JMIR Publications

ABSTRACT

Background:

Antenatal care (ANC) prevents perinatal morbidity and mortality, but utilization of these services in Uganda remains low, maternal mortality rates are among the highest in the world. There is growing evidence that mHealth approaches improve timely communication of health-related information, positive health behavior change, and health outcomes. Yet, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care is low.

Objective:

We developed a novel, patient-centered messaging intervention to encourage and support women to utilize maternity care services.

Methods:

Using an iterative development approach, we 1) conducted formative stakeholder interviews with 30 women and 5 healthcare providers(HCPs) to identify preferred key ANC topics and characterize preferred messaging intervention, 2) developed content for SMS text and audio messages with four medical experts based on identified topics; 3) designed an application prototype through partnership with an mHealth development company; and 4) pilot tested the prototype and sought user experiences and feedback to refine the intervention through iterative interviews, focus group discussions and cognitive interviews. Qualitative data was coded and analyzed using NVivo version 12.

Results:

Seventy-five women completed interviews during the prototype development, of whom 39 (52.3%) had at least primary education, and all had access to a mobile phone. Formative interviews identified 21 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. Six additional topics were identified by interviewed HCPs, including birth preparedness, skilled delivery, male-partner involvement, HCP interaction, immunization and caring for the baby. Women expressed a preference for positive messages without authoritative tones via audio or text messages. Iterative interviews and post-pilot FGDs revealed preference for customized messaging, reflecting individual need to be “included” and “connected” as desired. Women preferred short, concise, clear actionable messages that guided, supported and motivated them to “keep alert” and seek professional help. Complimentary weekly reminders to women’s significant others were also preferred to encourage continuity and the needed social support to care seeking.

Conclusions:

We used an iterative approach with diffuse stake holders to develop a patient-centered audio-SMS messaging application designed to communicate important targeted health-related information, and support rural pregnant women in southwestern Uganda. Involving both HCPs and end-users in developing and formulating mHealth interventions improved ownership and inclusiveness in the program.