Abstract
BackgroundAponjon (meaning “near and dear ones”), a mobile phone-based mHealth service, customized voice messages for expectant (6–42 weeks pregnancy) and new mothers (1–52 weeks after delivery) for promotion of recommended healthcare practices. The Aponjon system sent two voice messages per week to subscribers, tailored to the timing during pregnancy or post-partum. The current study is an external evaluation of the effect of Aponjon use on knowledge and behaviors related to maternal and newborn health (MNH) care.MethodsWe implemented an observational study of Aponjon users with propensity score matched non-users in Bangladesh. Subscribers with at least 3 months exposure to Aponjon and non-users were interviewed retrospectively on knowledge and practices surrounding MNH. The sample included women with infants ≤6 months (243 users; 369 non-user) for maternal health knowledge and practice indicators and women with infants > 6 to 12 months old (332 users; 454 non-user) for neonatal health knowledge and practice indicators. Data were analyzed using principal component analysis and categorized as ‘high’ and ‘low’ at the median of principal component scores. Interactions between duration of use of Aponjon services and self-reported patterns of receiving and listening to messages were examined to assess the effect on knowledge and practices for MNH.ResultsWomen reporting at least 6 months of using Aponjon were approximately 3 times as likely as the non-users to score high on both maternal healthcare knowledge questions and related practices. Similarly women with at least 6 months of Aponjon exposure were 1.5 times as likely as the non-users to score high on knowledge questions on newborn health. Reporting a good-pattern of Aponjon use (i.e. receiving a minimum of 3 messages per month and listening to all of them) had an even stronger association with knowledge and practices related to MNH care. However, a shorter exposure to Aponjon service (i.e. 3–5 months), despite having a good-pattern of use, did not have an effect on the related outcomes.ConclusionsThe use of Aponjon services for at least 6 months, with a good-pattern of receiving and listening to the messages, was associated with improved knowledge and practices related to MNH care.
Highlights
Aponjon, a mobile phone-based mHealth service, customized voice messages for expectant (6–42 weeks pregnancy) and new mothers (1–52 weeks after delivery) for promotion of recommended healthcare practices
After propensity score matching (PSM), the background characteristics of the participants were similar between the intervention and control groups for both categories of women, except for ownership of mobile phones
A relatively higher proportion of Aponjon service-users owned a mobile phone compared to non-users
Summary
Aponjon (meaning “near and dear ones”), a mobile phone-based mHealth service, customized voice messages for expectant (6–42 weeks pregnancy) and new mothers (1–52 weeks after delivery) for promotion of recommended healthcare practices. A randomized control trial of mHealth in Kenya found a significant increase in attendance of at least four antenatal care visits in the intervention group compared to the control group [4] Another randomized controlled trial of a mobile phone intervention consisting of short messages combined with a health voucher in Zanzibar found a positive effect on both attending at least four antenatal care visits and using skilled delivery care [5, 6]. A controlled pre-post study in Thailand showed a significant increase in the proportion of children receiving timely vaccination after implementation of a mobile phone-based intervention with automated text message reminders for appointments [7]. A quasi-experimental study in Shanghai found that text messages about infant feeding resulted in a significantly higher rate of exclusive breastfeeding at 6 months and a significantly lower rate of the introduction of solid foods before 4 months [9]
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