Modeling and testing maternal and newborn care mHealth interventions: a pilot impact evaluation and follow-up qualitative study in Guatemala.
Objective
To develop a descriptive model of structural characteristics of mHealth in the context of newborn nutrition, and to assess the effects of illustrative interventions through a mixed-methods study consisting of an impact evaluation and a qualitative assessment.


Materials and Methods
We conducted a 23-week intervention with 100 mothers in rural Guatemala in 2013 and 2014. In group 1 ( n  = 24), participants received health-promoting text messages. In group 2 ( n  = 32), peer-to-peer groups were formed. In group 3 ( n  = 30), peer-to-peer groups were formed, a health professional participated in the discussions, and participants received health-promoting messages. In the control group ( n  = 14), participants were simply given a mobile phone. We measured changes in knowledge and self-reported behavior. Four focus groups in 2015 showed the perceptions of 44 additional women and the potential of the previously tested interventions in other marginalized areas.


Results
Significant relationships were found between group membership and changes in knowledge ( P  < .001), and between changes in knowledge and self-reported behavior ( P  = .010). Within peer-to-peer groups, 3665 text messages were shared; discussions covered topics such as breastfeeding practices, health concerns, and emotional issues. Focus groups revealed a deficit of support for mothers, a precariousness of public services, different cultural barriers affecting access to care, and the potential for scaling up.


Discussion
The complementarity of structural arrangements of mHealth interventions can play an important role in helping to encourage recommended breastfeeding attitudes along with providing rich information about challenges in rural areas.


Conclusion
A mixed-methods study was appropriate to compare the effects and assess the potential of mHealth strategies in a complex rural setting.
['Prieto|José Tomás|JT|', 'Zuleta|Clara|C|', 'Rodríguez|Jorge Tulio|JT|']
D000293:Adolescent D000328:Adult D001942:Breast Feeding D005260:Female D017144:Focus Groups D006166:Guatemala D007722:Health Knowledge, Attitudes, Practice D006801:Humans D007224:Infant Care D007227:Infant Nutritional Physiological Phenomena D007231:Infant, Newborn D008507:Medically Underserved Area D018743:Perinatal Care D010865:Pilot Projects D012424:Rural Population D017216:Telemedicine D060145:Text Messaging D055815:Young Adult
mobile knowledge self-reported behavior breastfeeding comparison mixed methods