Background Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data. Results The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ≥3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies.

Background As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. Conclusions These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions.

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BACKGROUND As mobile phone uptake in India continues to grow, there is continued interest in mobile platform-based interventions for health education among other topics. Existing studies demonstrate a significant gender gap in mobile phone access, and suggest women’s access to mobile phones is constrained by economic and diverse social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions which particularly rely on women’s access to and facility with mobile phone use. OBJECTIVE This paper describes dynamics and patterns of women’s mobile phone access and use among both phone owners and non-owners, including potential barriers to mHealth participation. METHODS Mixed-methods data were obtained from two different surveys (n=102 and n=29), two sets of in-depth interviews (n=20 and 29), and weekly data collection obtained in preparation for or within the pilot of an mHealth postpartum care intervention in rural Punjab in July 2020-February 2021. RESULTS A majority of women owned their own phone, though about half (52%) of phone owners still reported sharing their phone with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households have strict preferences against daughters-in-law having phones, or otherwise significantly restrict or control women’s phone access. Others reported concerns about phone use-related health hazards during pregnancy or postpartum for mother and infant. CONCLUSIONS These findings suggest significant variability and nuance to what is meant by women’s phone ownership and access given the numerous additional constraints on their use of phones, particularly during pregnancy and postpartum. Future research and mHealth interventions should probe these domains to better understand these dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. mHealth, mobile health, digital health, India, pregnancy, pregnant women, postpartum, postpartum care INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.34087

BACKGROUND Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite its importance for maternal and neonatal health. Targeted postnatal education and support through an mHealth intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. OBJECTIVE We sought to understand feasibility and acceptability of our first pilot phase, a flexible six-week postnatal mHealth intervention delivered to three groups of women in Punjab, India, and integrate these findings into the intervention for our next pilot phase which will formally assess intervention feasibility, acceptability, and preliminary effectiveness. METHODS Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice and text-based, group approach to connect new mothers with a virtual social support group of other new mothers, increase their health-related communication with providers, and refer them as needed. We targeted deployment for feature phones to include diverse socioeconomic participants. We held moderated group calls weekly, disseminated educational audios, and created mobile text groups. We varied content delivery, group discussion participation, and text chat moderation. Three groups of postpartum women from Punjab, India were recruited for the 6-week pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (n=29), weekly moderator reports, structured endline in-depth interviews (IDIs) among some participants (n=15), and backend data from the technologies used. RESULTS Our 29 participants were 24-28 years and 1-3 months postpartum with parity 0-1. Half had their own phone. Half of participants attended 3 or more of the 6 calls; main barriers were childcare and household responsibilities, and network or phone issues. Most participants were very satisfied with the intervention and found the educational content and group discussion beneficial. Participants utilized the text chat, particularly where facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and socio-cultural challenges. CONCLUSIONS The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings, and developed a smartphone application for participants. We seek to overcome socio-cultural challenges through new strategies for increasing group engagement, including targeting mid-level female Community health Officers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at six months. Ultimately, we seek to support the health and wellbeing of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. CLINICALTRIAL NCT04636398