Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care

When HIPAA hurts: legal barriers to texting may reinforce healthcare disparities and disenfranchise vulnerable patients

Effective health communication between healthcare providers and patients is a cornerstone of quality healthcare. It underpins trust, comprehension, and patient-informed care. Robust research shows that effective communication, including the use of text messaging for communication can improve maternal/fetal and neonatal outcomes and patient satisfaction, particularly among vulnerable patients. Health information privacy laws that do not evolve with technological advances can inadvertently create barriers to effective health communication, reinforcing perinatal disparities. This is particularly true regarding maternal and child health, where the use of text messaging for patient communication has the potential to make a substantial impact on health disparities. This article explores the complex interplay between health information privacy laws and text messaging, highlighting challenges and examining potential solutions. It stresses the need for consistent health information privacy laws that protect the privacy security of health information for pregnant patients and new mothers, while also aligning with evolving communication technologies.

Effects of Face-to-Face Education Followed by Mobile Messaging to Primiparas on Maternal-Neonatal Care, Breastfeeding, and Motherhood Experience: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of education on breastfeeding and basic maternal-neonatal care and mobile message support given to primiparous women in the postpartum period on breastfeeding and motherhood experiences.

METHODS

This prospective randomized controlled study was conducted in a hospital located in a city in Turkey, with 130 primiparous patients in the postpartum period (65 individuals in the experimental group and 65 individuals in the control group). Participants in the experimental group were provided with education on breastfeeding and basic maternal-neonatal care at the hospital, and mobile messages were sent with the same content as an education program for six weeks after discharge.

RESULTS

Mean scores of the breastfeeding self-efficacy (58.95 vs. 54.87; P<.05) and breastfeeding attitude (60.80 vs. 57.55; P<.05) are significantly higher in the experimental group compared to the control group. Similarly, the mean score of satisfaction with the motherhood experience is significantly improved in the experimental group compared to the control group (22.95 vs. 26.46; P<.05). It was determined that 89.2% of the women in the experimental group were still breastfeeding; 93.8% of them did not have nipple problems, and 60% of them did not use a bottle or pacifier in the six-month postpartum period (P<.05).

CONCLUSION

Education on breastfeeding and basic maternal-neonatal care given in the early postpartum period and mobile messages sent for six weeks after discharge may help to improve breastfeeding self-efficacy, breastfeeding attitude, and maternal experience satisfaction among primiparous women.

Introducing an Antenatal Care Electronic Health System for Low and Middle Income Countries: A Cross-Sectional Study on 1217 Iranian Pregnant Women

Objective

Maternal health care is one of the main challenges worldwide, especially in low- and middle-income countries (LMICs) such as Iran. In this cross-sectional study, we introduce an electronic health software for maternal care that is active under the supervision of the Valiasr Reproductive Health Research Center of Tehran University of Medical Sciences in providing maternal health education to Iranian pregnant women. In addition to describing the details of this open-source software and encouraging LMICs health policymakers to develop such software, this manuscript also provides a cross-sectional report and statistical analysis on anonymous Iranian pregnant women who registered in this system.

Materials and methods

Since 2015, we have launched an electronic health software in Iran called "niniMED Pregnancy Calendar" in Persian. This system has multiple educational and motivational features for pregnant women, including momentary weight recommendations based on pregnancy week and recommended dates for common tests during pregnancy according to the first day of the last menstrual period in Jalali calendar format. Additionally, we measured user satisfaction with this system using a questionnaire.

Results

From 2015 to 2017, 1,217 anonymous Iranian pregnant women registered in this system. The average age of pregnant Iranian women was 30.67 years (30 years and 8 months). Users had a body mass index (BMI) of 24.68 kg.m-2, which had a significant direct relationship with their gestational age (P=5.81e-05) and indicated an improvement in appropriate weight for Iranian women compared to previous studies. We showed that there was a significant direct relationship between the age of Iranian pregnant women and the likelihood of a high-risk pregnancy (P=0.008). We also observed a significant inverse relationship between pregnancy week and their tendency to receive pregnancy-related education (P=0.018). Finally, we found that more than 88% of pregnant Iranian women assessed membership in such systems as completely useful for pregnancy.

Conclusion

The development of such electronic health systems for informing pregnant women can provide low-cost maternal education to LMICs pregnant women and potentially assist in managing weight gain during pregnancy and reducing associated risks. It can also be widely accepted by pregnant women.

Barriers and facilitating factors of postnatal blood glucose monitoring after structured intervention among mothers with gestational diabetes mellitus receiving care from a tertiary health centre, Puducherry - A qualitative study

BACKGROUND

In India, women with GDM are at an increased risk of developing type 2 diabetes mellitus (T2DM). Despite this, the rate of postnatal blood glucose monitoring is low, and the reasons are not well known. Hence, our study explored the barriers and facilitating factors associated with T2DM postnatal screening six weeks after delivery.

MATERIALS AND METHODS

We conducted a qualitative study among 21 mothers with GDM in obstetrics and gynecology department, women and child hospital (WCH), JIPMER, from December 2021 to January 2022. Mothers with GDM were selected purposively between 8 and 12 weeks after delivery to explore the barriers and facilitating factors associated with postnatal screening six weeks after getting mobile call reminders and health information booklet interventions. In-depth interviews were transcribed; manual content analysis with deductive and inductive coding was done.

RESULTS

We identified two themes; three categories and subcategories that illustrated barriers and five categories that illustrated facilitators to postnatal blood glucose monitoring. Lack of awareness and misconceptions about GDM, knowledge practice gap, lack of family support, and perception of health system failure by mothers with GDM were barriers to postnatal blood glucose monitoring. Concerns about health, standard advice on postnatal screening, information in health education booklet, mobile reminders, and family support were found to be facilitators.

CONCLUSION

We found several barriers and facilitating factors that showed mobile call reminders and booklet interventions had improved postnatal blood glucose monitoring. Our qualitative study has strengthened the findings of the previous RCT, and it would provide more insights to develop further interventions which we must focus on improving postnatal blood glucose monitoring.

Pregnant women's use and attitude toward Mobile phone features for self-management

BACKGROUND

This study aimed to examine the current use of mobile phones by pregnant women and their attitudes towards the use of a variety of prenatal care services through mHealth.

METHODS

This descriptive cross-sectional study was conducted in Iran in 2021. The study population included 168 pregnant women who referred to specialist obstetrics and gynecology clinic. The data collection tool was a questionnaire that included the demographics of the participants, their current mobile phone usage, and their attitudes toward mobile phone use for prenatal care services. The data were analyzed in SPSS with descriptive and analytical statistics.

RESULTS

The majority of participants (84.2%) had a smartphone and access to mobile internet. More than half of the respondents (58.9%) used their mobile phone for (only) phone calls, and 36.7% occasionally used mobile internet to access prenatal care services. To get information about the pregnancy and to communicate with other pregnant women, the participants mainly used social media, and to get reminders, they preferred phone calls.

CONCLUSIONS

In this study, pregnant women have a positive attitude towards using mobile phones for obtaining health services and prefer social media to seek prenatal care services. There seems to be a need for pregnant women to have high levels of digital health literacy and be advised by healthcare providers on using this technology to access prenatal care services.

SmartMoms Canada: An evaluation of a mobile app intervention to support a healthy pregnancy

BACKGROUND

There is a lack of cost-effective and readily available access to evidence-based information to manage healthy behaviours for pregnant individuals. Mobile health (mHealth) tools offer a cost-effective, interactive, personalized option that can be delivered anywhere at a time most convenient for the user. This study protocol was primarily developed to, i) assess the feasibility of the SmartMoms Canada intervention in supporting participants to achieve gestational weight gain (GWG) guidelines. The secondary objectives are to, ii) assess user experience with the app, measured by adherence to the program via app software metrics and frequency of use, iii) determine the impact of SmartMoms Canada app usage on the adoption of healthful behaviours related to nutrition, physical activity and sleep habits, improvements in health-related quality of life, pregnancy-related complications, and symptoms of depression, and iv) investigate the potential extended effects of the app on postpartum health-related outcomes.

METHODS

This is a feasibility trial. Pregnant individuals aged 18-40 years with pre-gravid body mass index between 18.5 and 39.9 kg/m², carrying a singleton fetus, having Wi-Fi access, and at ≤20 weeks' gestation will be recruited. Eligible people will be followed from recruitment until 12 months postpartum.

DISCUSSION

SmartMoms Canada is the first bilingual Canadian-centric app designed for pregnant people. This mHealth intervention, with its ability to supply frequent interactions, provides pregnancy- related health knowledge to users, potentially leading to an improvement in pregnancy-related outcomes and behaviours, and, ultimately a reduction in the present economic burden related to in-person interventions.

TRIAL REGISTRATION

ISRCTN, ISRCTN16254958. Registered 20 December 2019, http://www.isrctn.com/ ISRCTN16254958.

Perceptions on a mobile health intervention to improve maternal child health for Syrian refugees in Turkey: Opportunities and challenges for end-user acceptability

Background

Mobile health (mhealth) technology presents an opportunity to address many unique challenges refugee populations face when accessing healthcare. A robust body of evidence supports the use of mobile phone-based reminder platforms to increase timely and comprehensive access to health services. Yet, there is a dearth of research in their development for displaced populations, as well as refugee perspectives in design processes to improve effective adoptions of mhealth interventions.

Objective

This study aimed to explore healthcare barriers faced by Syrian refugee women in Turkey, and their perceptions of a maternal-child health mobile application designed to provide antenatal care and vaccine services. These findings guided development of a framework for enhancing acceptability of mobile health applications specific to refugee end-users.

Methods

Syrian refugee women who were pregnant or had at least one child under the age of 2 years old at the time of recruitment (n = 14) participated in semi-structured in-depth interviews. Participants had the opportunity to directly interact with an operational maternal-child health mobile application during the interview. Using a grounded theory approach, we identified critical factors and qualities mhealth developers should consider when developing user-friendly applications for refugees.

Results

It was observed that a refugee's perception of the mobile health application's usability was heavily influenced by past healthcare experiences and the contextual challenges they face while accessing healthcare. The in-depth interviews with refugee end-users identified that data security, offline capability, clear-user directions, and data retrievability were critical qualities to build into mobile health applications. Among the features included in the maternal-child health application, participants most valued the childhood vaccination reminder and health information features. Furthermore, the application's multi-lingual modes (Arabic, Turkish, and English) strengthened the application's usability among Syrian refugee populations living in Turkey.

Conclusions

The inclusion of refugee perceptions in mhealth applications offers unique developer insights for building more inclusive and effective tools for vulnerable populations. Basic upfront discussions of the mobile application's health goals and its personal value to the user may improve their long-term use. Further prospective research is needed on retention and use of mobile health applications for refugee women and other displaced populations.

The short-term effect of a mHealth intervention on gestational weight gain and health behaviors: The SmartMoms Canada pilot study

Gestational weight gain (GWG) has been shown to impact several maternal-infant outcomes. Since healthcare provider guidance on weight gain and healthy behaviors alone has failed to help women to meet guidelines during pregnancy, a practical adjunctive approach is to deliver evidence-based behavior change programs through mobile interventions. The present study aimed to assess the short-term effect of the SmartMoms Canada app to promote adequate GWG and healthy behaviors. Twenty-nine pregnant women were recruited in this app-based intervention trial to test whether a higher app usage (≥ 3.8 min·week^-1) between 12-20 gestational weeks and 24-28 gestational weeks improved GWG, diet, physical activity, and sleep, compared to women with a lower app usage (< 3.8 min·week^-1). Two-way mixed ANOVA for repeated measures was used to estimate the effect of the app usage and time, as well as their interaction on GWG and healthy behaviors. The likelihood ratio was used to examine the association between app usage categorization and GWG classification. Cramer's V statistic was used to estimate the effect size for interpretation of the association. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity (MVPA) daily average when compared with women with a lower usage (mean difference: 17.84 min/day, 95% CI: 2.44; 33.25). A moderate effect size (28.6% vs. 15.4%; Cramer's V = 0.212) was found for the association between app categorization and rate of GWG, representing a greater adherence to the GWG guidelines in women in the higher app usage group vs. the lower app usage group. Considering other physical activity, diet, and sleep variables, no app categorization effect was observed. A short-term higher usage of SmartMoms Canada app has a positive effect on objectively-measured MVPA.

Impact of mobile phone intervention on intermittent preventive treatment of malaria during pregnancy in Burkina Faso : A pragmatic randomized trial

PURPOSE

Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) coverage remains far below the desirable goal of at least three doses before delivery. This study evaluates an innovative intervention using mobile phones as a means of increasing coverage for the third dose of IPTp-SP.

METHODS

This study in Burkina Faso was designed as an open-label, pragmatic, two-arm, randomised trial. Pregnant women who attended antenatal clinic (ANC) visits were included at their first ANC visit and followed until delivery. The intervention was built around the use of mobile phones as means ensuring direct tracking of pregnant women.

RESULTS

Two hundred and forty-eight (248) pregnant women were included in the study. The proportion of women who received at least three doses of IPTp-SP was 54.6 %. In the intervention group, 54.1 % of women received at least three doses of IPTp-SP versus 55.1 % in the control group, a non-significant difference (adjusted odds ratio "aOR", 0.86 ; 95 % confidence interval "95 % CI", 0.49-1.51). Women in the intervention group were more likely to carry out their ANC visits in a timely manner than those in the control group (aOR, 3.21 ; 95 % CI, 1.91-5.39).

CONCLUSION

While mobile phone intervention did not increase the proportion of women receiving three doses of IPTp-SP, it did help to increase the proportion of timely ANC visits.

TRIAL REGISTRATION

PACTR202106905150440.

Mobile phone access, willingness, and usage for HIV-related services among young adults living in informal urban settlements in Kenya: A cross-sectional analysis

BACKGROUND

Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults' differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV.

METHODS

This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use.

RESULTS

The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR = 1.84, 95 %CI:1.14-2.97) and employed (OR = 1.70, 95 %CI:1.02 = 2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR = 0.47, 95 %CI:0.24-0.921), were religious minorities (OR = 0.56, 95 %CI:0.32-0.99), partnered/married (OR = 0.30, 95 %CI:0.10-0.91), or female (OR = 0.29, 95 %CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed.

CONCLUSION

Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.

Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data

Objective

The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women’s empowerment indicators to provide evidence for the need for policy change.

Methods

Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women’s empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women’s empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design.

Results

The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women’s knowledge level were associated with any PNC, but the association between women’s knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women’s knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant’s gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant’s size at birth.

Conclusions for Practice

PNC coverage after discharge in Indonesia needs improvement. Women’s empowerment indicators need to be addressed in improving PNC coverage.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-021-03324-y.

The Influence of Educational, Environmental and Social Factors in the Decision to Attend Prenatal Lectures among Pregnant Women in Romania

Introduction: Prenatal and postnatal education is an essential compound of prenatal care that prepares and facilitates the acquisition of women's skills, necessary for positive experiences during pregnancy, childbirth and postnatal period. Material and method: We conducted a prospective study that included pregnant women who attended prenatal courses. They were asked to fulfil a questionnaire about course topics, utility and impact on birth preparations. The pregnant women included in this group planned to give birth at Bucur Maternity, Saint John Clinical Hospital, Bucharest, Romania. Results:A number of 205 pregnant women answered the online questionnaire over a period of two months. Their age range was between 25 and 35 years (40.98%). Among them, 74.15% had higher education, 85.37% of them were from urban areas, 82.44% were primiparous and 63.41% intended to have natural birth. There has been a growing interest for natural birth among pregnant women in their first pregnancy (68.05%) and also for participating in pre- and postnatal education courses, which was influenced by the level of completed education (65.66% of pregnant women with higher education wanted to give birth naturally). Topics of interest for most pregnant women are mentioned too. Conclusion:In our study, the majority of participants were aware of the importance to get accurate information about the prenatal period, birth, childbirth and the next period, as well as the care of the new-born from specialized courses, provided by medical staff.

A national assessment of elective cesarean sections in Bangladesh and the need for health literacy and accessibility

There has been a gradual rise in the number of cesarean sections (CSs) in Bangladesh. The present study identified the cohort of women, who were more likely to opt for an elective CS based on their sociodemographic characteristics, pre-delivery care history, and media exposure, using the Bangladesh Multiple Indicator Cluster Survey-2019. The survey stratification adjusted logistic regression model and interpretable machine learning method of building classification trees were utilized to analyze a sample of 9202 women, alongside district-wise heat maps. One-in-five births (20%) were elective CSs in the 2 years prior to the survey. Women residing in affluent households with educated house-heads, who accessed antenatal care prior to delivery (AOR 4.12; 95% CI 3.06, 5.54) with regular access to media (AOR 1.31; 95% CI 1.10, 1.56) and who owned a mobile phone (AOR 1.25; 95% CI 1.04, 1.50) were more likely to opt for elective CSs, which suggests that health access and health literacy were crucial factors in women's mode of delivery. Spatial analyses revealed that women living in larger cities had more elective CS deliveries, pointing towards the availability of better health and access to multiple safe delivery options in peripheral areas.

How Did Prenatal Education Impact Women's Perception of Pregnancy and Postnatal Life in a Romanian Population

Background and Objectives: Prenatal education represents an important part of maternal prenatal care in Western countries. In Romania, prenatal education is of recent interest but there is no official information about prenatal courses and their impact on prenatal care and patients in Romania. Material and methods: A prospective study based on the STROBE statement was designed in order to assess the prenatal education delivered in our unit. The study group included women who gave birth at Bucur Maternity, "Saint. John" Hospital, Bucharest, Romania and attended the prenatal courses, compared with a control group (women who gave birth in our unit but did not attend the prenatal lecture). Patients' perception about the impact of prenatal education was collected by applying a questionnaire. Results: The analysis included 89 women who fulfilled the questionnaire online. In our study, 62 women (69.7%) attended the prenatal education classes and represented the study group while 27 women (30.3%) constituted the control group. Women who attended the prenatal lecture recognized the utility of the topic regarding newborn care (90.3%), while women from the control group did not consider it useful (n = 55.6%), χ2 = 18.412, p < 0.001. Patients from the study group admitted the importance of the topics (93.5%) from the lectures about breast feeding, while the percentage of these women from the control group is significantly lower (55.6%) χ2 = 27.867, p < 0.001. Conclusions: The benefits of prenatal education were recognized by women who attended the prenatal lecture, while women who did not participate underestimated the utility of the topics. Further actions are required to inform mothers about the necessity of antenatal education.

Mothers intention and preference to use mobile phone text message reminders for child vaccination in Northwest Ethiopia

OBJECTIVES

With the unprecedented penetration of mobile devices in the developing world, mHealth applications are being leveraged for different health domains. Among the different factors that affect the use of mHealth interventions is the intention and preference of end-users to use the system. This study aimed to assess mother's intention and preference to use text message reminders for vaccination in Ethiopia.

METHODS

A cross-sectional study was conducted among 460 mothers selected through a systematic random sampling technique. Initially, descriptive statistics were computed. Binary logistic regression analysis was also used to assess factors associated with the outcome variable.

RESULTS

In this study, of the 456 mothers included for analysis, 360 (78.9%) of mothers have intention to use text message reminders for vaccination. Of these, 270 (75%) wanted to receive the reminders a day before the vaccination due date. Mothers aged 35 years or more (AOR=0.35; 95% CI: 0.15 to 0.83), secondary education and above (AOR=4.43; 95% CI: 2.05 to 9.58), duration of mobile phone use (AOR=3.63; 95% CI: 1.66 to 7.94), perceived usefulness (AOR=6.37; 95% CI: 3.13 to 12.98) and perceived ease of use (AOR=3.85; 95% CI: 2.06 to 7.18) were predictors of intention to use text messages for vaccination.

CONCLUSION

In conclusion, majority of mothers have the intention to use text message reminders for child vaccination. Mother's age, education, duration of mobile phone use, perceived usefulness and perceived ease of use were associated with intention of mothers to use text messages for vaccination. Considering these predictors and user's preferences before developing and testing text message reminder systems is recommended.

Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study

BACKGROUND

Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2.

OBJECTIVE

The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices.

METHODS

Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not.

RESULTS

One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information.

CONCLUSIONS

Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

[Acceptability and satisfaction with pregnancy and newborn diagnostic assessment (PANDA) system providing prenatal care in Burkina Faso]

Introduction

les technologies mobiles en santé sont de plus en plus utilisées comme solutions innovantes pour améliorer les services de soins prénatals (SPN) dans les soins de première ligne. Cette étude a évalué l´acceptabilité et la satisfaction de l´utilisation du système Pregnancy and Newborn Diagnostic Assessment (PANDA) lors des SPN au Burkina Faso.

Méthodes

une étude transversale utilisant une approche mixte a été menée auprès de 35 utilisatrices des SPN et de 35 agents de santé dans le district sanitaire de Koupéla, dans la région du Centre-Est du Burkina Faso en septembre 2017. Des entretiens et 4 focus groups ont été réalisés auprès des utilisatrices des SPN et des d´entretiens semi-structurés auprès des professionnels de soin. Une analyse descriptive des données quantitatives a été effectuée avec le logiciel SPSS et les données qualitatives ont fait l’objet d´une analyse thématique avec NVivo 10.

Résultats

le système PANDA a été très bien accepté et très apprécié par les utilisatrices et les prestataires de soins. Les motifs de satisfaction chez les utilisatrices étaient l´amélioration des échanges avec les prestataires de soin et l´accès à des soins de meilleure qualité à moindre coût. Les agents de santé ont apprécié la pertinence du système PANDA et l´amélioration des prestations fournies, du suivi et de la prise en charge des femmes enceintes.

Conclusion

le système PANDA est très bien accepté et apprécié au niveau des soins primaires aussi bien par les prestataires de soins que par les utilisatrices de services de soins prénataux au Burkina Faso.

RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe

Background

Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe.

Methods

We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12.

Results

Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge.

Conclusion

Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be a challenge because of maternal health care barriers such as poor road network, poor phone network, and the high cost of transport. There is a need to investigate the social determinants of access to maternity services to inform RoadMApp implementation.

The Mobile Alliance for Maternal Action Text Message-Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study

Background

Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program.

Objective

The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback.

Methods

Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback.

Results

The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family.

Conclusions

These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system.

Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage

BACKGROUND

The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B.

OBJECTIVE

This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants' knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention.

METHODS

An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants' knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks' exposure to the text message-based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis.

RESULTS

A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants' perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B.

CONCLUSIONS

Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population.

Web and mobile-based technologies for monitoring high-risk pregnancies

Introduction

High-risk pregnancy is an illness in which there are severe complications and problems that may cause fetal loss and requires continuous care. It seems that using telemedicine technology is helpful to provide wider access to prenatal care. The aim of this study was to compare the feasibility of using web-based and mobile-based technologies in caring for high-risk pregnancy.

Materials and methods

This was a cross-sectional study and the participants included midwives and gynaecologists who worked at teaching hospitals. The data were collected by using two five-point Likert scale questionnaires which were designed based on the literature review. The questionnaires included two main sections: demographic questions and questions related to five aspects of a feasibility study. Face and content validity of the questionnaires were confirmed by the experts and the reliability was checked by using the test-retest method. The data were analysed using descriptive and inferential statistics.

Results

In this study, 79 questionnaires were completed by 50 midwives (63.29%) and 29 gynaecologists (36.71%). Overall, midwives (p=0.001) and gynaecologists (p=0.003) believed that using mobile-based technologies was more feasible than using web-based technologies in caring for high-risk pregnancies.

Conclusion

It seems that planning for the future technological direction and providing mobile-based applications should be taken into account and prioritised to improve the quality of prenatal care and to increase access to healthcare services for high-risk pregnancies.

Information = equity? How increased access to information can enhance equity and improve health outcomes for pregnant women in Peru

Background

The Peruvian health system provides care through numerous, disconnected health establishments and information systems. Our objective was to explore information use and needs of pregnant women to improve quality of care.

Methods

We carried out a mixed methods study in the Lima capital metropolitan area in 15 health centers. This included four focus groups with 34 pregnant women and surveys with 403 pregnant women.

Results

Pregnant women’s information needs depend on their age, number of pregnancies and environment. Women relied on their social networks for pregnancy-related advice and valued high-quality, timely and targeted information from the health system. Participants’ information needs include access to reliable information and responses to their questions in a warm, caring and safe environment. These needs can be met during prenatal check-ups and in group settings through informational talks and visual displays in waiting areas, as well as through appropriate digital technologies such as SMS messages and electronic health records.

Conclusions

Pregnant women need individualized health information in an understandable, secure and friendly manner to maximize their understanding of their pregnancy, follow recommendations and optimize health outcomes. Customizing e-Health programs that reach many pregnant women has greater potential for more equitable health outcomes.

Improving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access

Background

Ethnic minority women (EMW) in Vietnam experience disproportionately high infant and maternal mortality rates due to low social status, poverty and remoteness from health centres. This project piloted and evaluated a low-cost mobile health (mHealth) intervention called mMom utilizing behaviour change communication (BCC) to improve access to maternal, newborn and child health (MNCH) services and health equity among EMW living in remote areas.

Methods

The mMom intervention built an integrated mHealth platform which sent timely MNCH information and BCC text messages to participants, and engaged health workers towards increasing their interaction and building demand for quality natal care. Mid-term and final qualitative evaluations were conducted to assess the intervention's acceptability and impact.

Results

In evaluations, all participants expressed satisfaction with the quality, timeliness and convenience of the messages, and health workers reported increased efficiency and quality of care. The use of BCC increased care-seeking from EMW and strengthened relationships with health providers.

Conclusion

The mMom project demonstrated the acceptability of mHealth in a remote Vietnamese region with a high proportion of disadvantaged EMW. The messages promoted increased contact between participants and health providers, which holds potential to address the marginalization of EMW from the health system.

Keywords

behaviour change communication, eHealth, ethnic minorities, health equity, mHealth, MNCH, mobile health, Vietnam.

Assessing implementation modalities of mhealth intervention on pregnant women in Dschang health district, West region of Cameroon

Introduction

Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang health district, West Region of Cameroon.ng ba.

Methods

This was a cross sectional descriptive study in the Dschang health district, West region of Cameroon. Key informants were all pregnant women from 18 years and above and a total of 372 pregnant women were included. This study was carried out from March to July 2017.

Results

Majority of the women, that is, 252(67.74%) were married, 117(31.45%) declaredtheir status as being single, while 3(0.81%) were devorced. Out of the 335 women that declared wanting an mHealth intervention, 41.79% of this number preferred SMS texts in the afternoon, 111(33.13%) in the evening, 46(13.73%) anytime and 38(11.34%) in the morning hours. A total of 83.33% women confirmed using telephone services.

Conclusion

This study reveals that cell phones would be the acceptable medium of providing pregnancy and postpartum support to women in the Dschang health district. This is justified by the fact that a vast majority of women interviewed had access to a cell phone and referred to it as their desired and accepted means of communication.

Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis

BACKGROUND

Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support.

OBJECTIVES

To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH).

SEARCH METHODS

We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2).

SELECTION CRITERIA

We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally.

DATA COLLECTION AND ANALYSIS

We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness.

MAIN RESULTS

We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue.

AUTHORS' CONCLUSIONS

Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.

Effect of enhanced reminders on postnatal clinic attendance in Addis Ababa, Ethiopia: a cluster randomized controlled trial

Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low- and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia. Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge). Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study's primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis. Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51-5.8). Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.

Use of Text Messaging for Postpartum Depression Screening and Information Provision

OBJECTIVE

The objective of this study was to evaluate the feasibility of using text messages to enhance mental health screening and education of women in the immediate postpartum period.

METHODS

A total of 937 postpartum women were recruited from an obstetrics and gynecology clinic of a large urban hospital. Participants received a text message containing a two-question screen for postpartum depression every two weeks and three text messages per week about postpartum mental health for the first 12 weeks postpartum. Those who screened positive were administered the Edinburgh Postnatal Depression Scale. They were matched with a subset of women who were also assessed with the Edinburgh Postnatal Depression Scale after screening negative for depression with the text messaging screen. At 12 to 13 weeks postpartum, all participants received an online survey assessing satisfaction with the text messages.

RESULTS

Of 937 participants, 126 (13%) screened positive. Agreement between the texted screen and the Edinburgh Postnatal Depression Scale was moderate (κ=0.45), with good sensitivity (0.90, 95% confidence interval [95% CI]=0.81-0.96) and specificity (0.82, 95% CI=0.79-0.85). Nine hundred thirty (99%) participants responded to at least one of the six texted screens, whereas 632 (67%) responded to all six. Of the 589 (63%) who responded to the satisfaction survey, 459 (78%) recommended that all women be screened for postpartum depression via text messaging and that all women in the postpartum period be sent information texts about postpartum depression (N=504, 91%).

CONCLUSIONS

Using text messaging technology to screen women for postpartum depression and provide information on postpartum mental health appears to be sensitive, feasible, and well accepted.

The effect of short message service (SMS) on knowledge and preventive behaviors of diabetic foot ulcer in patients with diabetes type 2

OBJECTIVE

The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes.

MATERIAL AND METHODS

This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training.

RESULTS

The mean age of patients in intervention group was 48.11 ± 9.7 and control group was 47.3 ± 7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P < 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P < 0.001).

CONCLUSION

The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.

Effect of an interactive voice response system on self-management in kidney transplant recipients: Protocol for a randomized controlled trial

INTRODUCTION

Adherence to a complex and ongoing set of therapeutic recommendations significantly determines short and long-term outcomes after kidney transplantation (KT). Interactive voice response system (IVRS) is a novel phone-based platform which is potentially useful to deliver health behavior interventions.

OBJECTIVE

The aims of the study is to describe the development of a theory-driven and educational IVRS investigate the effect of an IVRS on the self-management outcomes in KT recipients as compared with the control group.

METHODS

This study has been designed as a randomized, 2 parallel groups controlled trial. The KT recipients' older than18 years of age with access to a cellphone will be included. A total of 120 patients will be randomly assigned to the control and intervention groups. The participants in the intervention group will receive completely automatic calls in 3 categories: educational, medication adherence, and reminders by the IVRS, whereas those in the control group will receive usual care. The follow up will be performed within 6 months. The primary outcome will be the medication adherence while patients' transplant knowledge, health-related quality of life, and rehospitalization rates will be considered as secondary outcomes.

RESULTS

Thus far, recruitment of participants has not been completed and results will be published in 2019.

DISCUSSION

The IVRS is potentially useful to help KT recipients improve the self-management outcomes. The hypothesis is using an IVRS intervention makes a significant difference between basel assessment of adherence to immunosuppressive medications scale, 12-item short form survey, second version, kidney transplant understanding tool baseline scores, and those obtained at the end of study.

TRIAL REGISTRATION NUMBER

This trial is registered with the Iran Trial Registrar under registration number IRCT20180124038492N1 and registration date 30 January 2018. https://irct.ir/trial/29215.

Communication Technology Use and Preferences for Pregnant Women and Their Caregivers

The rapid evolution of communication technologies has created new ways for healthcare consumers to manage their health. In a mixed-methods study, we examined technology use and willingness to use in pregnant women and caregivers, using surveys and semi-structured interviews. Most participants had used text messaging, automated phone calls, Skype/FaceTime, social media, and online discussion forums. To communicate with healthcare providers, most were willing to use text messaging and had not, but desired to use Skype/FaceTime. Fewer were willing to use social media or online discussion forums due to concerns about privacy and security. Most were willing to use text messaging, Skype/FaceTime, or online discussion forums to support health in other ways, but few had done so. About half were willing to use automated phone calls, but most did not like them due to the impersonal nature and time required. Developers should consider such preferences in design of health information technologies.

Mothers' perception of maternal and child health information disseminated via different modes of ICT in Nigeria

BACKGROUND

A few studies have examined mothers' perception of ICT and maternal and child health (MCH) information promoted using ICT. The effectiveness of different modes of delivery of such information is unclear.

OBJECTIVE

To investigate mothers' perceived usefulness of ICT and MCH information disseminated through e-health projects in Nigeria.

METHODS

The study was a descriptive survey that was based on the mixed method paradigm. A questionnaire was used to collect data from 1001 mothers involved in ongoing ICT based projects in Nigeria. The mothers were selected using a convenience sampling technique. Four focus group discussion sessions were also organised for thirty mothers.

RESULTS

Mobile phones were viewed as useful (35.0%) or very useful (42.2%) and radio as useful (34.8%) or very useful (57.5%%). But they expressed a negative perception towards the use of DVD/TV (Not useful, 66.5%) and the Internet/computer (Not useful 67.7%). Mothers' perception of MCH information disseminated was also positive. They reported the need for more MCH information products in local languages using acceptable ICT.

CONCLUSION

Mothers' perception of preferred modes of delivery of maternal and child health information varies according to location.

Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study

BACKGROUND

Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition.

OBJECTIVE

The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)-based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa.

METHODS

A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message-based mHealth intervention.

RESULTS

A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718).

CONCLUSIONS

A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message-based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message-based mHealth interventions.

mHealth Technology Use and Implications in Historically Underserved and Minority Populations in the United States: Systematic Literature Review

Background

The proportion of people in the United States who are members of at least two ethnic groups is projected to increase to 10% by the year 2050. This makes addressing health disparities and health inequities in minority populations increasingly more difficult. Minority populations, including those who classify themselves as African American and Hispanic, are using mobile phones to access health information via the internet more frequently than those who classify themselves as white, providing unique opportunities for those in public health and health education to reach these traditionally underserved populations using mobile health (mHealth) interventions.

Objective

The objective of this review was to assess studies conducted in the United States that have used mHealth tools and strategies to develop and implement interventions in underserved populations. This review also examines the ways in which mHealth strategies are being employed in public health interventions to these priority population groups, as mobile phone capabilities include text messaging, mobile apps, internet access, emails, video streaming, social media, instant messaging, and more.

Methods

A systematic literature review was conducted using key search phrases, the matrix method, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram to identify key studies conducted between the years of 2009-2016 in the United States. These studies were reviewed for their use of mHealth interventions in historically underserved and minority populations.

Results

A total of 16,270 articles were initially identified using key search phrases in three databases. Titles were reviewed and articles not meeting criteria were excluded, leaving 156 articles for further review. After additional review for relevance and inclusion criteria, 16 articles were qualified and analyzed.

Conclusions

mHealth is a promising area of development for public health and health education. While successful research has been done using text messaging (short message service, SMS) and other mHealth strategies, there is a need for more research using mobile phones and tablet applications. This literature review demonstrates mHealth technology has the ability to increase prevention and health education in health disparate communities and concludes that more specified research is needed.

Evaluating the Effectiveness of Text Messaging and Phone Call Reminders to Minimize No Show at Pediatric Outpatient Clinics in Pakistan: Protocol for a Mixed-Methods Study

BACKGROUND

Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules.

OBJECTIVES

The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based reminder system and further explore how to improve the attendance at the pediatric outpatient clinics. The primary objectives are to (1) determine the efficacy of the current clinic appointment reminder service at pediatric outpatient clinics at Aga Khan University Hospital, (2) assess the mobile phone access and usage among caregivers visiting pediatrics consultant clinics, and (3) explore the perception and barriers of parents regarding the current clinic appointment reminder service at the pediatric outpatient clinics at Aga Khan University Hospital.

METHODS

The study uses a mixed-method design that consists of 3 components: (1) retrospective study (component A) which aims to determine the efficacy of text messaging (SMS) and phone call-based reminder service on patient's clinic attendance during January to June 2017 (N=58,517); (2) quantitative (component B) in which a baseline survey will be conducted to assess the mobile phone access and usage among parents/caregivers of children visiting pediatrics consultant clinics (n=300); and (3) qualitative (component C) includes in-depth interviews and focus group discussion with parents/caregivers of children visiting the pediatric consultancy clinic and with health care providers and administrative staff. Main constructs will be to explore perceptions and barriers related to existing clinic appointment reminder service. Ethics approval has been obtained from the Ethical Review Committee, Aga Khan University, Pakistan (4770-Ped-ERC-17).

RESULTS

Results will be disseminated to pediatric quality public health and mHealth communities through scientific meetings and through publications, nationally and internationally.

CONCLUSIONS

This study will provide insight regarding efficacy of using mHealth-based reminder services for patient's appointments in low- and middle-income countries setup. The finding of this study will be used to recommend further enhanced mHealth-based solutions to improve patient appointments and decrease no show.

Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial

Background

Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide.

Objective

The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan.

Methods

This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses.

Results

Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant.

Conclusions

Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs).

Trial Registration

ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc)

Targeting strategies of mHealth interventions for maternal health in low and middle-income countries: a systematic review protocol

INTRODUCTION

Recently, there has been a steady increase in mobile health (mHealth) interventions aimed at improving maternal health of women in low-income and middle-income countries. While there is evidence indicating that these interventions contribute to improvements in maternal health outcomes, other studies indicate inconclusive results. This uncertainty has raised additional questions, one of which pertains to the role of targeting strategies in implementing mHealth interventions and the focus on pregnant women and health workers as target groups. This review aims to assess who is targeted in different mHealth interventions and the importance of targeting strategies in maternal mHealth interventions.

METHODS AND ANALYSIS

We will search for peer-reviewed, English-language literature published between 1999 and July 2017 in PubMed, Web of Knowledge (Science Direct, EMBASE) and Cochrane Central Registers of Controlled Trials. The study scope is defined by the Population, Intervention, Comparison and Outcomes framework: P, community members with maternal or reproductive needs; I, electronic health or mHealth programmes geared at improving maternal or reproductive health; C, other non-electronic health or mHealth-based interventions; O, maternal health measures including family planning, antenatal care attendance, health facility delivery and postnatal care attendance.

ETHICS AND DISSEMINATION

This study is a review of already published or publicly available data and needs no ethical approval. Review results will be published in a peer-reviewed journal and presented at international conferences.

PROSPERO REGISTRATION NUMBER

CRD42017072280.

Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project

Background

Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers.

Objective

The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam.

Methods

This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system.

Results

The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components.

Conclusions

This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam.

Text messaging to support a perinatal collaborative care model for depression: A multi-methods inquiry

OBJECTIVE

Mental health care integrated into obstetric settings improves access to perinatal depression treatments. Digital interactions such as text messaging between patient and provider can further improve access. We describe the use of text messaging within a perinatal Collaborative Care (CC) program, and explore the association of text messaging content with perinatal depression outcomes.

METHODS

We analyzed data from an open treatment trial of perinatal CC in a rural obstetric clinic. Twenty five women with Patient Health Questionnaire-9 score of ≥10 enrolled in CC, and used text messaging to communicate with their Care Manager(CM). We used surveys and focus groups to assessacceptability of text messaging with surveys and focus groups. We calculated the number of text messages exchanged, and analyzed content to understand usage patterns. We explored association between text messaging content and depression outcomes.

RESULTS

CMs initiated 85.4% messages, and patients responded to 86.9% messages. CMs used text messaging for appointment reminders, and patients used it to obtain obstetric and parenting information. CMs had concerns about the likelihood of boundary violations. Patients appreciated the asynchronous nature of text messaging.

CONCLUSION

Text messaging is feasible and acceptable within a perinatal CC program. We need further research into the effectiveness of text messaging content, and response protocols.

Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

BACKGROUND

Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.

METHODS

We interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates.

RESULTS

Of the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18-29 years (n = 663, 76.3%), and for women among those aged 30-39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status.

CONCLUSIONS

Compared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.

Feasibility and acceptability of a text message intervention used as an adjunct tool by WIC breastfeeding peer counsellors: The LATCH pilot

Breastfeeding rates among mothers in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lower than for other mothers in the United States. The objective of this study was to test the acceptability and feasibility of the Lactation Advice thru Texting Can Help intervention. Mothers were enrolled at 18-30 weeks gestation from two WIC breastfeeding peer counselling (PC) programmes if they intended to breastfeed and had unlimited text messaging, more than fifth-grade literacy level, and fluency in English or Spanish. Participants were randomized to the control arm (PC support without texting) or the intervention arm (PC support with texting). The two-way texting intervention provided breastfeeding education and support from peer counsellors. Primary outcomes included early post-partum (PP) contact and exclusive breastfeeding (EBF) rates at 2 weeks PP. Feasibility outcomes included text messaging engagement and mother's satisfaction with texting platform. Fifty-eight women were enrolled, 52 of whom were available for intention-to-treat analysis (n = 30 texting, n = 22 control). Contact between mothers and PCs within 48 hr of delivery was greater in the texting group (86.6% vs. 27.3%, p < .001). EBF rates at 2 weeks PP among participants in the texting intervention was 50% versus 31.8% in the control arm (p = .197). Intervention group mothers tended to be more likely to meet their breastfeeding goals (p = .06). Participants were highly satisfied with the Lactation Advice thru Texting Can Help intervention, and findings suggest that it may improve early post-delivery contact and increase EBF rates among mothers enrolled in WIC who receive PC. A large, multicentre trial is feasible and warranted.

Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol

Background

Mobile phone-based technology has been used in improving the delivery of healthcare services in many countries. However, data on the effects of this technology on improving primary healthcare services in resource-poor settings are limited. The aim of this study is to develop and test a mobile phone-based system to improve health, population and nutrition services in rural Bangladesh and evaluate its impact on service delivery.

Methods

The study will use a quasi-experimental pre-post design, with intervention and comparison areas. Outcome indicators will include: antenatal care (ANC), delivery care, postnatal care (PNC), neonatal care, expanded programme on immunization (EPI) coverage, and contraceptive prevalence rate (CPR). The study will be conducted over a period of 30 months, using the existing health systems of Bangladesh. The intervention will be implemented through the existing service-delivery personnel at various primary-care levels, such as community clinic, union health and family welfare centre, and upazila health complex. These healthcare providers will be given mobile phones equipped with Apps for sending text and voice messages, along with the use of Internet and device for data-capturing. Training on handling of the Smartphones, data-capturing and monitoring will be given to selected service providers. They will also be trained on inputs, editing, verifying, and monitoring the outcome variables.

Discussion

Mobile phone-based technology has the potential to improve primary healthcare services in low-income countries, like Bangladesh. It is expected that our study will contribute to testing and developing a mobile phone-based intervention to improve the coverage and quality of services. The learning can be used in other similar settings in the low-and middle-income countries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0502-9) contains supplementary material, which is available to authorized users.

Reproductive health information needs and maternal literacy in the developing world

This article provides an analysis of the relationship of literacy and education in the developing world as they intertwine with reproductive health, and explores the reproductive health-related informational needs of women from these regions. Every day more than 800 women die from causes relating to pregnancy, 99% of whom are in the developing world. In 2015 16,000 children under five died every day. This article first provides a systematized review of the extensive canon of literature that explores the relationship between maternal literacy and mother and child health. A content analysis is conducted with the aim of deciphering the reproductive health-related informational needs of women in the developing world. Following, there is a discussion of interventions that have demonstrated success at ameliorating these gaps. Some of these interventions have met information needs related to family planning, HIV/AIDS, sexually transmitted infections, violence against women, sexuality, pregnancy education, and emergency obstetric care.

SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions

BACKGROUND

We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada.

OBJECTIVE

To explore women's preferences for a prenatal education program by text messaging.

METHODS

We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings.

RESULTS

A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages "all the time" (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol.

CONCLUSIONS

This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes.

Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study

BACKGROUND

With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities.

OBJECTIVE

The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya.

METHODS

A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites.

RESULTS

A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use.

CONCLUSIONS

Despite the remoteness of northern Kenya's NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals.