A mobile education and social support group intervention for improving postpartum health in northern India: Development and Usability Study (Preprint)

BACKGROUND Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite its importance for maternal and neonatal health. Targeted postnatal education and support through an mHealth intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. OBJECTIVE We sought to understand feasibility and acceptability of our first pilot phase, a flexible six-week postnatal mHealth intervention delivered to three groups of women in Punjab, India, and integrate these findings into the intervention for our next pilot phase which will formally assess intervention feasibility, acceptability, and preliminary effectiveness. METHODS Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice and text-based, group approach to connect new mothers with a virtual social support group of other new mothers, increase their health-related communication with providers, and refer them as needed. We targeted deployment for feature phones to include diverse socioeconomic participants. We held moderated group calls weekly, disseminated educational audios, and created mobile text groups. We varied content delivery, group discussion participation, and text chat moderation. Three groups of postpartum women from Punjab, India were recruited for the 6-week pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (n=29), weekly moderator reports, structured endline in-depth interviews (IDIs) among some participants (n=15), and backend data from the technologies used. RESULTS Our 29 participants were 24-28 years and 1-3 months postpartum with parity 0-1. Half had their own phone. Half of participants attended 3 or more of the 6 calls; main barriers were childcare and household responsibilities, and network or phone issues. Most participants were very satisfied with the intervention and found the educational content and group discussion beneficial. Participants utilized the text chat, particularly where facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and socio-cultural challenges. CONCLUSIONS The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings, and developed a smartphone application for participants. We seek to overcome socio-cultural challenges through new strategies for increasing group engagement, including targeting mid-level female Community health Officers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at six months. Ultimately, we seek to support the health and wellbeing of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. CLINICALTRIAL NCT04636398