Developing Content for a mHealth Intervention to Promote Postpartum Retention in Prevention of Mother-To-Child HIV Transmission Programs and Early Infant Diagnosis of HIV: A Qualitative Study

Abstract

BackgroundMaternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT) of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps.MethodsWe conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women's engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM) and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention.ResultsFindings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important “cue to action.” Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women's motivation to attend clinic for childhood immunizations.ConclusionsApplying a multi-stage content development approach to crafting text messages – informed by behavioral theory – resulted in message content that was consistent across different focus groups. This approach could help answer “why” and “how” text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial.

Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa

“…Our research suggests that not only should the intensity of efforts to reduce MM not slacken, the findings also add to calls to move beyond vertical interventions aimed at proximate causes of MM, in order to provide strengthening for health systems that links maternal, newborn and child health (Jimenez Soto et al, 2012;Odeny et al, 2014;Rotheram-Borus et al, 2014;Spector et al, 2012), as well as for social protection systems, which affirmatively ameliorate gendered burdens of unpaid care work and include incentives for fathers to take part in caring for their children. Further, both public and targeted education campaigns (e.g.…”

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

“…Even in relationships that lack male partner support or HIV status disclosure, knowledge and awareness of safer conception options among women who are motivated to protect their future baby may facilitate discussions about safer conception and use of safer conception strategies. [40][41][42] Both HIV-infected men and women with serodiscordant partners have been receptive to safer conception counseling as part of routine HIV care. 43 Integration of safer conception counseling and discussion of fertility desires into routine HIV care provides opportunities to introduce safer conception strategies prior to pregnancy attempts, especially to HIVinfected men who are already established in HIV care and may not otherwise receive information on safer conception.…”

Maximizing adherence and retention for women living with HIV and their infants in Kenya (MOTIVATE! study): study protocol for a randomized controlled trial

“…Previously tested text messages sent antenatally through 6 weeks postpartum in this setting were adopted from Odeny et al [23, 24]. We conducted additional focus group discussions to refine the content, optimum frequency, and timing of the additional text messages to be used in this study, focusing on ART adherence and retention in care for Option B+ [28].…”

“…Separately, mobile phone interventions have shown promise for supporting service provision and retention of and adherence to HIV programs [21, 22]. In one randomized trial in Kenya, text messaging significantly improved maternal retention in the early postpartum period and increased rates of testing to facilitate early infant diagnosis of HIV [23, 24]. …”