SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions.
BACKGROUND
We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada.


OBJECTIVE
To explore women's preferences for a prenatal education program by text messaging.


METHODS
We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings.


RESULTS
A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages "all the time" (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol.


CONCLUSIONS
This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.
Sarah
http://orcid.org/0000-0002-3884-6592
S
Munro
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Amber
http://orcid.org/0000-0001-5494-0135
A
Hui
Maternal, Infant, Child and Youth, Public Health, Northern Health Authority, Quesnel, BC, Canada.
Vanessa
http://orcid.org/0000-0003-4405-0002
V
Salmons
Maternal and Women's Health, Public Health Services Branch, Population and Public Health Division, British Columbia Ministry of Health, Victoria, BC, Canada.
Carolyn
http://orcid.org/0000-0001-5071-3242
C
Solomon
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Emily
http://orcid.org/0000-0001-6336-407X
E
Gemmell
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Nahal
http://orcid.org/0000-0002-2726-2938
N
Torabi
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Patricia A
http://orcid.org/0000-0002-4178-1195
PA
Janssen
health behavior; pregnancy; prenatal education; text messaging