JMIR Publications

ABSTRACT

Background:

Innovative mHealth interventions have the potential to improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction and overcome literacy barriers. Short, animated storytelling is an innovative, emerging approach to mobile health messaging.

Objective:

We aimed to measure the effect of short, animated storytelling (SAS) videos on maternal knowledge and user satisfaction, for mothers enrolled in antenatal care programs at two public health facilities in the Tshwane District of South Africa.

Methods:

We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-care (SOC) Control and SAS Intervention groups. The intervention videos were delivered via WhatsApp and, one month later, participants responded to telephone surveys assessing knowledge. The intervention group then participated in a nested evaluation of user satisfaction.

Results:

We surveyed 204 participants. Of these, 49.5% were between the ages of 25 and 34. Almost all participants self-identified as Black African, with the majority (93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed only a slight increase of 0.28 [95% UI: -0.58–1.16] in the overall knowledge score in the intervention arm. We found that those with secondary education or above, scored higher than those with only primary education, by 2.24 [95% UI: 0.76–4.01]. Participants aged 35+ also scored higher than the youngest age-group 18-24 by 1.83 [95% CI: 0.39–3.33]. Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series.

Conclusions:

While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. While prior studies have shown the promise of animated video health education, most of this research is still being conducted in high-income countries. More research in under-resourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Given the high maternal satisfaction among the SAS video-users in this study, policymakers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, like MomConnect, to boost satisfaction and potentially enhance maternal engagement. Future studies should attempt to quantify the effect of SAS videos on maternal knowledge in hard-to-reach populations who may have limited or no access to antenatal care, although real-world, logistical challenges persist when implementing studies with expectant mothers in under-resourced South African populations. Clinical Trial: This trial was registered on 14 March 2022 with the Pan African Clinical Trials Registry (PACTR), registration number PACTR202203673222680.