Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy

Abstract

Introduction: Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Methods:StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability.Results: Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use.Discussion: Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.

Interventions Addressing Social Needs in Perinatal Care: A Systematic Review

“…One intervention consisted of a tablet-based screening tool with motivational interviewing prompts that were individually generated based on reported risks. 48 Women interviewed in this study reported feeling that they could better adhere to the treatment guidelines for IPV after using the tablet-based screener. Another intervention was a computer-based screener with a 15-min informational video and prompting card that was given to the provider.…”

“…Most interventions took place in prenatal care clinics (n =15), [25][26][27][28][29][30][31][32][33][34]39,40,43,47,48 hospitals (n = 8), [36][37][38][41][42][43]49,50 or primary care clinics (n = 5). 39,45,51,52 Some took place in midwife clinics (n = 3).…”

“…44,53,54 Settings were both private and public and included private obstetric offices (n = 2), 39,43 public clinics and hospitals (n = 4), 35,49,50,55 federally qualified health centers (n = 3), 45,46,51 Infant, and Children (WIC) sites (n = 1), 45 academic settings (n = 7), [25][26][27][28][29][30]49 and community settings (n = 4). 43,45,46,54 Studies were conducted in the United States (n = 17), [25][26][27][28][29][30][31][32][33][34][35]39,[41][42][43]45,46,48,49,51,52,55 Australia (n = 4), 36,44,50,…”

“…The vast majority of interventions addressed IPV (n = 19). [25][26][27][28][29][30][32][33][34][35][37][38][39][41][42][43][44][46][47][48]50,51,54,55 Of these, 15 interventions solely addressed IPV, while the other four also addressed additional social needs. The Antenatal Psychosocial Health Assessment form used by Carroll et al asked patients about social support in addition to IPV, and the DC-HOPE studies addressed both tobacco smoke exposure and IPV.…”

“…Another intervention was a computer-based screener with a 15-min informational video and prompting card that was given to the provider. 34 Women in this Validity of screening tool 40,42,49,50,51 Risk identification 28,32,34,41,42 Acceptability 30,32,33,41,44,46,47 Patient-rated helpfulness 32,34,38,43,45,48 Length of administration 30,45,49,51 Referral/patient use of referrals 33,35,45,46,53,54 Screening rate 54 Appointment adherence 45 Health knowledge 31,36 Social support 52,53 ETSE 25,26 IPV (episodes of violence, severity, behaviors) 29,11,35,[37][38][39]55 ...…”