Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi

BMC Med Inform Decis Mak

et al. 2020

204

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.

Section: Strengths and Limitationsmentioning

confidence: 63%

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

BMC Med Inform Decis Mak

et al. 2020

204

“…We selected the timing by considering the balance between the time needed to prepare for a visit and not forgetting the date of that visit. However, most untailored TCC interventions in the field of maternal and child health, reported sending more text messages per week than we propose [13,15,43].…”

Section: Strengths and Limitationsmentioning

confidence: 59%

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

et al. 2019

Preprint

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 co-design with users. Our aim is to describe the planning, development, and evaluation of a theory based TCC intervention, tailored to pregnant and postpartum women, and automated from an electronic maternal and child health registry in Palestine. 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 timely 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. Following the results from the Health Belief Model, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent via SMS. 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 timeliness in attending 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, such complications in pregnancy. We composed actionable text messages following recommended message framing models and iteratively improved the contents with users to bridge the identified gaps. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile. Conclusions: We developed an optimized text message based TCC intervention underpinned by behavior change theories and co-designed with users following an iterative process. The effectiveness of the TCC intervention is assessed in a cluster-randomized trial (ISRCTN10520687).

“…We selected the timing by considering the balance between the time needed to prepare for a visit (one week ahead as a cue to action and enable reflection and planning of practicalities) and not forgetting the date of that visit (24 hours before as a simple reminder). However, most untailored TCC interventions in the field of maternal and child health, has reported sending more text messages per week than we propose [13,15,47].…”

Section: Strengths and Limitationsmentioning

confidence: 85%

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

et al. 2019

Preprint

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.