JMIR Publications

ABSTRACT

Background:

Text or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn healthcare practices around the world. The XX service in Bangladesh provides twice weekly messages to subscriber women about their pregnancy and new born care on mobile phones that they own themselves or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and adoption of health messages before deploying such interventions in resource limited settings.

Objective:

The effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care was evaluated.

Methods:

In 2014, XX conducted a retrospective cross-sectional survey of 459 subscriber women who received mobile phone based messages during their pregnancy exclusively by themselves (n=253) or with family members (n=206). We undertook multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socio-economic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene.

Results:

In multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (OR: 1.71; 95% CI 1.12-2.62; P=.01), of recalling the service short code (OR: 2.87; 95% CI 1.90-4.34; P<.001), of consuming nutritious food five times a day (OR: 1.62; 95% CI 1.07-2.47; P=.02) and following instructions of XX on drinking potable water (OR: 1.83; 95% CI 1.13-2.96; P=.01) than women who shared access. Women aged between 20-24 years had higher odds of recalling the service short code than older women. Adolescent women and women from 20-24 years age group had lower odds of planning safe deliveries than older women (25 or above). Secondary education was statistically significantly associated with women’s ability of recalling the short code and pregnancy danger signs, planning safe delivery, selecting blood donor for emergencies, and maintaining balanced diet. Higher family income was associated with women’s satisfaction, recognition of danger signs and arrangement of blood donor and nutritious diet. Women who received more than four antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs and consuming nutritious food.

Conclusions:

The capacity of women to independently access mobile phones improves the adoption of mHealth services and pregnancy healthcare. Special efforts and equitable supports are required to improve access and knowledge of low literate and younger women in low income households.