SMARThealth Pregnancy: Development of a complex intervention using clinical decision support to detect & refer high-risk pregnant women in rural India

Lead Research Organisation: University of Oxford
Department Name: George Institute – Oxford (TGI)

Abstract

Context of Research: Heart disease is the leading cause of death in women worldwide, with the greatest burden affecting low and middle income countries (LMICs). Risk factors for heart disease include high blood pressure (hypertension) and diabetes. These risk factors can be modified through early detection and management using evidence-based lifestyle interventions and medications. Pregnancy may unmask an underlying susceptibility to the future development of non-communicable diseases (NCDs) such as hypertension and diabetes, and can identify women at increased risk of heart disease. Through early detection of high-risk women in pregnancy and in the first 5 years following pregnancy, NCDs may be prevented or more effectively managed, and serious complications associated with high blood pressure and diabetes in pregnancy (affecting mother and baby) may be reduced. This is of great importance in order to reduce maternal deaths in line with the UN's Sustainable Development Goals. Evidence-based interventions include the International Diabetes Federation's Model of Care for lifestyle modification during and after pregnancy, which reduces the risks associated with diabetes in pregnancy and beyond to baseline values. Such interventions may be delivered in a community context.

In rural India, there is a shortage of doctors. Community Health Workers (CHWs) represent the main link to pregnant women in the community and provide basic antenatal and postnatal care to women. They are in the ideal position to screen and refer women with high-risk pregnancies, however they need adequate training, support and supervision. This study utilises mobile technology to provide clinical decision support to empower CHWs to screen, detect and refer high-risk women to primary health centres, where they can be managed and receive follow-up care.

Intervention: The Systematic Medical Appraisal, Referral and Treatment (SMARThealth) platform is validated clinical decision support system, already in use in rural India. SMARThealth has been adapted to screen for mental health disorders, diabetes and TB in rural India, and the programme has been extended to China and Indonesia. This platform will be adapted to integrate evidence-based national and international guidelines on screening for high-risk pregnancies during routine antenatal and postnatal care to form SMARThealth Pregnancy.

Overall Aim:
To improve screening, detection, referral and management of women with high-risk pregnancies in rural Andhra Pradesh, India, so as to reduce: a) maternal and perinatal mortality and morbidity, and in the longer term, b) the burden of pregnancy-associated, non-communicable diseases for these women.

Specific Objectives:
1) Conduct formative research to identify the barriers and enablers within the health system and identify the evidence-practice gap.

2) Develop and validate a clinical decision support system (SMARThealth Pregnancy) to improve detection and referral of high-risk pregnancies in rural India.

3) Conduct training, content and usability testing of SMARThealth Pregnancy with end-users.

4) Evaluate the feasibility and acceptability of SMARThealth Pregnancy for use by Community Health Workers and Primary Health Care doctors to improve detection, referral and management of high-risk pregnancies.

Potential Applications & Benefits:
The development and feasibility study of SMARThealth Pregnancy will inform the evidence base on taking a life-course approach to women's health to prevent NCDs. It will also inform the debate on task-shifting of screening and counselling for lifestyle interventions to lower cadres of health workers in similar resource-poor settings. Additionally, the SMARThealth system enables bidirectional communication between primary care doctor and CHWs, thus helping to strengthen existing health systems and referral pathways, improve feedback and follow-up practices of high-risk women within the community.

Technical Summary

Aims: To adopt a life-course approach to prevention of non-communicable diseases (NCDs) in women through early detection & referral of women at high risk of cardiovascular disease during and after pregnancy, through the development of a complex intervention using a mobile clinical decision support system in rural India.

Objectives: To develop and assess the feasibility and acceptability of a mobile clinical decision support system (SMARThealth Pregnancy) for use by CHWs for improving the detection and follow-up of high-risk pregnancies in rural Andhra Pradesh, India.

Methodology: This will be a mixed methods feasibility study with four stages:
1) Formative research: Exploring the local context using in-depth qualitative interviews & focus groups with key stakeholders to identify barriers & enablers within the health system to providing best practice antenatal and postnatal follow-up for high-risk pregnancies.
2) Development and validation of the SMARThealth Pregnancy Application: Algorithm development using best practice guidelines, and a two-step validation process.
3) Training, content and usability testing with end-users in a series of workshops.
4) Field trial to evaluate the acceptability and feasibility of SMARThealth Pregnancy use by CHWS and Primary care doctors, using a mixed methods approach to generate data to inform a clinical trial.

Scientific & Medical Opportunities:
a) Improved detection, referral and management of high-risk pregnancies in rural India, to improve perinatal & long-term women's health.
b) Education and up-skilling of CHWs and their communities through increased awareness of NCDs.
c) Informing the debate for task-shifting to lower-skilled cadres of health workers in areas where medically-trained professionals are scarce.
d) To help inform the basis of a larger cluster-randomised controlled trial looking at clinical outcomes, process evaluation and cost-effectiveness.

Planned Impact

The UN and several multilateral organisations have called for a life-course approach to women's health, but there is limited evidence to support how this can be achieved. This study seeks to contribute to the evidence-base by adopting a life-course approach to the prevention of NCDs in women whilst also addressing major risk factors for maternal and neonatal mortality and morbidity in a resource-poor setting in India, using innovative mobile technology. This study is the formative phase of a proposed large-scale, cluster-randomised trial to address the use of SMARThealth Pregnancy by CHWs to detect and manage GDM and hypertension both antenatally and postnatally.

The research will be of direct benefit to the following groups:
1) Pregnant women and their communities in rural Andhra Pradesh India - through early detection and management of GDM and hypertension in pregnancy, and improved awareness of NCDs through education and engagement with communities.
2) CHWs working in this field - by providing: a) a mobile clinical decision support system (CDSS) to identify and refer women with high-risk pregnancies to primary care physicians; b) training and education relating to the prevention of NCDs in women, and c) the additional advantage of improved morale through engagement and training.
3) Primary Healthcare Physicians working in rural Andhra Pradesh, as a result of ensuring appropriate referral and risk-stratification of pregnant women to primary health centres, and provision of training and support.

Benefits to Society:
This study will address the feasibility and acceptability of integrating SMARThealth Pregnancy into local practice, and help inform both local and national policy, leading to:
1) Strengthened and improved referral pathways and communication between community-level health workers and primary and secondary care in rural Andhra Pradesh, India.
2) Integration within pre-existing Local and National Government schemes, to ensure best use and reduce out-of-pocket expenditure for rural populations.
3) Strengthened human and social capital by educating and screening women earlier in their life course about NCDs and reducing the economic burden associated with NCDs

Global Impact:
Advancing scientific knowledge and technology:
This study will be able to identify whether a CDSS utilised by CHWs can improve the identification and management of high-risk pregnant women. This will be of interest to:
1) WHO, as part of their commitment to the Sustainable Development Goals to reduce maternal mortality.
2) Key policymakers and think-tanks globally as well as governments in other LMICs.
3) NGOs working in maternal-child health in LMICs.
4) International Development agencies such as DFID.
5) m-Health Technology stakeholders by informing an evidence-based approach to the feasibility and acceptability of using m-health technologies in a rural setting.

Economic and Wider Impacts:
SMARThealth Pregnancy is an open source software program, and therefore has the potential to be used worldwide in areas where there are increasing demands on medically trained professionals and subsequent task-shifting to CHWs. SMARThealth Pregnancy, if feasible and acceptable for use by CHWs, may help inform the debate about task-shifting in other contexts, where there are increasing demands on healthcare systems. SMARThealth Pregnancy may also (with further study) have longer-term economic implications with regards to reducing NCDs through adopting a preventative life-course approach to women's health.

Publications

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Hirst J (2019) The obstetrician's role in preventing cardiometabolic disease in The Obstetrician & Gynaecologist

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Hirst JE (2019) The obstetrician's role in preventing cardiometabolic disease in The Obstetrician Gynaecologist

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Sy M (2020) Doing interprofessional research in the COVID-19 era: a discussion paper. in Journal of interprofessional care

 
Description National workshop on high-risk pregnancies and non-communicable diseases
Geographic Reach Asia 
Policy Influence Type Participation in a national consultation
URL https://www.georgeinstitute.org/events/national-workshop-on-high-risk-pregnancies-and-ncds
 
Description Training of community healthcare workers (CHWs) on High-risk Pregnancies and non-communicable diseases (SMARThealth Pregnancy)
Geographic Reach Asia 
Policy Influence Type Influenced training of practitioners or researchers
Impact We conducted training for Community Health Workers (CHWs) on the knowledge and skills associated with screening for gestational diabetes using the OGTT (using Government of India guidelines); screening for blood pressure problems in pregnancy; and the importance of anaemia before and after pregnancy, and women's lifelong health. The training has objectively improved knowledge of high-risk pregnancy conditions and non-communicable diseases in women amongst CHWS, and their skills in screening women with high-risk pregnancies.
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation Amref Health Africa
Country Kenya 
Sector Charity/Non Profit 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation George Institute for Global Health
Department George Institute for Global Health (India)
Country India 
Sector Charity/Non Profit 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation George Institute for Global Health
Country Australia 
Sector Academic/University 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation Kenyan Institute for Medical Research (KEMRI)
Country Kenya 
Sector Public 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation Omni Med
Country United States 
Sector Charity/Non Profit 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation University of Johannesburg
Department Africa Centre for Evidence
Country South Africa 
Sector Academic/University 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation University of Oxford
Department Department of Education
Country United Kingdom 
Sector Academic/University 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description Building an evidence network on technology-enhanced community health worker training in low- and middle-income countries (LMICs) 
Organisation University of Oxford
Department Nuffield Department of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution I provided input into the evidence map of mHealth used in the training and supervision of community health workers. This has been competed and submitted for publication - awaiting decision on the submitted manuscript.
Collaborator Contribution The Department of Education, together with the Africa Centre for Evidence, led the evidence mapping process. The George Institute India, UK and Sydney supported this process. Amref, Omni-Med and KEMRI run community health worker programmes using mHealth and were able to provide input into the final draft of the evidence map paper.
Impact A research paper has been written and submitted to a journal - we are awaiting the decision on the manuscript currently.
Start Year 2018
 
Description SMARThealth Pregnancy 
Organisation George Institute for Global Health
Department George Institute for Global Health (India)
Country India 
Sector Charity/Non Profit 
PI Contribution I have led the theory-informed design, development and evaluation of SMARThealth Pregnancy (a complex intervention for high-risk pregnant women in rural India). I worked with the software development team at the George Institute for Global Health, India to develop the SMARThealth Pregnancy intervention, building upon the Institute's SMARThealth platform. I have led the pilot study of SMARThealth Pregnancy, working with the field teams at the George Institute for Global Health, India.
Collaborator Contribution The George Institute for Global Health, India, have provided support with the software development and implementation of the complex intervention in rural India.
Impact SMARThealth Pregnancy intervention (Mobile clinical decision support and Training manual for Community Health Workers) Publications as listed Conference presentations as listed National Conference on high-risk pregnancies & NCDs, New Delhi, India Newspaper/media coverage as listed
Start Year 2018
 
Title SMARThealth Pregnancy 
Description SMARThealth Pregnancy is a complex intervention including mobile clinical decision support and targeted training for community healthcare workers and primary care doctors for the screening, referral and counselling of high-risk pregnant women in rural India. 
Type Health and Social Care Services
Current Stage Of Development Initial development
Year Development Stage Completed 2020
Development Status Under active development/distribution
Clinical Trial? Yes
Impact A pilot cluster randomised controlled trial of SMARThealth Pregnancy was conducted in 2019 - 2020. The trial demonstrated that the intervention was feasible and acceptable for use by Community Health Workers in two diverse districts of rural India, with implications for guideline-based screening for gestational diabetes mellitus, anaemia and hypertension in pregnancy and the postpartum period for rural women. 
 
Description "I'm a scientist, get me out of here!" 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact I was chosen to be a scientist on a national competition for scientists called: "I'm a scientist, get me out of here!". This was an online activity where primary and secondary school students connect with scientists to ask them any questions about science, and their careers. It's a competition between the chosen scientists, where students are the judges. Students challenge the scientists over fast-paced online text-based live chats. There are also live chats involving the teachers and the parents of the school children. It was an amazing experience and we learnt so much from the students questions, and also from our peer scientists during the process.
Year(s) Of Engagement Activity 2019
URL https://about.imascientist.org.uk
 
Description An introduction to Global Surgery 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Lead organiser and chair for a session on Global Surgery as part of the University of Oxford International Health & Tropical Medicine Masters programme.
Year(s) Of Engagement Activity 2021
URL https://twitter.com/DMazingi/status/1353708934872379393?s=20
 
Description Designing technologies for maternal child health in low resource settings - keynote talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was a keynote speaker at the Global Anaesthesia Surgery and Obstetrics Collaboration Annual conference in Leeds, 2019. The conference was on Global Medical Technology.
Year(s) Of Engagement Activity 2020
URL https://www.gasocuk.co.uk/annual-conference-2019
 
Description Expert panel member for: The Lancet's Medical applications of artificial intelligence and immersive technologies - discussion at The Global Health Film Festival 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact I was an expert member of a discussion on Medical applications of artificial intelligence and immersive technologies. This session was facilitated and chaired by The Lancet journal (Senior Editor) and involved a presentation, followed by a discussion and Q&A with audience members, consisting of film makers, media, artists and clinicians. It was a really interesting session!
Year(s) Of Engagement Activity 2019
URL https://hubble-live-assets.s3.amazonaws.com/globalhealthfilm/attachment/file/2/GHFF2019_final_progra...
 
Description Global Anaesthesia, Surgery and Obstetrics Collaboration (GASOC) Annual Conference , Blavatnik School of Government, University of Oxford . 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I spoke about Innovation and technology in Low resource settings. I was an invited keynote speaker at this Global Conference for Surgeons, Anaesthetists and Obstetricians. I spoke about my research on SMARThealth Pregnancy, and more widely on the applications of technology in low resource settings.
Year(s) Of Engagement Activity 2018
URL https://www.nds.ox.ac.uk/events/gasoc-conference-2018
 
Description How can technology promote women's life-long health? 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was a blog for the Women's & NCDs Taskforce. The blog highlighted the work being done with SMARThealth Pregnancy.
Year(s) Of Engagement Activity 2019
URL https://medium.com/@WomenAndNCDs/how-can-technology-promote-womens-life-long-health-d09079a0f478
 
Description Innovation and Implementation workshop Centre for Tropical Medicine and Global Health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I helped conduct a skills workshop on designing new innovations and implementation of new innovations in practice. I co-led the sessions on Human-centred design and spoke about Implementation science research building upon my current work.
Year(s) Of Engagement Activity 2019
 
Description Invited member of the NIHR Global Health's Community of Practice on Community Engagement & Involvement 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was an invited member to a new scheme - an online "Community of Practice", to review and discuss Community Engagement & Involvement with fellow colleagues working in this area, as part of the NIHR Global Health research programme review process.
Year(s) Of Engagement Activity 2021
URL https://www.nihr.ac.uk/blog/empowering-meaningful-community-engagement-and-involvement-in-global-hea...
 
Description National workshop on the management of high risk pregnancies and non-communicable diseases 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I was a speaker and expert panel member at the National workshop on the management of high risk pregnancies and non-communicable diseases, held at the India International Centre in New Delhi (29/3/2019) and The DV Manor, Vijayawada (1/4/2019). This was a high-level national meeting attended by key policy makers in maternal child health and non-communicable diseases in India, as well as non-governmental organisations, industrial partners and the media. A policy document was produced at the end of the meeting. I spoke about my work with the development of SMARThealth Pregnancy, and the importance of screening high-risk pregnant women in rural India.
Year(s) Of Engagement Activity 2019
URL https://www.georgeinstitute.org.in/sites/default/files/smarthealth_pregnancy_workshops.pdf
 
Description Oxford and the World 2021-22 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact I was contacted by the University of Oxford International Engagement Office to provide a summary of our research for their "Oxford and the World" Brochure. We were featured prominently at the start of the Society & Health section.
Year(s) Of Engagement Activity 2021
URL https://www.ox.ac.uk/sites/files/oxford/field/field_document/Oxford%20and%20the%20World%20brochure%2...
 
Description Panel member for Surgical Priorities in a Global Pandemic Conference 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was part of the expert panel of this conference. The panel discussion was live streamed on you tube, we received questions from global surgery researchers across the world and there was a lot of discussion following the talks.
Year(s) Of Engagement Activity 2020
URL https://www.eventbrite.com/e/ougsg-2020-conference-surgical-priorities-in-a-global-pandemic-tickets-...
 
Description Press release for publication: Better education can help reduce risk of BP and diabetes among rural women 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact I published a research paper from my research in rural India. This paper was highlighted by the national newspaper The Hindu in India in their science section.
Year(s) Of Engagement Activity 2019
URL https://www.thehindubusinessline.com/news/science/better-education-can-help-reduce-risk-of-bp-and-di...
 
Description SMARThealth Pregnancy: The development & evaluation of a complex intervention using mobile clinical decision support to screen, refer and manage pregnant women at high risk of future cardiometabolic disorders in rural India. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact I presented my DPhil research on the theory-informed development and evaluation of SMARThealth Pregnancy. This was a departmental seminar advertised more widely within the University of Oxford, and attended by researchers and students in the Department, University, and the George Institute for Global Health.
Year(s) Of Engagement Activity 2020
 
Description Skills Building Session on Innovative methodologies for global health systems strengthening at Health Systems Global Meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact I helped organise and deliver a Skills building workshop on Health Services research. My session was on Implementation science theories and frameworks. The workshop was very well attended with over 110 participants and we received excellent feedback following the session from the participants through their comments and thank yous.
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/symposium-program/
 
Description Speaker at Surgical Priorities in a Global Pandemic Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact An international conference was hosted by the Oxford University Global Surgery Group on Surgical Priorities in a Global Pandemic. I was asked to be a keynote speaker on the subject of: Discovering the important research questions for Global Surgery. The conference was live-streamed on youtube and aimed at reaching global surgery practitioners and researchers across the world, with a focus on reaching surgeons, anaesthetists and obstetricians in low and middle income settings. The live stream reached over 750 viewers globally and sparked discussions and questions during the final panel discussion.
Year(s) Of Engagement Activity 2020
URL https://www.eventbrite.com/e/ougsg-2020-conference-surgical-priorities-in-a-global-pandemic-tickets-...
 
Description Women and NCDs Taskforce Blog ahead of UN High Level Meeting on Universal Health Coverage 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact A blog on "How can technology promote life-long health" written in the lead up to the The United Nations High-Level Meeting on Universal Health Coverage on 23 September 2019. This showcased the work being done on using technology to link and engage high-risk pregnant women with their life-long cardiometabolic health as part of the Women and NCD's taskforce contributions to the UN high level meeting on Universal Health Coverage.
Year(s) Of Engagement Activity 2019
URL https://medium.com/@WomenAndNCDs/how-can-technology-promote-womens-life-long-health-d09079a0f478
 
Description Women's Health Taskforce on Non-Communicable Diseases Panel Member: Gender health equity over the life course: identifying and overcoming barriers women face in accessing health systems in low-resource settings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I was invited as an expert panel member on the Women's Health Taskforce Group at a session on at Health Services Global Conference in Liverpool, UK in October 2018. The title of the session was: Gender health equity over the life course: identifying and overcoming barriers women face in accessing health systems in low-resource settings.

I spoke about my research on SMARThealth Pregnancy, the use of mobile technologies in low resource settings and the need for life course approaches to women's health for the prevention of NCDs, drawing upon my research in cardiometabolic risk factors during pregnancy.
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/symposium-program/
 
Description Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact A research paper published as part of my project, received media attention by three media outlets/newspapers in India. It is unclear the extent of reach of this, however a life-course approach to women's health has been highlighted to the general public and policy makers in India.
https://www.biovoicenews.com/early-detection-of-disorders-in-pregnant-women-could-avoid-long-term-health-complications/
https://medicircle.in/early-detection-of-anaemia-high-blood-pressure-and-diabetes-in-pregnant-women
https://vigyanprasar.gov.in/isw/Better-education-can-help-reduce-risk-of-BP-and-diabetes-among-rural-women.html
Year(s) Of Engagement Activity 2019
URL https://www.biovoicenews.com/early-detection-of-disorders-in-pregnant-women-could-avoid-long-term-he...