Effect of a Text-Messaging Intervention on Oral Self-Care Practices in Antenatal Women in Delhi, India: A Pilot Randomized Control Trial

A scoping review of digital technologies in antenatal care: recent progress and applications of digital technologies

INTRODUCTION

Digital health technologies have vastly improved monitoring, diagnosis, and care during pregnancy. As expectant mothers increasingly engage with social media, online platforms, and mobile applications, these innovations present valuable opportunities to enhance the quality of maternal healthcare services.

OBJECTIVE

This review aims to assess the applicability, outcomes, and recent advancement of digital health modalities in antenatal care.

METHOD

We conducted a scoping review by searching four electronic databases (Scopus, Web of Science, PubMed, EBSCOhost), performing manual searches of Google Scholar, and examining the references of relevant studies. Eligible studies included original research published in English between 2010 and 2024 involving the use of digital health technologies for antenatal care, complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines.

RESULTS

One hundred twenty-six eligible articles were identified, with the majority (61.11%) conducted in high-income countries, including the United States, United Kingdom, and Australia. Digital health studies have increased over time, driven by telehealth adoption in affluent nations. Interventions predominantly focused on patient-provider consultations, remote monitoring, and health education, complementing in-person visits or as a substitute when necessary. High levels of acceptance and satisfaction were reported among users. These interventions primarily targeted general maternal care (28.57%), gestational diabetes mellitus (15.07%), and mental health (13.49%) while also addressing gestational weight management, hypertensive disorders, high-risk pregnancies and maternal education. The findings demonstrated positive outcomes in managing clinical conditions, enhancing knowledge, promoting birth preparedness, and improving antenatal care access and utilisation. Additionally, the findings revealed the cost-effectiveness of these approaches in alleviating financial burdens for patients and healthcare systems.

CONCLUSION

Digital health is emerging as a pivotal tool in maternal and child care, fostering positive outcomes and high acceptance among patients and healthcare providers. Its integration into antenatal care ensures the maintenance of standard care quality, with no adverse effects reported despite limited discussions on safety and privacy concerns. As these technologies continue to evolve, they are set to redefine antenatal care by offering more accessible, efficient, and patient-centred solutions, ultimately shaping the future of maternal healthcare delivery.

Mobile health (mHealth) interventions for health promotion during the perinatal period in India: a scoping review

Introduction

Perinatal and maternal mortality rates remain high in India compared to global levels, and there is significant heterogeneity in outcomes across Indian states. Many mobile health (mHealth) interventions have been developed to improve maternal and infant health outcomes in India, however it is unclear how mHealth can best support women in this culturally and resource diverse setting. Therefore, we aimed to identify mHealth interventions targeting women and their families in the perinatal period in India, identify barriers and facilitators to their uptake, and future research directions.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews was used for study selection and screening and the mHealth evidence reporting and assessment checklist was used for evaluating mHealth interventions. PubMed, CINAHL, Global Health, and ACM digital library were searched for records up to 2 April 2023. Studies were included where women who were pregnant, planning for a child, or in the 12 months after delivery, and their families, living in India received health advice via a technological medium.

Results

1,783 records were screened, 29 met the inclusion criteria, describing 22 different mHealth interventions. Most frequent behavioural targets for interventions were breastfeeding, antenatal nutrition, and infant healthcare. Most interventions communicated to women through one-way communication methods, most frequently SMS. Participants reported positive views of mHealth, reported facilitators included group communication, use of non-maternal informative content, and a pictorial information format. Reported barriers included household responsibilities, technical difficulties, difficulty accessing a phone and difficulty understanding, or misinterpreting messages.

Discussion

We conclude that mHealth interventions are acceptable to women in India during the perinatal period. However, current interventions lack evidence of long term behavioural change and fail to report on features important in sustainability and scalability, namely network infrastructure, data security and interoperability. We propose the need for a framework to understand existing cultural beliefs and support structures to avoid early intervention failure. Future research should investigate multimodal mHealth interventions for behavioural change, identify the appropriate frequency and format of mHealth messages, and address access limitations such as shared mobile phone ownership, and illiteracy rates.

Uptake, Engagement and Acceptance, Barriers and Facilitators of a Text Messaging Intervention for Postnatal Care of Mother and Child in India-A Mixed Methods Feasibility Study

This study aimed to test the feasibility and to identify barriers and facilitators towards adherence of a text messaging intervention for postnatal care in India. Mixed methods research involving both quantitative and qualitative methods were used. A survey questionnaire for feasibility and focus group interviews to identify the barriers and facilitators to the intervention were conducted. The top three reasons for activation of service were: helped the new mother to understand the changes (95%); provided continuation of care (90%) and clarified conflicting information (89%). Over 90% read the messages daily. 80% were happy with the message frequency. About 75% shared the content with others. The main reasons for non-activation were: 30% had technical issues, 15% did not think it would be useful, 17% did not have time to activate and for 5%, husbands made the decision. These findings were triangulated through the qualitative focus groups. The main themes identified via the focus groups were: (1) reliable, current information; (2) issues and themes well aligned with new mothers' needs and priorities; (3) expanded the repertoire of information sources available; and (4) high-quality accessible information. The satisfaction and trust rates were high. This technology may be useful for health information intervention in specific postnatal areas.