scholarly journals Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study (Preprint)

2020 ◽  
Author(s):  
Eric P Green ◽  
Yihuan Lai ◽  
Nicholas Pearson ◽  
Sathyanath Rajasekharan ◽  
Michiel Rauws ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Postpartum Period ◽  
Repeated Measures ◽  
Text Messaging ◽  
Perinatal Depression ◽  
Scale Up ◽  
Text Messages ◽  
Public Hospitals ◽  
Response To Treatment ◽  
New Mothers

BACKGROUND Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the <i>Thinking Healthy</i> Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting <i>Thinking Healthy</i> for automated delivery via a mobile phone. This new intervention, <i>Healthy Moms</i>, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. OBJECTIVE This prepilot study aims to gather preliminary data on the <i>Healthy Moms</i> perinatal depression intervention to learn how to build and test a more robust service. METHODS We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. RESULTS We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) <i>Healthy Moms</i> sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. CONCLUSIONS Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. INTERNATIONAL REGISTERED REPORT RR2-10.2196/11800

scholarly journals Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study

10.2196/17895 ◽  
2020 ◽  
Vol 4 (10) ◽  
pp. e17895
Author(s):  
Eric P Green ◽  
Yihuan Lai ◽  
Nicholas Pearson ◽  
Sathyanath Rajasekharan ◽  
Michiel Rauws ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Postpartum Period ◽  
Repeated Measures ◽  
Text Messaging ◽  
Perinatal Depression ◽  
Scale Up ◽  
Text Messages ◽  
Public Hospitals ◽  
Response To Treatment ◽  
New Mothers

Background Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID) RR2-10.2196/11800

scholarly journals Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Stage 2 Registered Report

2020 ◽  
Author(s):  
Eric Green ◽  
Yihuan Lai ◽  
Nicholas Pearson ◽  
Sathy Rajasekharan ◽  
Michiel Rauws ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Postpartum Period ◽  
Repeated Measures ◽  
Perinatal Depression ◽  
Text Messages ◽  
Public Hospitals ◽  
Conversational Agents ◽  
New Mothers ◽  
Low Resource Settings ◽  
Low Resource

Background. Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the *Thinking Healthy* Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting *Thinking Healthy* for automated delivery via a mobile phone. This new intervention, *Healthy Moms*, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users.Objective. The primary objective of this pre-pilot study was to gather preliminary data on the *Healthy Moms* perinatal depression intervention to learn how to build and test a more robust service. We did this through a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya.Methods. We invited women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via short message service every 3 days during the baseline and intervention periods, and we used this preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. IRRID: DERR1-10.2196/11800.Results. We invited 647 women to learn more about Zuri. Of those invited, 86 completed our automated SMS screening, and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (75.6%) and sent at least 1 message to Zuri (65.9%). A third of the sample engaged beyond registration (34.1%). The average woman who engaged with Zuri post-registration started and completed 3.4 (SD=3.2) and 3.1 (SD=2.9) *Healthy Moms* sessions, respectively. Most interviewees who had tried Zuri had a very positive attitude towards the service and expressed that they could trust Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri led to a 7% improvement in mood.Conclusions. Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this pre-pilot will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. The next step in Zuri's development is to refine the intervention content and add Swahili language support. Conversational agents like Zuri have great potential to address the large treatment gap that exists in many low-resource settings, both as a new channel of treatment and as an adjunct to traditional and task-shifting approaches.

scholarly journals Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study

10.2196/15890 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e15890
Author(s):  
Jessica L Watterson ◽  
Diego Castaneda ◽  
Caricia Catalani
Keyword(s):  
Data Analysis ◽  
Maternal Health ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Text Messaging ◽  
Individual Characteristics ◽  
Text Messages ◽  
Quasi Experimental ◽  
Text Messaging Intervention ◽  
Sms Text Messaging

Background Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization.

scholarly journals Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Mafruha Alam ◽  
Cathy Banwell ◽  
Anna Olsen ◽  
Kamalini Lokuge
Keyword(s):  
Health Care ◽  
Mobile Phone ◽  
Pregnant Women ◽  
Infant Health ◽  
Text Messages ◽  
New Mothers ◽  
Consultation Service ◽  
The Right ◽  
The Impact ◽  
Remote Consultations

BACKGROUND A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. OBJECTIVE We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. METHODS We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. RESULTS Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. CONCLUSIONS Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded.

scholarly journals Mobile Text Messaging for Tobacco Risk Communication among Young-Adult Community College Students: A Randomized Trial of Project DEBUNK (Preprint)

2020 ◽  
Author(s):  
Alexander V Prokhorov ◽  
Georges E Khalil ◽  
Karen Sue Calabro ◽  
Ashish Arya ◽  
Sophia Russell ◽  
...  
Keyword(s):  
Community College ◽  
Randomized Trial ◽  
Risk Communication ◽  
Repeated Measures ◽  
Perceived Risk ◽  
Text Messaging ◽  
Text Messages ◽  
Baseline Survey ◽  
Mixed Effect ◽  
Tobacco Products

BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that nearly all YAs (96%) own mobile phones, mobile phone text messaging is likely to be an effective strategy for tobacco risk communication. OBJECTIVE The objective of the current paper is to present the results of Project Debunk, a community-based randomized trial aimed to identify specific types of messages that are more effective than others in increasing the perceived risk of NETP use and CTP use among YAs in community college. METHODS With YAs recruited offline from three campuses at the Houston Community College (September 2016 – July 2017), we conducted a 6-month randomized trial with eight arms, based on the combination of three message categories: framing (gain-framed versus loss-framed), depth (simple versus complex), and appeal (emotional versus rational). Participants received fully automated online text messages in two 30-day long campaigns, consisting of 2 text messages per day. We conducted repeated-measures mixed-effect models predicting perceived CTP and NETP risks. RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of the 8 conditions (between 73 and 86 participants per condition), and received the text messages from both campaigns. However, 70.12% (446/636) completed all outcome measures at the two-month post-campaign 2 assessment. By the end of both campaigns, participants significantly increased in perceived NETP risk (P<.0001). Although not significant at the 0.007 level, participants increased in perceived CTP risk (P=.008). There was a significant increase at the 0.007 level in perceived NETP risk among participants who received rational messages (P=.005), simple messages (P=.003), and gain-framed messages about NETPs (p=0.003). There was an increase in perceived CTP risk at the 0.05 level of significance among participants who received emotional messages (P=.010), those who received complex messages (P=.026), and those who received loss-framed messages (P=.012). CONCLUSIONS In this trial, YAs increased in perceived NETP risk regardless of the type of message received. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, simple, and gain-framed messages. In addition, YAs generally increased in perceived CTP risk, particularly upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health (mHealth) programs may take advantage of our tailored messages through larger technology-based programs such as smartphone applications and social media campaigns. CLINICALTRIAL This trial was registered at the Clinical Trials registry, NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480?term=NCT03457480&rank=1 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap). INTERNATIONAL REGISTERED REPORT RR2-10.2196/10977

scholarly journals An Interactive Text Messaging Intervention to Improve Adherence to Option B+ Prevention of Mother-to-Child HIV Transmission in Kenya: Cost Analysis

10.2196/18351 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e18351
Author(s):  
Yilin Chen ◽  
Keshet Ronen ◽  
Daniel Matemo ◽  
Jennifer A Unger ◽  
John Kinuthia ◽  
...  
Keyword(s):  
Text Messaging ◽  
Health Care Systems ◽  
Scale Up ◽  
Weighted Average ◽  
Retention In Care ◽  
Text Messages ◽  
Hiv Care ◽  
Text Messaging Intervention ◽  
Mother To Child ◽  
Sms Text Messaging

Background Mobile health (mHealth) approaches offer potentially affordable ways to support the care of HIV-infected patients in overstretched health care systems. However, only few studies have analyzed the costs associated with mHealth solutions for HIV care. Objective The aim of this study was to estimate the total incremental costs and incremental cost per beneficiary of an interactive SMS text messaging support intervention within a clinical trial. Methods The Mobile WAChX trial (NCT02400671) evaluates an interactive semiautomated SMS text messaging intervention to improve adherence to antiretroviral therapy and retention in care among peripartum women infected with HIV in Kenya to reduce the mother-to-child transmission of HIV. Women were randomized to receive one-way versus two-way SMS text messages. Messages were sent weekly, and these messages included motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with the nurse as needed. Microcosting methods were used to collect resource-use data related to implementing the Mobile WAChX SMS text messaging intervention. At 2 sites (Nairobi and Western Kenya), we conducted semistructured interviews with health personnel to identify startup and recurrent activities by obtaining information on the personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records, and published government salary data were included to estimate the total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017. Results The weighted average annual incremental costs for the two-way SMS text messaging group were US $3725 per facility, US $62 per beneficiary, and US $0.85 per contact to reach 115 beneficiaries. For the one-way SMS text messaging group, the weighted average annual incremental costs were US $2542 per facility, US $41 per beneficiary, and US $0.66 per contact to reach 117 beneficiaries. The largest cost shares were for the personnel: 48.2% (US $1794/US $3725) in two-way and 32.4% (US $825/US $2542) in one-way SMS text messaging groups. Costs associated with software development and communication accounted for 29.9% (US $1872/US $6267) of the costs in both intervention arms (US $1042 vs US $830, respectively). Conclusions Cost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with the scale-up of the interventions.

scholarly journals Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study

JMIR Diabetes ◽  
10.2196/17794 ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. e17794
Author(s):  
Lynn Yee ◽  
Shaneah Taylor ◽  
Maria Young ◽  
Makayla Williams ◽  
Charlotte Niznik ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Text Messaging ◽  
Self Care ◽  
Perinatal Outcomes ◽  
Health Care Team ◽  
Text Messages ◽  
Self Management ◽  
Text Messaging Intervention ◽  
Sms Text Messaging

Background Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed. Objective This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy. Methods This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes. Results Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations. Conclusions Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

scholarly journals An Interactive Text Messaging Intervention to Improve Adherence to Option B+ Prevention of Mother-to-Child HIV Transmission in Kenya: Cost Analysis (Preprint)

2020 ◽  
Author(s):  
Yilin Chen ◽  
Keshet Ronen ◽  
Daniel Matemo ◽  
Jennifer A Unger ◽  
John Kinuthia ◽  
...  
Keyword(s):  
Text Messaging ◽  
Health Care Systems ◽  
Scale Up ◽  
Weighted Average ◽  
Retention In Care ◽  
Text Messages ◽  
Hiv Care ◽  
Text Messaging Intervention ◽  
Mother To Child ◽  
Sms Text Messaging

BACKGROUND Mobile health (mHealth) approaches offer potentially affordable ways to support the care of HIV-infected patients in overstretched health care systems. However, only few studies have analyzed the costs associated with mHealth solutions for HIV care. OBJECTIVE The aim of this study was to estimate the total incremental costs and incremental cost per beneficiary of an interactive SMS text messaging support intervention within a clinical trial. METHODS The Mobile WAChX trial (NCT02400671) evaluates an interactive semiautomated SMS text messaging intervention to improve adherence to antiretroviral therapy and retention in care among peripartum women infected with HIV in Kenya to reduce the mother-to-child transmission of HIV. Women were randomized to receive one-way versus two-way SMS text messages. Messages were sent weekly, and these messages included motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with the nurse as needed. Microcosting methods were used to collect resource-use data related to implementing the Mobile WAChX SMS text messaging intervention. At 2 sites (Nairobi and Western Kenya), we conducted semistructured interviews with health personnel to identify startup and recurrent activities by obtaining information on the personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records, and published government salary data were included to estimate the total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017. RESULTS The weighted average annual incremental costs for the two-way SMS text messaging group were US $3725 per facility, US $62 per beneficiary, and US $0.85 per contact to reach 115 beneficiaries. For the one-way SMS text messaging group, the weighted average annual incremental costs were US $2542 per facility, US $41 per beneficiary, and US $0.66 per contact to reach 117 beneficiaries. The largest cost shares were for the personnel: 48.2% (US $1794/US $3725) in two-way and 32.4% (US $825/US $2542) in one-way SMS text messaging groups. Costs associated with software development and communication accounted for 29.9% (US $1872/US $6267) of the costs in both intervention arms (US $1042 vs US $830, respectively). CONCLUSIONS Cost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with the scale-up of the interventions.

scholarly journals Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Lynn Yee ◽  
Shaneah Taylor ◽  
Maria Young ◽  
Makayla Williams ◽  
Charlotte Niznik ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Text Messaging ◽  
Self Care ◽  
Perinatal Outcomes ◽  
Health Care Team ◽  
Text Messages ◽  
Self Management ◽  
Text Messaging Intervention ◽  
Sms Text Messaging

BACKGROUND Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed. OBJECTIVE This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy. METHODS This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes. RESULTS Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations. CONCLUSIONS Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

scholarly journals A mindfulness and compassion-based program applied to pregnant women and their partners to decrease depression symptoms during pregnancy and postpartum: study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Olga Sacristan-Martin ◽  
Miguel A. Santed ◽  
Javier Garcia-Campayo ◽  
Larissa G. Duncan ◽  
Nancy Bardacke ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Health System ◽  
Pregnant Women ◽  
Mood Disorders ◽  
Postpartum Period ◽  
Perinatal Depression ◽  
Controlled Trial ◽  
National Health System ◽  
Randomized Controlled ◽  
Spanish National Health System

Abstract Background Pregnancy and the postpartum period are times of great change for women and their partners, often bringing substantial challenges and stress. Approximately 10%–20% of women suffer from mood disorders such as depression in the perinatal period. There are risks involved in using psychopharmacological interventions to treat perinatal depression. Mindfulness and compassion-based educational programs could be efficacious and cost-effective options for the prevention and treatment of perinatal mood disorders. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression. Methods A multicenter randomized controlled trial (RCT) will be conducted. Participants will be pregnant women (n = 122) and their partners who wish to participate. They will be enrolled and assessed in PC settings and randomly assigned to either: (1) an adapted MBCP educational program tailored to the Spanish National Health System + treatment as usual (TAU); or (2) TAU only. The main outcome to be assessed will be depression, evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Secondary outcomes will include self-reported measures of perceived stress, affects, mindfulness, self-compassion, maternal self-efficacy, and use of health and social services. Patients will be assessed at four timepoints: baseline; post-treatment; and at three and six months after childbirth. Intention-to-treat and per-protocol analyses will be carried out using linear regression mixed models. Effect sizes will be estimated using Cohen’s d. Discussion Perinatal depression is a significant health problem. An effective and low-cost childbirth education program that incorporates mindfulness and compassion practices may be a beneficial preventive complementary healthcare modality for expectant women and their partners. This study will be the first multicenter RCT in Spanish PC settings using adapted MBCP and compassion practices to reduce symptoms of depression during pregnancy and the postpartum period. Trial registration ClinicalTrials.gov, NCT03247491. Registered on 31 July 2017.

Sign in / Sign up

Export Citation Format

Share Document