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      Effect of a social media-based health education program on postnatal care (PNC) knowledge among pregnant women using smartphones in Dhulikhel hospital: A randomized controlled trial

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          Abstract

          Introduction

          Postnatal care services helps in detecting and subsequently managing life threatening complications. With the ubiquitous use of the mobile phone in Nepal, social media based postpartum education has the potential to increase PNC knowledge among pregnant women. This study aimed to assess the effect of social media-based health education program on PNC knowledge among pregnant women attending Dhulikhel hospital, Nepal.

          Materials and methods

          We conducted a two-arm open-label randomized controlled trial among literate pregnant women visiting Dhulikhel hospital for ANC check-up from May to August, 2021. A computer-based program allocated 229 pregnant women owning smartphones with internet connectivity in a 1:1 ratio to either intervention (n = 109) or usual care (n = 120). We assessed PNC knowledge in the participants by interviewing in-person or via phone. The intervention group received a 16 minutes video on PNC and the participants were reminded to view the video every week via telephone for a month. Control group received usual care. The primary outcome of the study was change in PNC knowledge score. We utilized intent-to-treat analysis and measured the effect of the intervention on PNC knowledge score using simple linear regression analysis.

          Results and discussion

          The mean PNC knowledge score increased by additional 8.07 points among pregnant women in the intervention group compared to the control group (95% CI: 2.35: 13.80; p-value = 0.006). The maternal care attribute knowledge increased by 4.31 points (95% CI: 1.51–7.10, p-value = 0.03) and newborn care attribute knowledge increased by 3.39 points (95% CI: 0.41–6.37, p-value = 0.02) among pregnant women in the intervention compared to the control group.

          Conclusion

          A social media-based health education is effective in improving PNC knowledge score among pregnant women. Further research is needed to evaluate if this increased knowledge is translated into the increased utilization of PNC care.

          Trial registration

          ClinicalTrials.gov ID: NCT05132608.

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          Most cited references36

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          Global causes of maternal death: a WHO systematic analysis.

          Lale Say, Doris Chou, Alison Gemmill … (2014)
          Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review. We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model. We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially. Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality. © 2014 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
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            Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review

            Stephanie Sondaal, Joyce Linda Browne, Mary Amoakoh-Coleman … (2016)
            Introduction Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC. Methods The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014–April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis. Results In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results. Conclusion mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth’s impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.
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              The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial

              Dejan Zurovac, Raymond K Sudoi, Willis S Akhwale … (2011)
              Summary Background Health workers' malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya. Methods From March 6, 2009, to May 31, 2010, we did a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. With a computer-generated sequence, health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months, or the control group, in which health workers did not receive any text messages. Health workers were not masked to the intervention, although patients were unaware of whether they were in an intervention or control facility. The primary outcome was correct management with artemether-lumefantrine, defined as a dichotomous composite indicator of treatment, dispensing, and counselling tasks concordant with Kenyan national guidelines. The primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, ISRCTN72328636. Findings 119 health workers received the intervention. Case-management practices were assessed for 2269 children who needed treatment (1157 in the intervention group and 1112 in the control group). Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points (95% CI 7·6–40·0; p=0·004) immediately after intervention and by 24·5 percentage-points (8·1–41·0; p=0·003) 6 months later. Interpretation In resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices. Funding The Wellcome Trust.
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                Author and article information

                Contributors
                Kalpana Chaudhary:
                ORCID: https://orcid.org/0000-0003-4882-6496
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draft
                Jyoti Nepal:
                ORCID: https://orcid.org/0000-0001-9911-6019
                Role: Project administrationRole: Writing – review & editing
                Kusum Shrestha: Role: Data curationRole: Writing – review & editing
                Manita Karmacharya: Role: Data curationRole: Writing – review & editing
                Dipesh Khadka: Role: Writing – review & editing
                Abha Shrestha: Role: ResourcesRole: Writing – review & editing
                Prabin Raj Shakya:
                ORCID: https://orcid.org/0000-0002-4824-2178
                Role: Writing – review & editing
                Shristi Rawal: Role: MethodologyRole: ResourcesRole: Writing – review & editing
                Archana Shrestha: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Miquel Vall-llosera Camps: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 20 January 2023
                Publication date Collection: 2023
                Volume: 18
                Issue: 1
                Electronic Location Identifier: e0280622
                Affiliations
                [1 ] Department of Public Health, Kathmandu University School of Medical Sciences, Panauti, Nepal
                [2 ] Department of Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
                [3 ] Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
                [4 ] Biomedical Knowledge Engineering Lab, Seoul National University, Seoul, Korea
                [5 ] Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, New Brunswick, NJ, United States of America
                [6 ] Institute for Implementation Science and Health, Kathmandu, Nepal
                [7 ] Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
                PLOS ONE, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-4882-6496
                https://orcid.org/0000-0001-9911-6019
                https://orcid.org/0000-0002-4824-2178
                Article
                Publisher ID: PONE-D-22-03664
                DOI: 10.1371/journal.pone.0280622
                PMC ID: 9858435
                PubMed ID: 36662821
                SO-VID: 81bdd089-9cb4-46ce-bba6-03b2c82323d0
                Copyright © © 2023 Chaudhary et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 20 February 2022
                Date accepted : 9 December 2022
                Page count
                Figures: 3, Tables: 9, Pages: 22
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Postpartum Care
                Subject: Postnatal Care
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Pregnancy
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Obstetrics and Gynecology
                Subject: Pregnancy
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Neonatal Care
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Neonatology
                Subject: Neonatal Care
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Neonatal Care
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Education and Awareness
                Subject: Biology and Life Sciences
                Subject: Developmental Biology
                Subject: Neonates
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Antenatal Care
                Subject: Engineering and Technology
                Subject: Equipment
                Subject: Communication Equipment
                Subject: Cell Phones
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Breast Feeding
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Neonatology
                Subject: Breast Feeding
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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