解决安全产科护理的一些挑战,并侧重于电话的使用,获取信息,全球定位系统(GPS),连通性,成本,和用户友好性。然而,结合已确定的实施挑战考虑了创新的可行性,包括连接不良,数字素养。该应用程序的实施需要考虑人道主义背景,关于产科护理的文化和性别规范,这将需要政策制定者和从业者的大量承诺和参与。
The health system in northern Iraq has been weakened by conflict and the internal displacement of over three million people. Mobile phone-based interventions (mHealth) may improve maternal and neonatal health outcomes by enabling emergency referrals, facilitating communication between patients and providers, and improving patient data management; however, they have not been sufficiently studied in conflict-affected settings. We explored stakeholders\' perspectives on challenges to obstetric referrals and the feasibility and acceptability of a mobile phone-based application to reduce delays in reaching emergency obstetric care in order to inform its development. We conducted a qualitative study in the Kurdistan region of northern Iraq from May to July, 2018. Using purposive sampling, we carried out 15 semi-structured interviews with coordination actors including healthcare management staff, government health officials, non-government health program managers and ambulance staff. The interviews explored obstetric care delivery, referral processes, mobile phone usage and mHealth implementation strategies. Eleven focus group discussions, which incorporated participatory activities on similar topics, were conducted with ambulance drivers, hospital and primary health center staff. Audio-recorded, transcribed and translated data were coded iteratively to identify emerging concepts, and analyzed thematically. Sixty-eight stakeholders (36 women and 32 men) participated. Challenges regarding the referral system included resource limitations, security concerns, costs and women\'s reluctance to be transported in male-staffed ambulances. In terms of obstetric care and decision-making, participants noted gaps in communication and coordination of services with the current paper-based system between health care providers, ambulance drivers, and hospital staff. Ambulance drivers reported incurring delays through lack of patient information, poor road conditions, and security issues. A prototype mobile phone application was found to be acceptable based on perceived usefulness to address some of the challenges to safe obstetric care and focused on phone usage, access to information, Global Positioning System (GPS), connectivity, cost, and user-friendliness. However, the feasibility of the innovation was considered in relation to implementation challenges that were identified, including poor connectivity, and digital literacy. Implementation of the app would need to account for the humanitarian context, cultural and gender norms regarding obstetric care, and would require substantial commitment and engagement from policymakers and practitioners.