A multi-component mhealth group social support and education intervention for postpartum women in India: Feasibility and acceptability study (Preprint)
Authors: Diamond-Smith Nadia , El Ayadi Alison , Bagga Rashmi , Duggal Mona , Kaur Jasmeet , Sharma Preetika , Singh Garima , Ahuja Alka , Kumar Vijay , Swendeman Dallas , Kankaria Ankita , Miglani Vaibhav , Mutyala Naveen , Singh Pushpendra 
Published: September 2023

BACKGROUND

Introduction: Postpartum care is critical for maternal and infant health. Women in India receive fewer than recommended postpartum visits and have limited social support. Through a community engaged process, we developed a mobile intervention (mhealth) for postpartum women that provided health related content and brought together groups of women in calls to promote social support. We describe the feasibility and acceptability of this intervention, consisting of weekly video/phone groups for 6 months postpartum, combined with interactive voice response (IVR) and mobile app based audios with content relevant to the specific week postpartum (including topics such as breastfeeding, maternal and infant complications and care, postpartum family planning uptake, self-care, stress and mental health, etc.).

OBJECTIVE

Objective: To test the feasibility and acceptability of different modalities of a postpartum digital health intervention.

METHODS

Methods:
Recruitment: In 2021, 201 women were recruited in the last 2 months of pregnancy in Punjab, India. Women were randomized into 4 modalities of intervention 1) app only (1 group), 2) IVR only (1 group), 3) Group call+Whatsapp+App (3 groups), 4) Group call+Whatsapp+IVR (3 groups), and compared to control.
Statistical Analysis: We analysed pre/post intervention survey and back-end data about engagement in the group calls, IVR, and app audios using descriptive statistics and multivariable regression models.

RESULTS

Results: Most (78%) participants were very satisfied, and satisfaction and system usability scores were highest among women who received the intervention with a group component (group calls [zoom or voice], WhatsApp and IVR or App) compared to women who only received IVR or App. Attendance on the group calls was between 4-10 of 20 participants invited per call, and was fairly stable over the 8 month intervention. App use was low with less than 31% of audios listened to for over half the duration.

CONCLUSIONS

Conclusions:
Principal Results: A mobile intervention for postpartum women that combined educational content via app and IVR with group calls was highly acceptable. While women reported high satisfaction and usability, most women offered the app or IVR audios did not listen to the content. Few women offered the app ever used it. The stability of group call participation suggests these were acceptable for a subset of women.
Limitations: This was a small pilot study in one region of India, limiting generalizability.
Comparison with Prior Work: This work reinforces the limitations of apps and IVR, as found by others, and adds to our understanding of how newer technologies such as zoom could reach these hard to reach populations.
Conclusions: Apps and IVR-based interventions may only be appropriate for select subpopulations, however, group calls hold potential and warrant further exploration as an innovative new direction for mhealth interventions.

CLINICALTRIAL

The intervention is registered at ClinicalTrials.gov (NCT04693585).