Patel Suha J, Subbiah Shalini, Jones Rachel, Muigai Faith, Rothschild Claire Watt, Omwodo Lucille, Ogolla Teresa, Kimenju Grace, Pearson Nick, Meadows Audra, Nour Nawal M
Division of Global Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
Jacaranda Health, Nairobi, Kenya.
Mhealth. 2018 May 21;4:14. doi: 10.21037/mhealth.2018.04.05. eCollection 2018.
Group-based health services can improve maternal and newborn health outcomes. Group antenatal care and participatory learning and action cycles (PLA) with women's groups have been cited by the WHO as health systems interventions that can lead to improvements in adherence to care and health outcomes in pregnancy and the postpartum period.
We used a mixed-methods approach to assess the feasibility of a light touch group-based support intervention using the WhatsApp text-messaging platform. Pregnant women were enrolled at Jacaranda Health (JH), a maternity center in peri-urban Kiambu County, Kenya. Their phone numbers were added to WhatsApp groups consisting of participants with similar estimated due dates. The WhatsApp group administrator was a JH employee. Acceptability, demand, implementation, and practicality of this service were evaluated through in-depth interviews (IDIs), surveys, chart review, and analysis of group chats. Limited analysis of program efficacy (ANC visits, any PNC, and post-partum family planning uptake) was assessed by comparing participant data collected through chart review using a concurrent comparison of the general JH patient population.
Fifty women (88%) of 57 eligible women who were approached to participate enrolled in the study. Five WhatsApp groups were created. A total of 983 messages were exchanged over 38 weeks. No harms or negative interactions were reported. Participants reported several benefits. Participants had differing expectations of the level of the group administrator's activity in the groups. ANC and PNC attendance were in line with the hospital's metrics for the rest of JH's patient population. Higher rates of postpartum long acting reversible contraception (LARC) uptake were observed among participants relative to the general patient population.
A moderated mobile-based support group service for pregnant women and new mothers is safe and feasible. Additional research using experimental designs to strengthen evidence of the effectiveness of the support intervention is warranted.
基于群体的卫生服务可改善孕产妇和新生儿健康结局。世卫组织已将群体产前保健以及与妇女团体开展的参与式学习与行动周期（PLA）列为卫生系统干预措施，这些措施可提高孕期和产后对保健的依从性并改善健康结局。
我们采用混合方法评估使用WhatsApp短信平台开展轻度群体支持干预的可行性。孕妇在肯尼亚基安布县城郊的一家产科中心——蓝花楹健康中心（JH）登记入组。她们的电话号码被添加到由预产期相近的参与者组成的WhatsApp群组中。WhatsApp群组管理员是JH的一名员工。通过深入访谈（IDI）、调查、病历审查以及群组聊天分析，对这项服务的可接受性、需求、实施情况和实用性进行了评估。通过比较使用JH普通患者群体的同期对照，通过病历审查收集的参与者数据，对项目效果（产前检查就诊、任何产后检查以及产后计划生育采用情况）进行了有限分析。
57名受邀参与研究的符合条件的女性中有50名（88%）登记入组。创建了5个WhatsApp群组。在38周内共交换了983条信息。未报告有任何危害或负面互动。参与者报告了多项益处。参与者对群组管理员在群组中的活动水平期望各异。产前检查和产后检查的出勤率与JH其他患者群体的医院指标相符。与普通患者群体相比，参与者中产后长效可逆避孕（LARC）的采用率更高。
为孕妇和新妈妈提供的基于手机的适度支持性群组服务是安全可行的。有必要开展更多采用实验设计的研究，以加强支持性干预有效性的证据。
