Research Article: Understanding women’s, caregivers’, and providers’ experiences with home-based records: A systematic review of qualitative studies

Date Published: October 4, 2018

Publisher: Public Library of Science

Author(s): Olivia Magwood, Victoire Kpadé, Ruh Afza, Chinedu Oraka, Jennifer McWhirter, Sandy Oliver, Kevin Pottie, Sharon Mary Brownie.


Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants’ reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records’ potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems.

Partial Text

The home-based record (HBR) offers an approach that women and countries can use to improve both the processes, such as communication and empowerment, and outcomes of health care, including pregnancy complications, child development and vaccination [1]. The HBR is a document that may include components of preventive or curative antenatal, postnatal, newborn, and child health. This type of record has been used in various paper or electronic formats since the introduction of the Japanese Maternal and Child Health Handbook in 1948 [2]. Today, over 163 countries have used HBRs [3]. New card designs and delivery approaches that span the spectrum of care, from pregnancy through to childhood, offer opportunities for countries that wish to enhance the continuity of care and reduce child and maternal mortality.

We searched for qualitative studies exploring the experiences of mothers, caregivers and healthcare providers with home-based records for maternal, newborn and child health. We utilized the best fit framework analysis method for the synthesis of this systematic review [13]. We selected a framework a priori and searched for constructs of acceptability, feasibility, affordability and equity as defined by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) [14]. We identified qualitative key findings and assessed the confidence of the key findings using GRADE-CERQual [15, 16].

Our search strategy identified 10,486 citations. After removing the duplicates, we screened 7,904 articles by title and abstract. We went on to screen 159 articles, using a full-text assessment for eligibility. Fig 1 shows the 19 studies that met our inclusion criteria.

The UN Sustainable Development Goals called for the adoption and strengthening of sound policies that promote gender equality, the empowerment of all women and improvements in maternal and child health [4]. The WHO is responsible for providing guidance on interventions that have the potential to improve outcomes in both health and empowerment at the primary-care level. The findings of this review confirm that women, caregivers and providers from a wide range of cultural and social contexts engage positively with HBRs.

The experience of women, caregivers and providers clearly illustrates how HBRs can empower women and children. Women across countries spoke of improved maternal health, communication, and patient centeredness. Women living with low literacy and those in areas with less-developed health care systems reported positive interactions and care continuity. In general, women reported obtaining more learning from nurses and support during pregnancy, with decreased fear and increased empowerment, when HBRs were used. In general, frontline nurses confirmed the acceptability and value added of home-based records. Mothers who used online records had concerns about privacy; however, similar data on patients’ perceptions of online records is scarce and more research is needed. Policy makers need to take stakeholder’s perceptions on the value of home-based records into consideration when making decisions on the use of home-based records in their context.




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