JMIR Publications

ABSTRACT

Background:

The Text4baby™ mobile health (mhealth) program has received national attention and is acclaimed to provide pregnant women with greater access to prenatal healthcare, resources, and information. However, without sufficient piloting, little is known whether urban and Afro-Caribbean immigrant pregnant women are open and receptive to such innovative health communication methods, or of the cultural and systematic barriers that inhibit their behavioral intent to use Text4baby.

Objective:

We aimed to understand the lived experiences of urban and immigrant pregnant women with accessing prenatal health care and information in Brooklyn New York; and to utilize behavioral and technology assimilation theoretical constructs to measure their knowledge, perceptions and behavioral intent to use the Text4baby program.

Methods:

This exploratory mixed methods study first used a phenomenological approach to explore and describe the lived experiences of pregnant women while receiving prenatal care at University Hospital of Brooklyn at Downstate prenatal health clinic. Data from the qualitative arm led to the development of a theoretically inspired survey instrument that was then used in a repeated measures pre-post test design to evaluate changes in participants’ knowledge, attitudes, beliefs and perceptions of Text4baby after a minimum of four weeks exposure to the program’s messages.

Results:

Three themes emerged during the focus groups and interviews and were major factors affecting participant experiences: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care; inadequate patient provider engagement often left many participants with feelings of indifference regarding the prenatal care and information they received in the clinical setting. However, pregnant women reported strongly positive attitudes towards the use of mobile health and Text4baby with 63% of survey respondents reporting strong agreement with Text4baby providing them extra support during their pregnancy. Overall, on a scale of 1 -5, participant perception of the usefulness of Text4baby ranked at 4.26, and their perception of the compatibility and relative advantage of using Text4baby ranked 4.41 and 4.15 respectively. There was a 14% increase in participants reporting their intent to use Text4baby; and a 28% increase from pre and post-test in pregnant women strongly agreeing to speak more with their doctor about the information learned through Text4baby.

Conclusions:

Urban and immigrant pregnant women in Brooklyn endure a number of social determinants of health that create barriers when accessing quality prenatal health care and information which negatively impacts prenatal outcomes. Low-income expecting mothers often lack access to vital information about pregnancy, preparation for birth, and best practices when caring for their newborn. Our study indicates a number of systematic, political, and other macrosystem-level factors that perpetuate health disparities in our study population. In addition, traditional, cultural, and environmental patterns also perpetuate suboptimal prenatal behaviors and practices that influence access to quality care and prenatal outcomes.