Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma

Abstract

Background Mobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy). Objective The protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway. Methods A pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results Following study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway. Conclusions The study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application. International Registered Report Identifier (IRRID) DERR1-10.2196/19073

The COVID-19 emergency as an opportunity to co-produce an innovative approach to health services provision: the women's antenatal classes move on the web

“…The research group of the Management and Healthcare Laboratory of the Sant’Anna School, which have been already collaborating with the Regional Health Authority for the maternal care pathway monitoring and evaluation (Murante et al, 2014 ; Bonciani et al, 2020 ; Bonciani et al, 2021 ), proposed to coordinate an action-research intervention to cope with this criticality of the ACs interruption. The idea was to support the identification of a new model of ACs provision at the regional level thanks to the collaborative involvement of users and health professionals and enhancing the digital resources already present in Tuscany.…”

“…The idea was to support the identification of a new model of ACs provision at the regional level thanks to the collaborative involvement of users and health professionals and enhancing the digital resources already present in Tuscany. Indeed, since March 2019 the Regional Health Authority promoted the implementation of hAPPyMamma system, which includes a mobile and web app for women and a web portal for operators, with specific but integrated functions for both (Bonciani et al, 2021 ). The app for users is a digital tool that accompanies women during pregnancy, childbirth and up to the child’s first year with the objective to facilitate the access to and use of the services and health opportunities of maternal care pathway.…”

Pregnancy-related urinary and faecal incontinence: systematic and longitudinal collection of Patient-Reported Outcome measures in a large Italian population.

“…Data were obtained from the questionnaires systematically and longitudinally collected by the MeS (Management and Health ) Laboratory of Sant'Anna School of Advanced Study of Pisa, Italy, and stored in the online platform of the same institution. This collection program was launched in 2019 by Sant'Anna School in collaboration with Tuscany Region and gradually integrated within the phone ApphAPPyMamma , which is the digital version of the Maternity Services Dataset of Tuscany, Italy (20).…”

A qualitative study on professionals’ attitudes and views towards the introduction of patient reported measures into public maternity care pathway

“…The benefits of the routine collection of PREMs across the maternity care pathway, e.g. allowing healthcare authorities and providers to be aware of the quality of care along the whole care pathway as perceived by the patients, which helps identify gaps and insufficiencies in service provision, have been suggested in several studies by the Italian team [ 19 – 23 ]. However, more evidence-based, transferrable and practical knowledge about the implementation of this kind of system is needed for practitioners and researchers from other countries or institutions to integrate PRMs into local maternity care pathway.…”