Abstract:
Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health
services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the
delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve
the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the
lack of context and preliminary evidence on how to make the transition.
Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care
as well as willingness to receive a text message (short message service, SMS)–based mHealth intervention for antenatal care
services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration,
Northwest Ethiopia, Africa.
Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March
27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info
version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression
analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to
receive a text message–based mHealth intervention.
Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of
respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone
owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they
are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more
than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS
text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS
text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy.
Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained
secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319,
95% CI 0.141-0.718).
Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and
are willing to receive an SMS text message–based mHealth intervention. Age, educational status, and the frequency of mobile
phone use are significantly associated with the willingness to receive SMS text message–based mHealth interventions.
