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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Forgone Health Care.

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Strategy. Technology-Based Initiatives

Approach. Use innovative digital health tools, mobile applications, and telehealth services to increase convenience and accessibility for families

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Overview. Innovative technologies, such as digital health platforms and mobile applications with a featured locator for services can increase knowledge and awareness to better enable children, youth, and their families to seek and obtain health care when needed.[1,2,3] These tools increase convenience and accessibility enabling more children, youth, and their families to access care. In addition, electronic health record (EHR)-based tools can help clinics provide children's insurance assistance to ensure that children are adequately and continuously covered and able to access needed preventive and acute care when needed.[3] There is a growing evidence base showing the positive impacts of technology-based initiatives.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of digital health tools, mobile applications, and telehealth services implemented to improve access and convenience for families. (Measures availability of technology solutions.)
  • Number of families enrolled in and utilizing digital health platforms and telehealth services. (Captures reach and engagement.)
  • Number of providers trained to effectively deliver care and support through digital health tools and telehealth modalities. (Assesses workforce capacity building.)

OUTCOME MEASURES:

  • Number of children who receive timely health care services through digital health tools and telehealth, avoiding delays and foregone care. (Measures impact on access.)
  • Number of families who report improved ability to manage their children's health needs and navigate the healthcare system using digital tools. (Indicates empowerment impact.)
  • Number of children with chronic conditions who achieve better health outcomes through remote monitoring and support enabled by digital health technologies. (Captures care quality impact.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of digital health tools and platforms that meet established standards for usability, privacy, and security. (Measures adherence to quality and safety guidelines.)
  • Percent of telehealth services that are reimbursed at parity with in-person care by insurance providers. (Assesses financial sustainability and access.)
  • Percent of families who receive training and support to effectively use digital health tools and telehealth services. (Evaluates user empowerment and digital literacy.)

OUTCOME MEASURES:

  • Percent of children due for preventive care services who successfully complete visits through telehealth or with the aid of digital health tools. (Measures care continuity impact.)
  • Percent of families who report high satisfaction and trust in the digital health tools and telehealth services they use for their children's care. (Captures user experience impact.)
  • Percent of children with positive health outcomes (e.g., controlled chronic conditions, healthy development) attributed to the use of digital health technologies. (Assesses health impact.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of healthcare organizations that integrate digital health tools and telehealth into their standard care delivery and payment models. (Captures system-level adoption.)
  • Number of community partnerships established to improve digital access and literacy among families, enabling participation in digital health initiatives. (Measures collaborative efforts.)
  • Number of policies and regulations enacted to support the sustainable and equitable expansion of digital health tools and telehealth for children. (Assesses enabling environment.)

OUTCOME MEASURES:

  • Number of communities that achieve sustained reductions in child foregone care rates through the widespread adoption of digital health technologies. (Measures population health impact.)
  • Number of unnecessary child emergency department visits and hospitalizations prevented through early intervention using digital health tools and telehealth. (Indicates health system impact.)
  • Number of children who experience improved educational and social outcomes due to better health and development supported by digital health innovations. (Captures cross-sector impact.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of digital health tools and telehealth services that are designed with and for historically marginalized communities. (Measures inclusive and culturally responsive design.)
  • Percent of families from underserved communities who have access to affordable broadband internet and devices to engage in digital health initiatives. (Assesses equitable digital access.)
  • Percent of community health workers and peer support specialists trained to help families navigate and benefit from digital health resources. (Evaluates community-based capacity.)

OUTCOME MEASURES:

  • Percent reduction in disparities in foregone care between children from disadvantaged backgrounds and those from more privileged circumstances through digital health interventions. (Measures equity impact.)
  • Percent of children from low-income and racial/ethnic minority groups who meet health promotion and disease management goals using digital health tools. (Captures health equity impact.)
  • Percent increase in digital health literacy and self-efficacy among caregivers from historically marginalized communities. (Assesses empowerment and equity.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Sao, S. S., Barre-Quick, M., Yu, R., Abboud, S., & Coleman, J. S. (2023). Advancing Access to Care through Digital Health: Perspectives from Youth on a Novel Platform to Increase Access to Sexual and Reproductive Health Care and Education for Adolescents and Young Adults. Journal of pediatric and adolescent gynecology, 36(5), 449–454.

[2] Steinberg, A., Griffin-Tomas, M., Abu-Odeh, D., & Whitten, A. (2018). Evaluation of a Mobile Phone App for Providing Adolescents With Sexual and Reproductive Health Information, New York City, 2013-2016. Public health reports (Washington, D.C. : 1974), 133(3), 234–239.

[3] DeVoe, J. E., Hoopes, M., Nelson, C. A., Cohen, D. J., Sumic, A., Hall, J., Angier, H., Marino, M., O'Malley, J. P., & Gold, R. (2018). Electronic health record tools to assist with children's insurance coverage: a mixed methods study. BMC health services research, 18(1), 354.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.