Factors associated with pregnant women's participation in a mHealth intervention in Timor-Leste

Thesis (Master's)--University of Washington, 2016-06

Background: Mobile health (mHealth) programs have become increasingly popular as a method of harnessing the power of technology to improve health, yet there remains a deficit of rigorous analyses to determine the uptake and effectiveness of these initiatives. This study aims to contribute to a better understanding of the potential impact of mHealth for improving maternal and newborn health as part of an evaluation of a mobile phone project called Liga Inan in Timor-Leste. We analyze demographic and service utilization factors that are associated with women’s participation or non-participation in the project to explore what barriers might prevent women from enrolling in such programs. We also analyze the extent to which women’s enrollment is associated with utilization of maternal health services. Methods: A total of 315 women ages 15-49 who had a child under two years old were surveyed in Manufahi municipality of Timor-Leste in 2015. The survey included knowledge, practices, and health services coverage information, including questions on antenatal and postpartum care, birthing practices, and postpartum care, as well as information about mobile phone ownership and usage. Bi-variate and multi-variate logistic regression models were used to examine the association of enrollment of eligible women in the mHealth program with key demographic variables and maternal health service utilization. Findings: Women who were wealthiest (Odds Ratio [OR]: 2.2, 95% Confidence Interval [CI]: 1.1-4.3), had less than 5 children (OR: .37, CI: .16-.81), and could read (OR: 2.5, CI: 1.2-5.2) were significantly more likely to enroll in the program. There was no association between program enrollment and woman’s age, the distance from nearest health facility, phone ownership, or phone reception in the home. Controlling for wealth, literacy, and parity, enrollment was positively associated with attendance at four antenatal care visits (OR: 3.7, CI: 1.8-7.3), having a skilled birth attendant present at delivery (OR: 3.1, CI: 1.7-5.7), and giving birth in a health facility (OR: 2.0, CI: 1.0-3.9). No significant association was found between enrollment and receiving postpartum or postnatal care within two days of the birth. Conclusion: Our study found that women who were poorest, were unable to read, or had many children encountered barriers making them less likely to participate in an mHealth program in Timor-Leste. Other mHealth programs may need to take extra steps to reach out to such women so that they too can benefit from the critical health services being promoted. By contrast, certain groups expected to participate at lower rates overcame barriers to participation, including women who were older, lived far from a health facility, did not own their own phone, and did not have reception in their home. Finally, we found that enrollment in this mHealth program was associated with substantial benefits to participants, including an increased likelihood of attending at least four antenatal care visits, utilizing a skilled birth attendant, and giving birth in a health facility. Barriers to women’s enrollment in mHealth programs should be addressed to maximize the benefit to all women.