Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature
Table 1
Summary of included articles on mHealth interventions to increase use of antenatal care, postnatal care, and childhood immunization, classified by methods used.
“Mobile Phones Improve Antenatal Care Attendance in Zanzibar: A Cluster Randomized Controlled Trial”
Antenatal care attendance
Text message reminders and educational messages for mother delivered to mobile phone and mobile vouchers to contact health workers. Tools used: custom Wired Mothers software
Two messages per month before gestational week 36 and two messages per week after week 36
44% of women in the intervention group received the recommended four or more antenatal visits, compared with 31% in the control group. The odds for receiving four or more antenatal care visits were 2.39 (1.03–5.55) for women benefitting from the mobile phone intervention. 59% of intervention women stated that received text messages influenced the number of times they attended antenatal care
Clinic attendance was compared for cluster randomized intervention and control groups
Intervention group: 1311 Control group: 1239 Total: 2550
Urban and rural healthcare facilities in Zanzibar
RCT with low risk of bias
Studies with nonrandomized control group or before/after design
“Role of Reminder by Text Message in Enhancing Postnatal Clinic Attendance”
Postnatal care attendance
Text message reminders for mother delivered to mobile phone. No specific mHealth tools mentioned
Two messages sent for each appointment: two weeks prior and 5 days prior
Patients who received an SMS reminder were 50% less likely to fail to attend (FTA) their postnatal appointment (relative risk of FTA 0.50; 95% CI, 0.32–0.77; = 0.002)
Clinic attendance compared for intervention group and historic control group (from previous 6 months)
Intervention group: 1126 Control group: 971 Total: 2097
“Application of Smart Phone in “Better Border Healthcare Program”: A Module for Mother and Child Care”
Antenatal care attendance and childhood immunization (EPI)
Smartphone application used by health workers to update antenatal and immunization status when outside clinic and SMS reminders for both health workers and mothers. Tools used: custom Mother and Child Care Module (MCCM)
Appointment reminders a few days prior to scheduled appointment
58.68% of pregnant women came to ANC on time after implementation as compared to 43.79% before ( < 0.001). After adjusting for personal characteristics, sending appointment message increased odds of on-time visit by 2.97 (1.60–5.54). 44.22% of children received scheduled vaccines on time after implementation as compared to 34.49% before ( < 0.001). After adjusting for personal characteristics, follow-up cases and updating immunization data on cell phones increased odds of on-time EPI by 2.04 (1.66–2.52). Sending appointment reminder increased odds of on-time EPI by 1.48 (1.09–2.03)
Clinic attendance for ANC and EPI were compared before and after MCCM implementation
“Antenatal Health Promotion via Short Message Service at a Midwife Obstetrics Unit in South Africa: A Mixed Methods Study”
Antenatal care attendance
Text messages with antenatal health information. No specific mHealth tools mentioned
Varied from three messages per week to daily messages
92% of participants in the intervention group reported not missing more than two antenatal visits. A focus group of intervention participants reported that they had improved health related behaviors, including attending the clinic regularly, as a result of the text messages. No statistically significant difference in knowledge was seen between the intervention and control groups at the exit interview
Baseline questionnaire and exit interview were administered to convenience-sampled intervention and control groups to assess knowledge of antenatal health and clinic procedures. A focus group was conducted with a further convenience sample of the intervention group
Intervention group: 102 but 45 were lost to follow-up Control group: 104 but 43 were lost to follow-up Total: 206 recruited, 118 included in analysis
Urban primary care facility in Cape Town, South Africa
“SMS versus Voice Messaging to Deliver MNCH Communication in Rural Malawi: Assessment of Delivery Success and User Experience”
Antenatal care attendance, postnatal care attendance, and childhood immunization
Text (SMS) or voice message reminders and educational messages for mother delivered to mobile phone or retrieved by calling a toll-free hotline. Tools used: Village-Reach custom application (SMS) and INTELLIVR software (voice messages)
Once (voice) or twice (SMS) per week
91% of SMS enrollees surveyed reported that they had already changed or intended to change their behavior based on the messages, including attending more ANC/PNC or bringing their child for vaccines. SMS enrollees were significantly more likely to report intended or actual behavior change than voice enrollees
Phone based surveys of participants. Participants in the pushed SMS and pushed voice groups were randomly sampled but participants in the retrieved voice group were convenience sampled
“Innovations in Communication Technologies for Measles Supplemental Immunization Activities: Lessons from Kenya Measles Vaccination Campaign, November 2012”
Childhood immunization
Smartphone application used by volunteers to update immunization records when canvassing door-to-door and to provide text message and phone call reminders to caretakers. Tools used: EpiSurveyor
Varied/as needed
In precampaign house-to-house visits, 25% of households had no plans to bring their children for the measles supplemental dose if they had not been contacted by the volunteers. Of the children found in the postcampaign house visits, 96% reported to have received a measles supplemental immunization dose, although only 92% had confirmation (finger mark) of vaccination
Precampaign household canvassing and data collection for entire target population, followed by postcampaign verification of vaccine coverage
Precampaign: 164,643 households with 161,695 children Postcampaign: 17,627 households with 17,993 children
“Designing and Implementing an Innovative SMS-based Alert System (RapidSMS-MCH) to Monitor Pregnancy and Reduce Maternal and Child Deaths in Rwanda”
Antenatal care attendance
Electronic registration of pregnant women through text messages by community health workers (CHWs) and reminder text messages for antenatal care sent to CHWs’ mobile phones. Tools used: customized version of RapidSMS
As needed for upcoming antenatal visits and estimated delivery date
81% of the estimated annual pregnancies in the district were registered in the system. Reporting compliance among CHWs was 100%. CHWs reported being more proactive in finding new pregnant women and following up registered pregnant women as a result of reminders forwarded to their mobile phones
Reporting compliance, system usage patterns, and error rates were monitored and feedback sessions were held with CHWs
“The Feasibility of Using Mobile-Phone Based SMS Reminders and Conditional Cash Transfers to Improve Timely Immunization in Rural Kenya”
Childhood immunization
Text message reminders for mother delivered to mobile phone and free airtime or mobile cash transfers for mothers that brought child in on time. Tools used: customized version of RapidSMS and mPESA
Three days before vaccine due date and on due date
91% of mothers reported that the SMS reminders influenced their decision to come in for vaccination
Enrolled mothers were randomized to receive either mMoney or airtime for on-time vaccinations. Questionnaires were administered in home follow-up visits
mMoney group: 48 Airtime group: 24 Total: 72
Rural district of Kenya
4/9
Quality score assigned using the Cochrane Risk of Bias Assessment Tool (for RCTs) or the Newcastle-Ottawa Quality Assessment Scale (for observational studies). For RCTs, a low risk of bias is the best possible score and for observational studies the highest possible score is 9. Please see Section 2 for more details.
