SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions

Sarah Munro, Amber Hui, Vanessa Salmons, Carolyn Solomon, Emily Gemmell, Nahal Torabi, Patricia A Janssen, Sarah Munro, Amber Hui, Vanessa Salmons, Carolyn Solomon, Emily Gemmell, Nahal Torabi, Patricia A Janssen

Abstract

Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada.

Objective: To explore women's preferences for a prenatal education program by text messaging.

Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings.

Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages "all the time" (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol.

Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes.

Keywords: health behavior; pregnancy; prenatal education; text messaging.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sarah Munro, Amber Hui, Vanessa Salmons, Carolyn Solomon, Emily Gemmell, Nahal Torabi, Patricia A Janssen. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 07.02.2017.

Figures

Figure 1
Figure 1
Home page for the SmartMom website.
Figure 2
Figure 2
Example health promotion messages provided through the SmartMom program.

References

    1. Walker DS, Visger JM, Rossie D. Contemporary childbirth education models. J Midwifery Womens Health. 2009;54(6):469–476. doi: 10.1016/j.jmwh.2009.02.013.
    1. Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD002869. doi: 10.1002/14651858.CD002869.pub2.
    1. Brixval CS, Axelsen SF, Andersen SK, Due P, Koushede V. The effect of antenatal education in small classes on obstetric and psycho-social outcomes: A systematic review and meta-analysis protocol. Syst Rev. 2014 Feb 13;3:12. doi: 10.1186/2046-4053-3-12.
    1. Ferguson S, Davis D, Browne J. Does antenatal education affect labour and birth? A structured review of the literature. Women Birth. 2013 Mar;26(1):e5–e8. doi: 10.1016/j.wombi.2012.09.003.
    1. Public Health Agency of Canada . What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa, ON: Public Health Agency of Canada; 2009. [2017-01-27]. .
    1. Sutherns R, Bourgeault IL. Accessing maternity care in rural Canada: There's more to the story than distance to a doctor. Health Care Women Int. 2008 Sep;29(8):863–883. doi: 10.1080/07399330802269568.
    1. Shub A, Huning EY, Campbell KJ, McCarthy EA. Pregnant women's knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes. 2013;6:278. doi: 10.1186/1756-0500-6-278.
    1. Lee A, Belski R, Radcliffe J, Newton M. What do pregnant women know about the healthy eating guidelines for pregnancy? A web-based questionnaire. Matern Child Health J. 2016 Oct;20(10):2179–2188. doi: 10.1007/s10995-016-2071-4.
    1. McDonald SD, Pullenayegum E, Taylor VH, Lutsiv O, Bracken K, Good C, Hutton E, Sword W. Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy. Am J Obstet Gynecol. 2011 Oct;205(4):333.e1–333.e6. doi: 10.1016/j.ajog.2011.05.039.
    1. Yudin MH, Salaripour M, Sgro MD. Pregnant women's knowledge of influenza and the use and safety of the influenza vaccine during pregnancy. J Obstet Gynaecol Can. 2009 Feb;31(2):120–125.
    1. Novick G. Women's experience of prenatal care: An integrative review. J Midwifery Womens Health. 2009;54(3):226–237. doi: 10.1016/j.jmwh.2009.02.003.
    1. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med. 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362.
    1. Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;4:CD006611. doi: 10.1002/14651858.CD006611.pub4.
    1. Evans W, Nielsen PE, Szekely DR, Bihm JW, Murray EA, Snider J, Abroms LC. Dose-response effects of the Text4baby mobile health program: Randomized controlled trial. JMIR Mhealth Uhealth. 2015;3(1):e12. doi: 10.2196/mhealth.3909.
    1. Tamrat T, Kachnowski S. Special delivery: An analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Matern Child Health J. 2012 Jul;16(5):1092–1101. doi: 10.1007/s10995-011-0836-3.
    1. Whittaker R, Matoff-Stepp S, Meehan J, Kendrick J, Jordan E, Stange P, Cash A, Meyer P, Baitty J, Johnson P, Ratzan S, Rhee K. Text4baby: Development and implementation of a national text messaging health information service. Am J Public Health. 2012 Dec;102(12):2207–2213. doi: 10.2105/AJPH.2012.300736.
    1. Text4Baby. 2016. [2017-01-25]. Text4Baby enrollment data
    1. Evans WD, Wallace BJ, Szekely D, Nielsen P, Murray E, Abroms L, Snider J. Initial outcomes from a 4-week follow-up study of the Text4baby program in the military women's population: Randomized controlled trial. J Med Internet Res. 2014;16(5):e131. doi: 10.2196/jmir.3297.
    1. Gazmararian JA, Elon L, Yang B, Graham M, Parker R. Text4baby program: An opportunity to reach underserved pregnant and postpartum women? Matern Child Health J. 2014 Jan;18(1):223–232. doi: 10.1007/s10995-013-1258-1.
    1. Wolpin S, Stewart M. A deliberate and rigorous approach to development of patient-centered technologies. Semin Oncol Nurs. 2011 Aug;27(3):183–191. doi: 10.1016/j.soncn.2011.04.003.
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32:56–69. doi: 10.1093/epirev/mxq004.
    1. Government of Canada. Canadian Radio-television Telecommunications Commission (CRTC) Communications Monitoring Report. Ottawa, ON: Canadian Radio-television Telecommunications Commission (CRTC); 2015. Oct, [2017-01-27]. .
    1. Poushter J. Pew Research Center. Washington, DC: Pew Internet & American Life Project; 2016. Feb 22, [2016-11-29]. Smartphone ownership and Internet usage continues to climb in emerging economies
    1. British Columbia Ministry of Health . Baby’s Best Chance: Parents’ Handbook of Pregnancy and Baby Care. 5th revision, 6th edition. Victoria, BC: Province of British Columbia, Ministry of Health; 2015. Mar, [2017-01-29]. .
    1. Healthy Families BC. Victoria, BC: British Columbia Ministry of Health; 2016. [2016-11-03].
    1. British Columbia Perinatal Health Program . BCPHP Obstetric Guideline 19: Maternity Care Pathway. Vancouver, BC: British Columbia Perinatal Health Program; 2010. Feb, [2016-11-30]. .
    1. SmartMom. Vancouver, BC: SmartMom Mobile Health Education; 2016. [2017-01-26]. .
    1. Perinatal Services BC. Vancouver, BC: Provincial Health Services Authority; [2016-11-04].
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Strecher VJ, Rosenstock IM. The health belief model. In: Baum A, Newman S, Weinman J, West R, McManus C, editors. Cambridge Handbook of Psychology, Health and Medicine. New York, NY: Cambridge University Press; 1997. pp. 113–116.
    1. O'Donnell BE, Lewkowitz AK, Vargas JE, Zlatnik MG. Examining pregnancy-specific smartphone applications: What are patients being told? J Perinatol. 2016 Oct;36(10):802–807. doi: 10.1038/jp.2016.77.
    1. Willcox JC, van der Pligt P, Ball K, Wilkinson SA, Lappas M, McCarthy EA, Campbell KJ. Views of women and health professionals on mHealth lifestyle interventions in pregnancy: A qualitative investigation. JMIR Mhealth Uhealth. 2015 Oct 28;3(4):e99. doi: 10.2196/mhealth.4869.
    1. Cormick G, Kim NA, Rodgers A, Gibbons L, Buekens PM, Belizán JM, Althabe F. Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care. Reprod Health. 2012;9:9. doi: 10.1186/1742-4755-9-9.
    1. Currie LM. Evaluation frameworks for nursing informatics. Int J Med Inform. 2005 Dec;74(11-12):908–916. doi: 10.1016/j.ijmedinf.2005.07.007.

Source: PubMed

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