BackgroundWe engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada.ObjectiveTo explore women’s preferences for a prenatal education program by text messaging.MethodsWe conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings.ResultsA total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol.ConclusionsThis formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes.

Endemic pertussis contributes to childhood morbidity and mortality in Canada, particularly among infants younger than 4 months of age. 1,2 A single dose of tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine during pregnancy boosts maternal pertussis antibodies and provides passive protection for newborn infants until they are old enough to be vaccinated. 3 In 2018, the National Advisory Committee on Immunization (NACI) recommended Tdap vaccination in every pregnant woman between 27 and 32 weeks' gestation, and the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommended it between 21 and 32 weeks. 2,4 The vaccine is publicly funded for every pregnancy in all Canadian provinces and territories except British Columbia and Ontario. 5 This was the second vaccine to be recommended routinely in pregnancy in Canada since influenza vaccine, in 2007. New vaccines to be administered during pregnancy are under development and may be recommended routinely in the future; 6 therefore, an understanding of perinatal vaccine counselling and provision is important.Evidence-based vaccine recommendations by professional bodies are effective only when they can be translated consistently into clinical practice. Canadian family physicians, midwives, nurses and obstetricians all provide, and frequently share, care for pregnant women. Given the diversity of educational experiences, practice settings and models of care among