BackgroundToll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications.MethodsIn-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted.ResultsPrior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with Solution Linked Group.ConclusionsThe use of mobile technology in this intervention took a leap from simply rendering information to providing more rapid services. Active participation of service providers along with mothers’ accessibility motivated both the service providers and mothers to communicate through mobile phone for maternal health issues. These altogether made the shift towards adoption of an innovation.

Toll free mobile phone intervention was tested in one sub district of Bangladesh. Prior to implementation, we conducted a formative research to explore perceived advantages and disadvantages of mobile phone communication for maternal and neonatal complication management. We conducted in-depth interviews among twelve community skilled birth attendants and fourteen mothers along with their husbands. All husbands were supportive in their wives' accessibility to their phone, but wives revealed disparity in access to husbands' phone. The advantages identified were reduced cost of consultation and transportation to appointments with skilled providers, time saving during emergencies and controlling barriers to pregnant women's mobility. Other direct benefit was consultation with health professionals to increase confidence of community based skilled birth attendants (CSBAs) in handling emergencies. Respondents sensed that determining the management without examining patient might affect the appropriateness in providing treatment, when the communication mode is only phone. Mothers and their husbands who communicated through mobile phone with providers for their health issue noted some other barriers: irritability from the provider's side and switched off phones. Mobile phone access pathway should be explained to pregnant women, their husbands and service providers from the beginning of an intervention. The well designed e-health solutions based on evidence of formative research may have larger impact on quality of care in Bangladesh.