Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study

Abstract

Background: Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. Methods: We used the Health Belief Model to develop interview guides to explore women’s perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. Results: We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. Conclusions: We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.

Would they trust it? An exploration of psychosocial and environmental factors affecting prescriber acceptance of computerised dose‐recommendation software

“…Further, incorporation of unfamiliar terminology, such as AUC, has been shown to reduce usability of dose reports produced by dose‐prediction software 35 . Identifying knowledge gaps such as these could help inform the design of effective preimplementation strategies, such as targeted education and communication 16,36–38 . Exploring the effectiveness of these strategies would inform future decisions about intervention modifications and implementation approaches.…”

Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study

“…The use of digital health interventions is increasingly prioritized to strengthen healthcare systems, with many low- and middle-income countries implementing digital health technologies to address specific challenges in maternal and child health. Digital health interventions have the potential to improve ANC attendance through behavior change messages and targeted client communication (TCC) [ 23 ]. TCC is defined as the transmission of targeted health content to a specified population or an individual within a predefined health or demographic group [ 24 ].…”