Cluster randomized trial of a mHealth intervention “ImTeCHO” to improve delivery of proven maternal, neonatal, and child care interventions through community-based Accredited Social Health Activists (ASHAs) by enhancing their motivation and strengthening supervision in tribal areas of Gujarat, India: study protocol for a randomized controlled trial
Open accessAbstract
BACKGROUND: To facilitate the delivery of proven maternal, neonatal, and child health (MNCH) services, a new cadre of village-based frontline workers, called the Accredited Social Health Activists (ASHAs), was created in 2005 under the aegis of the National Rural Health Mission in India. Evaluations have noted that coverage of selected MNCH services to be delivered by the ASHAs is low. Reasons for low coverage are inadequate supervision and support to ASHAs apart from insufficient skills, poor quality of training, and complexity of tasks to be performed. The proposed study aims to implement and evaluate an innovative intervention based on mobile phone technology (mHealth) to improve the performance of ASHAs through better supervision and support in predominantly tribal and rural communities of Gujarat, India. METHODS/DESIGN: This is a two-arm, stratified, cluster randomized trial of 36 months in which the units of randomization will be Primary Health Centers (PHCs). There are 11 PHCs in each arm. The intervention is a newly built mobile phone application used in the public health system and evaluated in three ways: (1) mobile phone as a job aid to ASHAs to increase coverage of MNCH services; (2) mobile phone as a job aid to ASHAs and Auxiliary Nurse Midwives (ANMs) to increase coverage of care among complicated cases by facilitating referrals, if indicated and home-based care; (3) web interface as a job aid for medical officers and PHC staff to improve supervision and support to the ASHA program. Participants of the study are pregnant women, mothers, infants, ASHAs, and PHC staff. Primary outcome measures are a composite index made of critical, proven MNCH services and the proportion of neonates who were visited by ASHAs at home within the first week of birth. Secondary outcomes include coverage of selected MNCH services and care sought by complicated cases. Outcomes will be measured by conducting household surveys at baseline and post-intervention which will be compared with usual practice in the control area, where the current level of services provided by the government will continue. The primary analysis will be intention to treat. DISCUSSION: This study will help answer some critical questions about the effectiveness and feasibility of implementing an mHealth solution in an area of MNCH services. TRIAL REGISTRATION: Clinical Trial Registry of India, CTRI/2015/06/005847 . Registered on 3 June 2015.
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Less attention has been paid to using digital technologies to train community health workers in delivering psychological interventions, particularly in rural India.
“Digital interventions appear to have been effective for training community health workers in general health care delivery (Agarwal et al., 2015), though use of digital technologies for training community health workers to deliver psychological interventions, especially in settings in rural India, has received less attention (Barnett et al., 2018; Borkum et al., 2014; Modi et al., 2017; Naslund et”
From Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India (2019) · cites this paper as Modi et al., 2017
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Cites
Consort 2010 statement: extension to cluster randomised trials
Campbell, M. K., Piaggio, G., Elbourne, D. R., Altman, D. G., & for the CONSORT Group (2012) · BMJ · doi:10.1136/bmj.e5661 · Cited by 3,510 · see citing works
Global, regional, and national causes of child mortality in 2008: a systematic analysis
Black, R. E., Cousens, S. N., Johnson, H. L., Lawn, J. E., Rudan, I., Bassani, D. G., Jha, P., Campbell, H. J., Walker, C. L. F., Cibulskis, R. E., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60549-1 · Cited by 3,062 · see citing works
Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M., Lopez, A. D., Lozano, R., & Murray, C. J. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60518-1 · Cited by 2,194 · see citing works
Strategies for reducing maternal mortality: getting on with what works
Campbell, O. M., & Graham, W. J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69381-1 · Cited by 1,785 · see citing works
Evidence-based, cost-effective interventions: How many newborn babies can we save?
Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., & de Bernis, L. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71088-6 · Cited by 1,541 · see citing works
Barros, A. J. D., Ronsmans, C., Axelson, H., Loaiza, E., Bertoldi, A. D., França, G. V., Bryce, J., Boerma, J. T., & Victora, C. G. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60113-5 · Cited by 552 · see citing works
Jt, B. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60560-7 · Cited by 300 · see citing works
Victora, C. G., Barros, A. J. D., Axelson, H., Bhutta, Z. A., Chopra, M., França, G. V., Kerber, K. J., Kirkwood, B. R., Newby, H., Ronsmans, C., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61427-5 · Cited by 244 · see citing works
Improving the Performance of Accredited Social Health Activists in India
Dholakia, R. H., & Bajpai, N. (2011) · doi:10.7916/d8988g63 · Cited by 82 · see citing works
Modi, D. K., Gopalan, R., Shah, S., Venkatraman, S., Desai, G., Desai, S., & Shah, P. (2015) · Global Health Action · doi:10.3402/gha.v8.26769 · Cited by 78 · see citing works
Self-citationColonic Perforation after Exchange Transfusion
Corkery, J. J., Dubowitz, V., LISTER, J. W., & Moosa, A. (1968) · BMJ · doi:10.1136/bmj.4.5627.345 · Cited by 76 · see citing works
Role of ASHA (accredited social Health Activist) in National Rural Health Mission
Wani, M. H. (2018) · International Journal for Social Studies · Cited by 1 · see citing works
Flagged first, then by citations
2 of the 14 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [22]WHO and UNICEF Home visits for the newborn child: a strategy to improve survival: WHO and UNICEF joint statement 2009 Geneva WHO 24809117
Cited by
Sorted by citations
Schedules for home visits in the early postpartum period
Yonemoto, N., Dowswell, T., Nagai, S., & Mori, R. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009326.pub2 · Cited by 148 · see citing works
Modi, D. K., Dholakia, N. B., Gopalan, R., Venkatraman, S., Dave, K., Shah, S., Desai, G., Qazi, S., Sinha, A., Pandey, R. M., et al. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002939 · Cited by 127 · see citing works
Self-citationMuke, S. S., Shrivastava, R. D., Mitchell, L., Khan, A., Murhar, V., Tugnawat, D., Shidhaye, R., Patel, V., & Naslund, J. A. (2019) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2019.09.006 · Cited by 98 · see citing works
Fischer, F., & Kleen, S. (2020) · Journal of Medical Internet Research · doi:10.2196/17691 · Cited by 55 · see citing works
Schedules for home visits in the early postpartum period
Yonemoto, N., Nagai, S., & Mori, R. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009326.pub4 · Cited by 47 · see citing works
Modi, D. K., Saha, S., Vaghela, P. C., Dave, K., Anand, A., Desai, S., & Shah, P. (2020) · JMIR mhealth and uhealth · doi:10.2196/17066 · Cited by 35 · see citing works
Self-citationASHA Kirana: when digital technology empowered front-line health workers
Srinidhi, V., Karachiwala, B., Iyer, A., Reddy, B., Mathrani, V., Madhiwalla, N., Periodi, V., Sreevathsa, A., Viswanatha, L., & Sen, G. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2021-005039 · Cited by 26 · see citing works
Pandya, S., Kan, L., Parr, E., Twose, C., Labrique, A. B., & Agarwal, S. (2024) · Global Health Science and Practice · doi:10.9745/ghsp-d-23-00429 · Cited by 22 · see citing works
Bonciani, M., Rosis, S. D., & Vainieri, M. (2020) · JMIR Research Protocols · doi:10.2196/19073 · Cited by 22 · see citing works
Birth and death notification via mobile devices: a mixed methods systematic review
Vasudevan, L., Glenton, C., Henschke, N., Maayan, N., Eyers, J. E., Fønhus, M. S., Tamrat, T., Mehl, G. L., & Lewin, S. A. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012909.pub2 · Cited by 16 · see citing works
Effectiveness of mHealth application in improving knowledge of mothers on preterm home care
Phagdol, T., Nayak, B. S., Lewis, L., Ramesh Bhat, Y., & Guddattu, V. (2022) · Journal of Neonatal Nursing · doi:10.1016/j.jnn.2022.08.004 · Cited by 13 · see citing works
Saha, S., & Zahiruddin, Q. S. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.856561 · Cited by 14 · see citing works
Saing, C. H., Ung, M., Suy, S., Oy, S., Dary, C., Yam, E. L. Y., Chhorn, S., Hayashi, M., Khuon, D., Mam, S., et al. (2023) · Trials · doi:10.1186/s13063-023-07724-z · Cited by 11 · see citing works
Saha, S., Kotwani, P., Pandya, A., Patel, C. D., Shah, K. H., Saxena, D. B., Puwar, T. I., Desai, S., Patel, D., Sethuraman, A., et al. (2020) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_835_19 · Cited by 12 · see citing works
Self-citationAgarwal, S., Chin, W. Y., Vasudevan, L., Henschke, N., Tamrat, T., Foss, H. S., Glenton, C., Bergman, H., Fønhus, M. S., Ratanaprayul, N., et al. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012925.pub2 · Cited by 9 · see citing works
Varshney, P., Malathesh, B. C., Nirisha, P. L., Harshitha, N. R., Kulal, N., Kumar, C. N., Gajera, G., Suhas, S., Patley, R., Harshitha, H. A., et al. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_543_22 · Cited by 7 · see citing works
Haghparast‐Bidgoli, H., Hull‐Bailey, T., Nkhoma, D. B., Chiyaka, T., Wilson, E., Fitzgerald, F., Chimhini, G., Khan, N., Gannon, H., Batura, R., et al. (2023) · JMIR mhealth and uhealth · doi:10.2196/50467 · Cited by 5 · see citing works
Dave, K., Shah, P., Desai, S., & Modi, D. K. (2022) · The Indian Journal of Pediatrics · doi:10.1007/s12098-022-04123-1 · Cited by 2 · see citing works
Self-citationPower, Technology and Empowerment
Pandey, P., & Zheng, Y. (2020) · IFIP advances in information and communication technology · doi:10.1007/978-3-030-64697-4_13 · Cited by 1 · see citing works
Haghparast‐Bidgoli, H., Hull‐Bailey, T., Nkhoma, D. B., Chiyaka, T., Wilson, E., Fitzgerald, F., Chimhini, G., Khan, N., Gannon, H., Batura, R., et al. (2023) · doi:10.2196/preprints.50467
Factors motivating maternal healthcare clients to use mHealth interventions in rural Malawi
Maliwichi, P., Chigona, W., & Malata, A. M. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000805
Morrison, T., Akseer, N., Heidkamp, R. A., Maïga, A., & Tasic, H. (2025) · doi:10.12688/verixiv.2006.1
Saing, C. H., Ung, M., Suy, S., Oy, S., Dary, C., Yam, E. L. Y., Chhorn, S., Nagashima-Hayashi, M., Khuon, D., Mam, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26632351
Saing, C. H., Ung, M., Suy, S., Oy, S., Dary, C., Yam, E. L. Y., Chhorn, S., Nagashima-Hayashi, M., Khuon, D., Mam, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26632342
Saing, C. H., Ung, M., Suy, S., Oy, S., Dary, C., Yam, E. L. Y., Chhorn, S., Nagashima-Hayashi, M., Khuon, D., Mam, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26632336
Saing, C. H., Ung, M., Suy, S., Oy, S., Dary, C., Yam, E. L. Y., Chhorn, S., Nagashima-Hayashi, M., Khuon, D., Mam, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26632339
Jarathi, A., Sundar, A. S., & Jothula, K. Y. (2026) · Cureus · doi:10.7759/cureus.101135
- Authors
- Modi, D., Desai, S., Dave, K., Shah, S., Desai, G., Dholakia, N., Gopalan, R., & Shah, P.
- Affiliations
- Society for Education Welfare and Action Rural (IN)
- Government of Gujarat (IN)
- Corresponding author
- Desai, Shrey
- Venue
- Trials
- Published
- 2017-06-09
- Volume
- 18
- Issue
- 1
- Pages
- 270-270
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC5466719
- OpenAlex
- W2622745382
- Cited by
- 27
- References
- 14
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 2 · 2013: 1
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Indian Council of Medical Research (5/7/589/Gujarat/2011-RCH)
- World Health Organization (MCA00615)
- John D. and Catherine T. MacArthur Foundation (G-108398-0)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- Accredited Social Health Activists, mobile health, mobile application, job aids, auxiliary nurse midwives, home-based neonatal care, tribal communities, rural health, National Rural Health Mission, Gujarat, service coverage, primary health centers, health worker motivation
- MeSH terms
- Accreditation, Maternal Health, Infant Health, Clinical Protocols, Community Health Workers, Community Health Services, Female, Humans, India, Infant, Newborn, Maternal Health Services, Midwifery, Patient Care Team, Pregnancy, Research Design, Time Factors, Treatment Outcome, Models, Organizational, Telemedicine, Delivery of Health Care, Integrated, Rural Health Services, Cell Phone, Mobile Applications
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