Technologies that empower women for better access to healthcare in India – A scoping review

Figures & data

Figure 1. PRISMA 2020 flow diagram for the scoping review (Page et al., 2021).

Table 1. Various technologies used by women across studies in India (n = 43 articles).

Themes	No. of articles^#
Audio visual aid	7
IVRS technology	7
SMS reminders	10
Phone calls/helpline services	7
Mass media (television, radio and/or movie)	5
mHealth/web technology aided health workers in primary care	9
Telemedicine	3

^# Number of articles are not mutually exclusive.

Figure 2. Thematic analysis of health outcomes assessed in studies among women in India (n = 43 articles).

Table 2. Mapping of various technologies to health outcomes assessed in studies done among women in India.

Themes	Subthemes
Audio visual aid	Video-based health education to enable mothers screen for biliary atresia in newborns to improve knowledge about exclusive breast feeding, awareness about intimate partner violence, and, prevention practices for dengue and chikungunya in community to motivate diabetic women for diabetic retinopathy screening to improve adherence to anti-retroviral medications among postnatal women with HIV and follow-up testing in newborns Audio-based health education played by Front-line health worker in village meetings to improve maternal knowledge and practices regarding reproductive, maternal and child health
IVRS technology	Maternal knowledge on antenatal care practices, nutrition and well-being exercises during pregnancy, childhood immunisation, and, prevention and, management of childhood illnesses Family planning services, practices related to exclusive breastfeeding and, infant and child feeding
SMS reminders	Antenatal care practices, childhood immunisation and practices related to exclusive breastfeeding, infant and child feeding Positive mental health tips Adherence to self-breast examination, anti-hypertensive and DOTS TB medications
Phone call/helpline	Infant and child feeding practices, and, contraception Maternal knowledge about mental health and child care among postnatal women with psychiatric illnesses Treatment and follow-up of hypertension, and, adherence to DOTS TB medications Follow-up care for children with epilepsy
Mass media (radio, television and movies)	Family planning campaign and practices related to antenatal and postnatal care Promotion of use of oral rehydration therapy and/or zinc for diarrhoeal illnesses in children
mHealth/web technology aided health worker in primary care	Mobile application to help ASHAs schedule home visits, postnatal counselling and increase community-based care seeking for maternal and newborn illnesses to improve maternal knowledge on antenatal care, track childhood immunisation and refer to checklists/referral algorithms for maternal and child related illnesses during home visits to track cancer screening services and screen for common mental disorders in community Web-based application to administer point of care test and track results among pregnant women
Telemedicine	Fetal heart rate monitoring in homes of pregnant women Mobile van-based testing for auditory brainstem response in newborns Improve uptake of family planning services and care seeking for common illnesses in women

Table 3. Barriers encountered while using technologies by women and recommendations provided in the studies.

	BARRIERS	RECOMMENDATIONS
Themes	Subthemes	Subthemes
Technology related barriers	Poor network coverage, non-delivery of calls from study team and cap on number of messages that can be sent daily Hardware and software issues with device and application Issues with electricity supply	Support through adequate training and establishment of call centre/help line to rectify technical glitches
Participant’s attitude related barriers	Fear of using new technology, losing real doctor experience in telemedicine consultation and stigma of getting diagnosed with diseases Lesser uptake of messages that are not being aligned with community norms	Tailoring of health messages as per feedback from community during the study period
Field level barriers	Limited smart phone users in community, and, change of sim/phone by participants, Lack of motivation to use new technology among staff and need for extensive training Incremental job responsibilities for field level workers in an overburdened health system	Establishing integrated health app to enable health workers to enter various health outcomes in a comprehensive platform Digitalising immunisation records and GPS enabled tracking of caregivers
Knowledge level barriers	Poor literacy status in women resulting in difficulty in comprehension of health messages that are too technical Linguistic barriers	Use of mass media / IVRS in population with lower literacy status Reinforcement of health messages delivered through mhealth platform by face to face counselling by healthcare workers or mass media Inclusion of photos/videos in application for better understanding
Family level barriers	Lack of mobile phone ownership and dependence on family members, which challenges transmission of health messages to women Lack of autonomy for women in patriarchal families, work commitments at home and prevailing reservations that women face in talking to helpline service providers of male gender Economical barriers faced by women with regards to recharging mobile accounts	In-built provision in research studies to overcome linguistic and socio-cultural barriers in community Evaluation of cost effectiveness of interventions are needed
Barriers in mode of delivery	Difficulty into ensuring active involvement of women while health messages are delivered through passive technologies such as IVRS and SMS	Need to compare effectiveness of technology that are provided directly to participants Vs. those delivered through healthcare worker assistance

Table

Section	Item	PRISMA-ScR checklist item	Reported on page #
TITLE
Title	1	Identify the report as a scoping review	Page 1
ABSTRACT
Structured summary	2	Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives	Page 1
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach	Pages 2, 3 & 4
Objectives	4	Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g. population or participants, concepts, and context) or other relevant key elements used to conceptualise the review questions and/or objectives	Page 4
METHODS
Protocol and registration	5	Indicate whether a review protocol exists; state if and where it can be accessed (e.g. a Web address); and if available, provide registration information, including the registration number	Page 4
Eligibility criteria	6	Specify characteristics of the sources of evidence used as eligibility criteria (e.g. years considered, language, and publication status), and provide a rationale	Page 5
Information sources*	7	Describe all information sources in the search (e.g. databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed	Page 4
Search	8	Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated	Supporting information – Supplementary file – Table S1
Selection of sources of evidence†	9	State the process for selecting sources of evidence (i.e. screening and eligibility) included in the scoping review	Page 5
Data charting process‡	10	Describe the methods of charting data from the included sources of evidence (e.g. calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators	Page 6
Data items	11	List and define all variables for which data were sought and any assumptions and simplifications made	Page 6
Critical appraisal of individual sources of evidence§	12	If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate)	Not appropriate
Synthesis of results	13	Describe the methods of handling and summarising the data that were charted	Page 8
RESULTS
Selection of sources of evidence	14	Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram	Supporting information – Figure 1 (PRISMA chart)
Characteristics of sources of evidence	15	For each source of evidence, present characteristics for which data were charted and provide the citations	Supporting information – Supplementary file – Table S2
Critical appraisal within sources of evidence	16	If done, present data on critical appraisal of included sources of evidence (see item 12)	Not appropriate
Results of individual sources of evidence	17	For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives	Pages 7 - 16
Synthesis of results	18	Summarise and/or present the charting results as they relate to the review questions and objectives	Pages 7–16
DISCUSSION
Summary of evidence	19	Summarise the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups	Pages 17–21
Limitations	20	Discuss the limitations of the scoping review process	Page 21
Conclusions	21	Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps	Page 21
FUNDING
Funding	22	Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review	Page 27

JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

* Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms and Web sites.

† A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g. quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote).

‡ The frameworks by Arksey and O’Malley (6) and Levac and colleagues (7) and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting.

§ The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of ‘risk of bias’ (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g. quantitative and/or qualitative research, expert opinion, and policy document).

From: Tricco et al. (2018).

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

 PubMed Web of Science ®Google Scholar

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA extension for Scoping Reviews (PRISMA–ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850

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