Expectant Parents’ Preferences for Teaching by Texting: Development and Usability Study of SmartMom

Abstract

Background Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.

Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom

“…We have worked closely with public health practitioners to develop our messages. The intervention for this study was developed in response to a series of focus groups conducted with expectant parents conducted by members of the trial investigator group 14 27. We developed supplemental ‘opt-in’ messages in response to users request that the programme be tailorable to the needs of individual users.…”

“…The intervention for this study was developed in response to a series of focus groups conducted with expectant parents conducted by members of the trial investigator group. 14 27 We developed supplemental ‘opt-in’ messages in response to users request that the programme be tailorable to the needs of individual users. We also embedded links to online sources of information in every message, based on focus group feedback.…”

“…13 In addition, expectant parents participating in focus groups in British Columbia (BC) have revealed that information from apps or the internet is overwhelming in its sheer volume and that they 'don't have time' to scroll through windows and search for topics. 14 In the absence of effective, structured prenatal education, expectant parents are experiencing concerning gaps in knowledge. For example, a Canadian populationbased survey indicated that only 25% of respondents had been informed that there are risks associated with suboptimal weight gain during pregnancy.…”

“…However, there are serious concerns about the quality and comprehensiveness of this information 13. In addition, expectant parents participating in focus groups in British Columbia (BC) have revealed that information from apps or the internet is overwhelming in its sheer volume and that they ‘don’t have time’ to scroll through windows and search for topics 14…”