JMIR Publications

ABSTRACT

Background:

Short message service (SMS) and other mobile health(mHealth) interventions may improve knowledge transfer, strengthen access to social support, and promote positive health behavior among women in the perinatal period. Yet, few mHealth applications have been taken to scale in sub-Saharan Africa.

Objective:

We evaluated the feasibility, acceptability, and preliminary efficacy of a novel mHealth-based, patient-centered audio-SMS messaging application designed using behavioral science frameworks to promote maternity care use by pregnant women in rural Southwestern Uganda.

Methods:

We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC)(control), scheduled SMS and or audio messages from a novel messaging prototype (scheduled messaging), as well as scheduled messaging, plus SMS reminders to two participant-identified social supporters (social support). Participants completed surveys at enrolment and postpartum. Primary outcomes were feasibility and acceptability of the messaging prototype. Secondary outcomes included ANC attendance, skilled delivery, and social support. Qualitative exit interviews with 15 women from each intervention arm were conducted to explore patterns of social support and intervention mechanisms of effect. Quantitative and qualitative data were analyzed using STATA V13 and NVivo V12 respectively.

Results:

Over 80% (arm difference(df)= 2.5, CI -13.57-18.57) and 70% (df=12.5, CI -5.92-30.92) of participants received at least 85% of intended SMS or voice calls, respectively. Over 80% (df=2.5 -14.55-19.55) of messages were received within one hour of expected time; less than 20% experienced network issues. Clarity and language of the message was ranked as important for both intervention groups. Over 90% of participants in the intervention arms found this application useful, easy-to-use, interesting, engaging, compatible, and would strongly recommend it to others. Seventy, 78%, and 98% of women in the control, scheduled messaging, and social support arms, respectively, had a skilled delivery. Half, 83%, and 100% of women in the control, scheduled messaging, and social support arms attended ≥4 ANC visits. Women in the social support arm reported the highest support (Median=3.4, IQR 2.8,3.6). Qualitative data showed women were able to receive and; 1) understand messages easily and independently, 2) trust actionable information sent directly on their mobile phones, 3) appreciate scheduled, personalized and precautionary messages delivered in a friendly tone, 4) enjoy complementary educational support for sharing or future reference, and 5) engage partners and social networks for needed support.

Conclusions:

We demonstrate that developing a novel patient-centered and customized audio-SMS messaging application that leverages social support networks and relationships is a feasible and appropriate approach to communicate important targeted health-related information and support rural pregnant women in Southwestern Uganda. Women liked the application, describing it as useful and easy-to-use: helping them learn, prepare and take action within a friendly atmosphere. Further evaluation of the effectiveness and integration of this intervention into routine care is needed. Clinical Trial: NCT04313348