Facilitators of and barriers to mobile phone-based interventions for perinatal mental conditions in low- and middle-income countries: A qualitative systematic review (Preprint)
Authors: Mahmudunnabi - , Waqas Ahmed , Rahman Omar , Rahman Din M. Sumon , Sikander Siham , Rahman Atif 
Published: February 2024

BACKGROUND

mHealth (mobile health) is seen as a viable option to achieve universal health coverage in low- and middle-income countries (LMICs). An increasing body of evidence demonstrates the potential of mobile phone-based psychological interventions for treating perinatal depression and anxiety, a major public health concern that remains largely unaddressed in LMICs.

OBJECTIVE

This review aims to: a) identify the facilitators and barriers to delivering psychological interventions through mobile phones for perinatal mental health conditions in LMICs, and b) to assess the acceptability of such interventions among perinatal women in LMICs.

METHODS

This review included qualitative and mixed method studies that discussed the use of mHealth or mHealth combined with eHealth features for perinatal mental disorders in LMICs. Using a pretested search strategy, relevant studies were identified by searching three databases including PubMed, Web of Science, and PsycInfo. We considered studies that reported prospective or retrospective feedback or opinions of perinatal women receiving mHealth psychological interventions. The selected studies were critically appraised using the Mixed Methods Appraisal Tool. The thematic synthesis approach was used to meta-synthesize the evidence from the included studies. This approach facilitated the extraction of common themes directly from the data, ensuring an inductive analysis that reflected the nuanced experiences and outcomes reported in the studies.

RESULTS

A systematic database search yielded 774 articles, with 42 selected for full-text screening and 8 for evidence synthesis. This review delineated seven facilitators and five barriers to mHealth interventions for perinatal mental healthcare in LMICs. Facilitators encompassed the ubiquity of mobile devices (n=2), rising digital literacy (n=3), and the intrinsic efficacy of mobile phones in disseminating information (n=6) while maintaining flexibility (n=3) and ensuring privacy (n=2). mHealth services additionally empower women to make informed health decisions (n=2) and mobilize family members through the provision of relevant health information (n=2). Barriers primarily stemmed from unequal access to mobile phones and the Internet (n=5), social stigma associated with mental illness (n=1) and the financial burden linked to mHealth services (n=2). Nevertheless, women across diverse settings demonstrated a positive attitude toward mHealth interventions for perinatal mental healthcare.

CONCLUSIONS

This review outlines essential prerequisites, such as understanding the target population, creating culture-specific content, and adopting multi-platform approaches, for developing effective and acceptable interventions for the treatment of perinatal mental health conditions. By attending to these aspects, mHealth can be seen as a transformative social technology in this critical healthcare domain.