JMIR Publications

ABSTRACT

Background:

South Africa’s adolescent fertility rate is far higher than that of high-income countries. Adolescent girls and young women (AGYW) have an increased risk of pregnancy related complications and have lower antenatal attendance rates. Mobile health (mHealth) interventions to improve health behaviours among pregnant AGYW in low- and middle-income countries are scarce.

Objective:

This paper describes the development and initial evaluation by means of a pilot randomised controlled trial (RCT) of an mHealth intervention to improve antenatal attendance and health behavioural determinants among pregnant AGYW in South Africa.

Methods:

The intervention, Teen MomConnect, sends tailored motivational behaviour-change and behavioural reinforcement SMS messages to participants about antenatal appointment keeping and pregnancy behaviours. The delivery methodology of the intervention is adapted from MomConnect, a mobile health education programme for pregnant women in South Africa that has nation-wide coverage. In addition, participants receive a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant AGYW aged 13-20 years were recruited from health facilities and community networks. A total of 419 participants were randomised into the control group that received the MomConnect health SMS’s and the experimental group that received the Teen MomConnect intervention. Participants complete a baseline questionnaire upon enrolment into the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assess demographic characteristics, pregnancy behaviours and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention and action planning). Feasibility will be assessed from descriptive analyses on acceptability, study implementation processes and perceived satisfaction with the intervention. The number of appointments attended is recorded from the participants’ clinic records. Appointment attendance will be compared between the control and experimental groups as well as awareness of HIV status, the psychosocial determinants of antenatal attendance, and perceptions of healthy pregnancy behaviours.

Results:

Participant recruitment was conducted during May – December 2018, and questionnaire-based data collection was completed by December 2019.

Conclusions:

This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviours among AGYW. The results on the interventions’ preliminary efficacy and user acceptability will inform policy makers and health programme officers on how tailored, age-appropriate and motivational health behaviour messages can be delivered via mobile phone to pregnant AGYW. Clinical Trial: Pan African Clinical Trial Registry (PACTR201912734889796).