A WhatsApp-Based Intervention to Improve Maternal Social Support and Maternal–Child Health in Southern Brazil: The Text-Message Intervention to Enhance Social Support (TIES) Feasibility Study

Abstract

Participatory learning and action cycles with women’s groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12–18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal–child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00–4:00pm), and evenings (9:00–11:00 pm). Engagement was higher at weeks 1–4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal–child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.

Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review

“…Online supplemental file 6 shows the results of the risk of bias assessment for the non-RCTs. Among the 11 quasi-experimental studies, 4 had a serious risk of bias,53–56 4 had a moderate risk57–60 and 3 were assessed as low risk 61–63. The two observational studies did not have clear information on confounding variables and blinding of the outcome assessors 64 65.…”

“…Twelve studies assessed the roles of mHealth in self-reported levels of depressive symptoms 37 44 45 49 50 54–56 60 61 63 70. Five studies found a positive effect, four studies had mixed findings and three studies found no significant effect (GRADE certainty of evidence: low).…”

“…Ten studies reported on the roles of mHealth in social support from other sources (eg, family, friends and online community) 37 38 41 43 56 67 69 74 78 79. Six studies found a positive effect, while three reported mixed findings and one study reported no significant effect (GRADE certainty of evidence: low).…”

Childbirth counseling by WhatsApp group to reduce the anxiety of primigravida

“…Group discussions through the WhatsApp group, where participants in the group can listen wherever they are, and they are freer to ask questions in the chat group forum and are not limited by time (Patel et al, 2018;Pham et al, 2014;Puertas-Gonzalez et al, 2021). Whatsapp group-based services are really good to be used to provide social support during pregnancy, in the WhatsApp group pregnant women are calmer after getting assistance and discussing through the WhatsApp group (Trude et al, 2021). Health education can be used as an appropriate method to improve the welfare of the community (Ningsih et al, 2021).…”

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth

“…WhatsApp use is frequent among Brazilians 7 , and it is being increasingly used as a health communication tool in digital mental health programs 4,7 . The widespread of mobile phones in low-and middle-income countries (LMICs) has created an incentive for the use of WhatsApp in primary health care 8 .…”