title: Integrating an eHealth program for pregnant women in midwifery care: a feasibility study among midwives and program users.
abstract: BACKGROUND
  Health messages may have the highest impact if they are given early in life. Therefore, the Dutch Ministry of Health identified pregnant women as a target population and initiated an innovative eHealth program to serve as a communication channel of health messages to pregnant women.
  
  
  OBJECTIVE
  The aim was to study the feasibility of implementing this eHealth program into standard midwifery care and to investigate use and user perceptions of the online program among pregnant women.
  
  
  METHODS
  All midwifery practices in Amsterdam affiliated with the Dutch Organization of Midwives (n = 25) were requested to implement the eHealth program within a pilot study from March to August 2006. Structured interviews were used to study feasibility of implementation among midwives. During the study period, 488 pregnant women registered themselves on the program website, after which monthly emails were sent to them. The emails were tailored to the stage of pregnancy and provided interactive questions plus answers on six topics and links to related websites. User statistics were registered until January 2007, and user perceptions were assessed with electronic questionnaires.
  
  
  RESULTS
  In total, 80% (20/25) of midwifery practices implemented the program. These midwives gave a short oral explanation about the eHealth program to their clients (n = 1382; about 45% of the total number of clients during this period) and handed out an information brochure. After the pilot, 12 midwifery practices were willing to integrate the eHealth program into their standard care procedures. Regarding program usage, 84% (408/488) of the enrolled women accessed health information within the program. They opened 59% (1296/2213) of the quiz emails and accessed, on average, 16 topics (SD 11). Only 35% (143/408) of users used the hyperlinks to visit related websites. Most women perceived the eHealth information as easy to understand (96%; 157/163) and reliable (81%; 130/161), but only 39% (48/153) agreed that the information was available at the right time. Accessing more topics within the quiz emails was associated with a more positive perception of the program (P = .02), but the number of clicks to related websites was not associated with program perception (P = .32). The main improvement suggested by program users was to expand the information within the program.
  
  
  CONCLUSIONS
  It is feasible to integrate an innovative eHealth program in standard midwifery care, and about half of the practices would like to continue doing so. Program users accessed a substantial proportion of available health information; however, user perceptions were mixed. Therefore, this eHealth program may be a feasible communication channel to promote a healthy lifestyle to pregnant women after suggested revisions have been carried out.
authors.affiliation: National Institute of Public Health and the Environment (RIVM), Centre for Prevention and Health Services Research, Bilthoven, The Netherlands. moniek.van.zutphen@rivm.nl
authors.forename: Moniek
authors.initials: M
authors.lastname: van Zutphen
authors.forename: Ivon E
authors.initials: IE
authors.lastname: Milder
authors.forename: Wanda J
authors.initials: WJ
authors.lastname: Bemelmans
mesh_terms: D001290:Attitude; D004521:Educational Measurement / Q000379:methods; D034742:Electronic Mail; D004581:Electronics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008427:Maternal Health Services; D008880:Midwifery; D009426:Netherlands; D024802:Nurse's Role; D010465:Perception; D010865:Pilot Projects; D011247:Pregnancy / Q000523:psychology*; D015397:Program Evaluation; D011795:Surveys and Questionnaires