|BRIEF RESEARCH ARTICLE
|Year : 2015 | Volume
| Issue : 2 | Page : 149-152
Experiences from Garbha-Swasthya helpline
Koumudi G Godbole1, Shilpa S Kulkarni2, Girish P Godbole3, Aparna M Kulkarni4
1 Consultant, Department of Genetic Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
2 Coordinator, Department of Prenatal Medicine Program, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
3 Consultant, Department of Obstetrics and Gynecology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
4 Consultant, Department of Fetal Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
|Date of Web Publication||25-May-2015|
Koumudi G Godbole
Consultant Clinical Geneticist, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune - 411 004, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Garbha-Swasthya helpline is a telephone helpline run by a tertiary care private hospital to address issues related to pregnancy and its complications. A review of the helpline data from September 2010 to December 2012 was conducted to study caller characteristics, number of calls and related information, and the reasons to call. Out of the total 696 voice calls, 421 were new callers and 275 were repeat callers and they comprised mainly pregnant women (73.3%), their relatives (24.8%), and medical professionals (1.9%). Most calls were related to first pregnancy and were mainly from Pune and other cities of Maharashtra. All calls by the medical professionals were regarding drug safety in pregnancy. The commonest category of questions (27.4%) was about exposures (drugs, alcohol, eclipse, radiation, etc.) and preexisting medical illness followed by pregnancy complications (18.5%), common medical issues such as nausea/vomiting during pregnancy, and delivery and postpartum period (14% each). Although the total number of calls received has steadily increased, efforts to create public and professional awareness to increase the usage of this helpline are warranted.
Keywords: Fetal, pregnancy, telephone helpline
|How to cite this article:|
Godbole KG, Kulkarni SS, Godbole GP, Kulkarni AM. Experiences from Garbha-Swasthya helpline. Indian J Public Health 2015;59:149-52
|How to cite this URL:|
Godbole KG, Kulkarni SS, Godbole GP, Kulkarni AM. Experiences from Garbha-Swasthya helpline. Indian J Public Health [serial online] 2015 [cited 2020 Feb 18];59:149-52. Available from: http://www.ijph.in/text.asp?2015/59/2/149/157538
A helpline is a special service that people can avail to get information, counseling, or advice about a particular topic of interest. "Garbha-Swasthya" (fetal wellbeing) helpline is a telephone helpline established in 2010 by the Prenatal Medicine Program of Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra to address issues related to pregnancy and its complications. It is possibly the only pregnancy helpline in India run by a private sector hospital for public benefit as a voluntary effort.
We chose a telephone helpline because of its proven use in health care in other conditions such as mental health, , human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS),  the easy and relatively inexpensive access to mobile phones even in rural areas with limited medical care,  and callers' preference to talk to a real person than a machine.  HIV/AIDS or mental illness helplines are largely used because they provide information without disclosing the identity, while pregnancy is not a disease and there are plenty of apparent sources of information from family, friends, and the media. Despite this, pregnant women often have many questions and concerns that remain unanswered during the quick visits with busy obstetricians. Our initial observations on how a pregnancy helpline is utilized by Indian callers are shared in this brief report.
Garbha-Swasthya helpline provides information in Marathi, Hindi, and English, as per the caller's choice. A trained counselor is available between 10 AM and 4 PM on all working days supported by a voice message facility. This specially designed software has a data storage facility, apart from a database of over 400 common questions with regular updates on new questions and current medical evidences. This observational study used the caller data recorded in the software and in the register between September 2010 and December 2012, which was analyzed for the following: The number of calls and relevant information, caller characteristics including personal and obstetric histories as applicable, and the reasons for calling.
Data regarding the reasons for calling is presented as the percentage frequency, and Z-test for independent proportions has been applied to find out whether the questions asked by the two groups, that is, pregnant and nonpregnant callers are significantly different. Trends in the number of callers and the number of "do not know" calls over the 2-year period were analyzed using linear regression considering the number of callers as well as calls with inadequate information ("do not know" calls) as the dependent variables and time as the independent variable.
Institutional Ethics Committee clearance for publication in a medical journal was obtained.
A. Calls and relevant information: Garbha-Swasthya helpline was contacted 706 times during the audit period of about 2 years (696 voice calls related to helpline + eight voice messages of which only three could be traced back according to the telephone number provided + two unrelated calls). Out of the total 699 callers who could be contacted, 423 were new callers and 276 were repeat callers, and most calls were received between 12 noon and 3 PM. The callers reported newspaper articles as the commonest source as to how they came to know about this helpline.
B. Caller characteristics: Most of the callers (511/699, 73.1%) were pregnant women followed by their relatives (173/699, 24.8%) and medical professionals (13/699, 1.8%). Out of the 173 calls from relatives, 170 were male relatives with 163 being husbands of pregnant women. Although the age range of pregnant callers was 19-41 years, most of the pregnant callers (213/414, 51.44%) were in the age group of 26-35 years. Most calls (430/706, 60.9%) were made to find out information regarding the first pregnancy. Previous obstetric history was available in 278 out of 423 (65.7%) new callers, out of whom 35 had previous history of miscarriage; eight had previous abnormal children while 235 callers did not have any significant past history.
Most callers were from Maharashtra, 686/706 (97.1%) of whom 514/686 (74.9%) were from Pune, and 19 (2.6%) were from cities outside Maharashtra [Chennai, Delhi, Bangalore, Hyderabad, and Nipani (Karnataka)]. There was one caller from the US.
C. Reasons to call: There were a total of 723 questions asked and [Table 1] shows the reasons for calling and their frequency distribution. They were grouped under six different categories as follows: Exposures during pregnancy (drugs, alcohol, eclipse, and radiation, etc.); preexisting maternal disorder; pregnancy complications such as gestational diabetes, high blood pressure in pregnancy, and thyroid disorders; delivery and postpartum period; common medical issues in pregnancy such as diet, constipation, nausea, vomiting, and white discharge; and investigations and parent preparation/antenatal classes. The rest of the questions were related to issues such as assisted reproduction, contraception, and previous miscarriage.
Questions related to common complaints, such as nausea, vomiting, and complications of pregnancy, were more specifically asked by the pregnant callers than by the nonpregnant callers (81% vs 18.27%, P < 0.05 and 81.95% vs 18.04%, P < 0.05, respectively). All calls from the medical professionals were related to drug safety in pregnancy.
The proportion of calls in the "do not know" (calls where no previous medical/personal history was available) category for previous obstetric history declined from 70% in 2010 to 36.2% in 2011 and 4.1% in 2012. The trends in the number of callers as well as the "do not know" calls from September 2010 to December 2012 were analyzed by linear regression. As seen in [Figure 1]a, although there is a positive trend (B = +0.575), i.e., an increase in the number of calls with the passage of time, it is not significant (P = 0.114). But a significant and decreasing trend in the "do not know" calls is evident from the negative significant regression coefficient, B = –0.608, P = 0.000 [Figure 1]b.
This is possibly the first brief report sharing the initial experience of a pregnancy helpline and its reception by Indian callers. There are a few Indian medical helplines for mental health, HIV/AIDS, etc., ,, while Jansankhya Sthirata Kosh (JSK) , funds a toll-free helpline that addresses questions regarding reproductive and sexual health, family planning, child health, etc. While psychiatric illness and HIV/AIDS are disorders with social stigma, pregnancy is a natural condition and not a disease. Usage of a pregnancy helpline might differ from other helplines, given that related information is easily available from nonmedical sources including senior family members, neighbors, and the print and electronic media although their credibility may be questionable and there is no need of avoiding face-to-face discussion or hiding identity.
The JSK helpline , is run by a business process outsourcing (BPO) organization through trained personnel who get assistance from leading medical institutions in New Delhi. Garbha-Swasthya helpline has appointed a medical doctor with special training, which makes it easier for asking leading medical questions to provide the best possible medical advice. The JSK helpline,  like many others, does not ask any personal information; while we request relevant information similar to that of the Motherisk Alcohol and Substance Abuse Helpline  from Canada, it is up to the user whether to share it or not. We believe that documentation of such information, while maintaining confidentiality, is useful for audits and evaluation, generating and answering specific research questions, and it also helps to get back to the caller if a question was not immediately answered.
Garbha-Swasthya helpline was contacted 706 times in the first 2 years (6 hours each of approximately 590 days, omitting Sundays and hospital holidays), which may seem like a small number. However, this number needs to be interpreted considering the limited working hours unlike a 24-h mental health helpline with 3,273 calls over a period of 4.5 years  and no special effort/advertising for publicity of this service unlike the Asha Foundation HIV/AIDS helpline that put up public announcements in newspapers, radio, yellow pages, and stickers. 
There is a continuous increase in the number of calls although it is not statistically significant [Figure 1]a. However, the "do not know" caller category has significantly decreased from 2010 to 2012 [Figure 1]b, possibly reflecting better sharing of information by the callers and/or improved experience and communication skills of the counselor.
Questions about exposures during pregnancy (drugs, alcohol, eclipse, and radiation) or preexisting maternal disorders such as mental illness topped the list. Almost 14% of the questions were related to issues taken as a part and parcel of normal pregnancy that often receive a poor hearing by medical experts; these issues include nausea, vomiting, and backache, as reported by Madjunkova et al. from the Motherisk Nausea Vomiting In Pregnancy helpline.  No significant difference was noted between the proportion of pregnant and nonpregnant callers for other questions such as investigations during pregnancy.
There were some limitations in our analysis including a relatively smaller number of calls received and the nonavailability of information such as education and occupation of the callers, which would have helped to identify the factors influencing usage of the helpline and areas for improving the service.
| Conclusion|| |
In conclusion, Garbha-Swasthya pregnancy helpline is receiving a steadily increasing response but it is possibly underutilized and efforts are needed to increase both public and professional awareness to make better use of this voluntary service.
We thank Deenanath Mangeshkar Hospital for supporting Garbha-Swasthya helpline and also thank all the consultants of this hospital for their contributions to the helpline database.
We are grateful to Param Software Solutions, Pune, Maharashtra, India for their noble gesture of developing this helpline software free of cost for this voluntary program.
We also thank Dr. Asawari Kanade and Ms. Varada Bivalkar from Deenanath Mangeshkar Hospital & Research Center for their help in statistical analysis.
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