Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study

Abstract

Background Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization.

Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study

“…In this study, age, and prenatal care visits were independent risk factors for health status. Mobile health or SMS text messaging could be used for improving the quality of antenatal care [ 28 , 29 ].…”

Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review

“…Out of 27 studies that were included, 15 (56%) of them were conducted in Africa, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] nine were from Asia, 33,[38][39][40][41][42][43][44][45] two were from South America, 46,47 and one Australia/Oceania. 48 The other six studies were from six countries, Zanzibar, Nigeria, Samoa, Guinea, Bangladesh, and Myanmar, each contributing one.…”

“…Of the 27 studies, 22 (81%) addressed client education and behavior change communication. 23,[26][27][28][29][31][32][33][34][35][36][37][38][41][42][43][44][45][46][47][48]50 Most of the studies were assigned to more than one category: Registries/vital event tracking (n=11), [24][25][26][27]30,35,[39][40][41]43,51 data collection and reporting (n=6), 24,27,28,32,38,40 Provider to provider communication (n=2), 34,35 electronic decision support (information, protocols, algorithms, checklists) (n=5), 24,27,[39][40][41] provider work planning and scheduling (n = 2). 26,40 The results of the classification are illustrat...…”

“…However, few studies 23,48 reported that digital health interventions had no positive effect on client education and behavioral change communication.…”

“…Based on our analysis, the most reported use of digital health interventions was for client education and behavior change communication, [27][28][29][31][32][33][34][35][36][37][38][41][42][43][44][45][46][47][48]50,51 followed by Registries and vital event tracking. [24][25][26][27]30,34,35,39,41,43,51 Other categories were digital health solutions as a data collection and reporting system aimed to ensure data recording and completeness.…”