A mobile health (mHealth) intervention acted as a supporting tool to improve maternal health awareness and maternal health–related behavioral changes among pregnant women living in tribal and rural communities in Jharkhand, India, according to a study published in JMIR mHealth and uHealth.

This study is part of a larger, more extensive trial in collaboration with the Rural Health Mission of the Government of Jharkhand under the European Union–funded Initiative for Transparency and Good Governance.

Despite several government-level initiatives, there are noticeable disparities in maternal health in India based on socioeconomic status due to poor health awareness, the study authors noted.

The “3 delays” model suggests that delays in deciding to seek care, obtaining timely care, and receiving appropriate treatment are primary factors leading to maternal mortality in rural communities in India. Further, lack of maternal health awareness has caused several public health concerns such as anemia, neural tube defects, tetanus infection, immunodeficiency syndrome, and perinatal deaths.

Another contributor to maternal health issues is people in rural India not using available health care facilities, largely due to belief systems that may not line up with modern health care practices, the authors added. According to them, the mobile app Mobile for Mothers (MfM) and other similar mHealth interventions could be used as educational tools for members of tribal societies to help take up modern maternal health care recommendations.

The study included 800 accredited social health activists (ASHAs) from a community-based health worker group founded as a part of the National Rural Health Mission by the Indian Ministry of Health and Family Welfare. Half of the ASHAs were assigned to the intervention group, where they used the MfM app to engage with pregnant women during each home visit.

A total of 1480 pregnant women from 2 rural villages in Jharkhand were included in the study, with 740 women each in the intervention and control groups. The study included women aged between 18 and 45 years and, of note, the majority of women were aged 20 to 24 years and were younger than 18 years when they were married. Further, approximately 90% of all women included listed their occupational status as housewife, and more than half of participants in each group reported not receiving any education.

Women in the intervention group received government-mandated maternal care through the MfM mHealth app, while women in the control group received the same government-mandated care via traditional means such as verbal communication.

Participants completed baseline and end line surveys. The authors noted participant awareness of various maternal health behaviors and the 5 cleans (5Cs): clean hands, clean place, clean cloths, clean cord cut with a clean blade, and clean cord clamped with a clean thread.

The surveys showed that, of 740 women in the intervention group, awareness of the 5Cs increased from 143 participants at baseline to 555 participants at end line. In the control group, there was still a large increase in awareness of the 5Cs before and after the study was conducted (66.5%), from 108 of 740 participants at baseline to 492 at end line, but the increase was significantly greater in the intervention group.

For other survey questions, not all participants answered every question, which may skew results.

Pregnant women are advised to receive 2 shots of tetanus vaccine. Awareness of tetanus vaccine injections increased significantly in the intervention group, from 9.9% of women at baseline to 67% at end line. This percentage increased significantly less in the control group, from 36.1% at baseline to 44.7% at end line.

The women were also asked, “Do you know that if you have problems like painful or burning urination and itchy genitals during pregnancy they are indicative of a reproductive tract infection?” In response, only 2% in the intervention group and 0.9% in the control group answered yes at baseline. At end line, 82.2% in the intervention group answered yes, but only 17.8% of women in the control group were able to answer yes.

Similarly, knowledge on why pregnant women need to test for HIV/AIDS before or during pregnancy was increased significantly more at end line for the intervention group. This percentage jumped from 5.3% to 77.3% for the intervention group, but only from 3.8% to 17.7% for the control group.

Finally, the percentage of pregnant women who consumed the prescribed dosage of iron tablets increased from 67% to 92.3% in the intervention group, and from 60.8% to 75.1% in the control group.

“Existing literature has acknowledged several mobile apps that can assist with maternal education and support socially disadvantaged pregnant women,” the authors said. “Despite having minimal prior experience with mobile devices and no health literacy, our study demonstrates how tribal communities learned information about maternal health and hygiene when delivered through the mHealth app in a user-centered manner (ie, using their regional language and visuals).”

Reference

Choudhury A, Choudhury M. Mobile for mothers mHealth intervention to augment maternal health awareness and behavior of pregnant women in tribal societies: randomized quasi-controlled study. JMIR Mhealth Uhealth. 2022;10(9):e38368. doi:10.2196/38368