title: mHealth to promote pregnancy and interconception health among African-American women at risk for adverse birth outcomes: a pilot study.
abstract: BACKGROUND
  The use of mobile phone applications (mHealth) to provide health education and behavioral prompts is 1 of the 12 common mHealth functions identified by the World Health Organization as innovations to strengthen health systems. Among low-income pregnant and parenting women, health education is widely recognized as a way to improve maternal and infant health outcomes, but the efficacy of written health education materials to change knowledge and behavior for this population is questionable. mHealth prompts, in contrast, is a promising alternative.
  
  
  METHODS
  A team of researchers in medicine/epidemiology, anthropology/midwifery, computer science/sensors, and community-based case management created and pilot tested a mHealth application (mHealth app) for African-American women at high risk for adverse birth outcomes. We tested the acceptability and feasibility of the interactive application among women during the reproductive stages of early and late pregnancy, postpartum, and interconception.
  
  
  RESULTS
  Interview data from 14 women in the various reproductive stages revealed that most women found the mHealth messages helpful. Also, 62 Ob-Gyn physicians and nurses and 19 Family Medicine residents provided feedback. Women's responses to specific messages trended down over time. Women in the postpartum phase had the highest response rate to particular text messages, followed by those in the pregnancy phase. Responses dropped off dramatically during the interconception period. About 21% of women lost their phones. Unexpected findings were that all participants already had smartphones, women wanted messages about depression, and clinicians wanted the app to link to case management for individualized medical care.
  
  
  CONCLUSIONS
  Logistical challenges to app management were limitations but are useful for consideration before scale-up. This study corroborates findings in the health literacy literature that women most at risk for adverse birth outcomes need additional face-to-face support with mHealth applications.
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Atlanta, GA 30322, USA;; Rollins School of Public Health, Emory University, 1520 Clifton Road Atlanta, GA 30322, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
authors.affiliation: Fox Valley Family Medicine Residency, 229 S. Morrison St. Appleton, WI 54911, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Miller
authors.affiliation: Information and Communications Lab, Georgia Technology Research Institute, Atlanta, GA 30332, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Isbell
authors.affiliation: Atlanta Healthy Start Initiative, Center for Black Women's Wellness, 477 Windsor St. Atlanta, GA 30312, USA.
authors.forename: Tekesia
authors.initials: T
authors.lastname: Shields
authors.affiliation: Atlanta Healthy Start Initiative, Center for Black Women's Wellness, 477 Windsor St. Atlanta, GA 30312, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Worthy
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Atlanta, GA 30322, USA.
authors.forename: Anne Lang
authors.initials: AL
authors.lastname: Dunlop
keywords: Community participation; health disparities; mHealth; pregnancy; reproductive health