Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study

Abstract

Background Mobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn’s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh. Objective The aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up. Methods We conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test. Results Overall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of par...

Do mothers pick up a phone? A cross-sectional study on delivery of MCH voice messages in Lagos, Nigeria

“…Those not having picked up a phone received its reminder call either at noon or 2 PM. Several previous studies reported that participants received the voice messages at the time predesignated by themselves [ 9 , 10 , 26 , 34 ].…”

“…As shown in Model 2 regression analysis results, the participants having picked up the phone between 10 AM and noon were less likely to complete listening up to or beyond the time threshold (core message part) than those having picked up the phone between noon and 2 PM. This may imply that some participants were too busy with economic activities or household chores [ 9 , 19 ] to pick up a phone in the morning. In fact, most participants (369/513, 71.9%) were either employed or self-employed.…”

“…Thus, in some cases, the participants could not pick up the phone and listen to voice message. For example, a previous study in Afghanistan reported that the participants having opted for voice messages ended up receiving fewer messages than those having opted for SMS [ 9 ]. In an intervention for pregnant women in Ghana, more than 80% of the participants picked up the phone and listened to at least 50% of the length of each message prenatally, while less than 54% of the participants did so postnatally [ 26 ].…”

“…In developing countries, voice message has been used for HIV [3][4][5] and diabetes patients [6] to improve and maintain their medication adherence, and for commercial sex workers (CSWs) to get screened for sexually transmitted infections [7]. In the area of maternal and child health (MCH) care, voice message has been used to encourage less literate [8] and less educated [9] mothers to increase their use of health services. In addition, voice message has helped low-income pregnant women to take iron tablets [10] and parents to improve infant and young child feeding practices [11].…”

The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings

“…Furthermore, male participation in mHealth interventions can increase joint health-related decision-making between partners and enhance health-related communication, translating into better health practices. Participants in a mobile phone-based messaging service in maternal and newborn health in Afghanistan reported that involving fathers was beneficial, and joint decision-making between wives and husbands increased [45]. The "Super Abbu" (Super Dad) pregnancy and infant hotline in Pakistan was inundated with calls from fathers, with approximately 40,000 calls within the first 2 months, illustrating the need to include fathers and engage men for optimal health outcomes for women and children [46].…”