PRENACEL – a mHealth messaging system to complement antenatal care: a cluster randomized trial

Abstract

BackgroundThe aim of this study was to determine whether PRENACEL (a bi-directional, mobile-phone based, short text message service (SMS)) increases the coverage of recommended antenatal care (ANC) practices.MethodsA parallel, cluster-randomized trial in which 20 public primary Health Care Units (PHCUs) were randomly allocated to the intervention (10 PHCUs) or control (10 PHCUs) group. The study population included pregnant women aged 18 or above with a gestational age of 20 weeks or less. Pregnant women receiving ANC in intervention PHCUs were invited through leaflets and posters to register in PRENACEL. Women who registered in PRENACEL received a weekly set of short text messages with health education and health promotion content related to pregnancy and childbirth and were also able to clarify ANC queries through SMS. All women received routine ANC. The primary outcome was the proportion of women with high ANC Score, a composite measure of coverage of recommended ANC practices. Chi-square or Fisher’s exact tests and multivariate log-binomial regression were used to analyze the outcomes.ResultsA total of 1210 eligible women received ANC in the participating PHCUs and took part of this study (770 in the intervention group and 440 in the control group). 20.4% (157/770) of intervention-group women registered in PRENACEL, but only 116 read all messages (73.9% of women who registered in PRENACEL, 116/157). The adjusted intention-to-treat analysis suggested no difference between intervention and control groups in the primary outcome (Adjusted Relative Risk (AdjRR): 1.05 (95% Confidence Interval (CI): 1.00–1.09). Both crude and adjusted per-protocol analysis suggested a positive effect of PRENACEL (Crude RR (95% CI): 1.14 (1.06–1.22), AdjRR (95% CI): 1.12 (1.05–1.21). The multivariate analysis also suggests that the PRENACEL group (women who read all SMS) had higher mean ANC score [48.5 (±4.2) vs 45.2 (±8.7), p < 0.01], higher proportion of women with ≥6 ANC visits (96.9% vs. 84.8%, p = 0.01), and higher rates of syphilis testing (40.5% vs. 24.8%, p = 0.03) and HIV testing (46.6% vs. 25.7%, p < 0.01) during ANC.ConclusionsA bi-directional, mobile-phone based, short text message service is potentially useful to improve the coverage of recommended ANC practices, including syphilis and HIV testing.Trial registrationClinical trial registry: RBR-54zf73, U1111–1163-7761.ResumoIntroduçãoO objetivo deste estudo foi determinar se o PRENACEL, um serviço bidirecional de mensagens curtas de texto (SMS) com base na telefonia celular, aumenta a cobertura das práticas recomendadas de cuidados pré-natais (PN).Métodosum ensaio paralelo, aleatorizado por conglomerados, no qual 20 unidades básicas de saúde (UBS) foram alocadas aleatoriamente para o grupo de intervenção (10 UBS) ou controle (10 UBS). A população estudada incluiu gestantes com idade igual ou superior a 18 anos com idade gestacional de 20 semanas ou menos. As gestantes que receberam PN em UBS intervenção foram convidadas através de folhetos e cartazes para se inscreverem n...

mHealth resources for asthma and pregnancy care: Methodological issues and social media recruitment. A discussion paper

“…Most tellingly related to asthma and pregnancy and for our study, although many studies relating to asthma and mHealth have been conducted with adolescents rather than adults, one systematic review indicated that mobile technology could improve adherence with asthma medications and was beneficial for self‐management (Miller, Schüz, Walters, & Walters, ). mHealth has beneficial impacts on self‐management in general lifestyle factors associated with pregnancy, according to some primary research studies (Naughton et al., ; Oliveira‐Ciabati et al., ; Van Dijk et al., ) and reducing hospital admissions in those with more severe asthma (McLean et al., ).…”

PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial

“…This study was registered at the Brazilian Clinical Trials Registry (REBEC, registration number RBR-54zf73, available at http:// ensaiosclinicos.gov.br/rg/RBR-54zf73/. The component for pregnant women was published in 2017 and 2019 [39,40].…”

“…In the first stage, two groups (with ten units each one) were randomly selected, balanced considering the size of the affiliated population and the vulnerability situation (evaluated by the number of beneficiaries of the government welfare program) of each health unit. Groups were balanced when the difference between population size and vulnerability was less than 15% stipulated by some criteria [39]. For the randomization, Microsoft Excel 2013 was used.…”

“…The participants of PRENACEL, the PHCUs health professionals and the PRENACEL staff were not blinded to Data management PRENACEL data collection was described elsewhere [39]. PRENACEL Partner data was collected through telephone interviews with partners after childbirth.…”

Adaptação de mensagens educativas para parceiros de gestantes para uso em tecnologias móveis em saúde (mHealth)

“…Our study aims to discuss the process of developing and evaluating messages sent via SMS to the partners of pregnant women with a view to engaging them in the pregnancy-puerperal period and encouraging the acceptability of this content. These messages were prepared in the context of PRENACEL (Prenatal in the Cell Phone), which developed a bidirectional communication channel by sending short text messages (SMS) to the cell phone, addressing the Brazilian reality of pregnant women and partners using the National Health System (SUS) in a municipality in the state of São Paulo, providing information, receiving complaints and grievances, clarifying doubts and stimulating the engagement and demand for effective interventions during prenatal, delivery and the puerperium period 18 .…”