Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Apr 11, 2026
Open Peer Review Period: Apr 14, 2026 - Jun 9, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Reminders for Antenatal Care in a Refugee Population: A Quasi‑Experimental Evaluation of a Mobile Health Intervention (HERA) in Türkiye
ABSTRACT
Background:
Pregnant refugee women face intersecting barriers to antenatal care (ANC), including language, legal-entitlement, and access constraints. Digital health interventions, such as mobile reminder apps, may help improve continuity of ANC, but rigorous evaluations among refugees are rare and often complicated by implementation challenges.
Objective:
To evaluate the association between a mobile antenatal reminder application (HERA) and ANC visit attendance among Syrian refugee women in Türkiye, and to document discrepancies between the planned randomized controlled trial (RCT) protocol and real-world implementation.
Methods:
We conducted a quasi-experimental study at two migrant health centers in Istanbul, comparing pregnant Syrian refugee women with confirmed exposure to the HERA mobile reminder app (n = 48) to a retrospective baseline cohort identified from routine clinic records over the same period (n = 949). The intervention consisted of installing the HERA smartphone application, which provided push-notification reminders for upcoming antenatal visits and brief pregnancy-related information, alongside routine care; the study was originally planned as a three-arm randomized controlled trial, but incomplete recording of allocation and identifiers precluded an intention-to-treat analysis.
Results:
Pregnant women who received reminders through HERA attended more ANC visits than those in the baseline cohort (mean 2.5 vs 1.9 visits), with consistent evidence of higher probabilities of achieving ≥2 visits across frequentist and Bayesian analyses.
Conclusions:
A simple mobile reminder intervention was associated with increased ANC attendance among Syrian refugee women, despite substantial implementation barriers that transformed a planned RCT into a quasi-experimental evaluation. Our study highlights both the potential of digital health tools in humanitarian settings and the importance of robust identification and data-linkage strategies when designing digital health trials with refugees. Clinical Trial: NCT05094518 - https://clinicaltrials.gov/ct2/show/NCT05094518
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