Table 1 Summary of studies of digital technology-enabled health interventions (mHealth and Telehealth) implemented during the coronavirus crisis to support pregnancy care, globally
Authors | Publication year | Origin | Intervention (s) | Facilitators | Study design | Study population, age, Sample size | Context for facilitators | Outcomes |
|---|---|---|---|---|---|---|---|---|
mHealth for mental and physical wellness (6 studies) | ||||||||
Pregnancy | ||||||||
Kiani & Pirzadeh [96] | 2021 | Iran | Physical activity educational intervention delivered via mobile app to increase physical activities in pregnant women during the coronavirus crisis. | Perceived app benefits: motivational content and images that emphasize both physical and psychological benefits. | Quasi-experimental study | 93 pregnant women aged 16–20 weeks of gestation participating in the childbirth preparation classes. | Training on how to use the application, app did not require an Internet connection. | Mobile Apps increased scores of perceived benefits, barriers, social support, enjoyment, and improved levels of physical activity in pregnant women. |
Smith et al. [97] | 2021 | USA | Consumer-based mobile phone meditation application (app) to help pregnant women self-manage stress and anxiety. | Satisfaction with the Calm app, and easy to use. | Randomized Controlled Trial | Pregnant women 18 years and older with confirmed pregnancy between 14 and 34 weeks of gestation attending a university outpatient clinic of obstetrics and gynecology. | Ability to regularly access a smart device, self-reported use of app; Training on how to download and use the mobile app. | Women who used the prescribed consumer-based mobile meditation app during the coronavirus crisis had significant reductions in perceived stress, depression, anxiety, and sleep disturbance compared with standard care. |
Kubo et al. [98] | 2021 | USA | Self-paced, guided mindfulness meditations provided through a website or mobile application (iOS and Android) Headspace™ app to improve adherence and efficacy in pregnant women. | Convenience of the intervention; ease of use and the short dosage (10–20 min a day). | Single-arm trial | 27 pregnant women age ≥ 18 years with moderate-to-moderately severe depression symptoms and < 28 weeks of gestation identified through the electronic health records, and self- or clinician-referral from obstetrics and gynecology clinical staff or study brochures. | Access to a smartphone, tablet, and/or computer with Internet connection. | Improvements observed in pre-postintervention scores for depression symptoms, perceived stress, sleep disturbance, and mindfulness; over half of participants used the app ≥50% of the days during the 6-week intervention. |
Postpartum period | ||||||||
Avalos et al. [49] | 2020 | USA | Self-paced, guided mindfulness meditation training delivered via mobile app Headspace™ app (iOS and Android) or website to deepen mindfulness and encourage routine use in postpartum women. | Convenience of the intervention delivered via commercially available mindfulness app (headspace). | Mixed methods single-arm feasibility trial | 13 women aged 18 years; within 6 months of giving birth, with moderate to moderately severe depressive symptom was recruited via electronic health records, self- or clinician referral in obstetrics and gynecology clinics. | Seeking standard postpartum care and access to a smartphone, tablet, or computer with internet access. | Preliminary efficacy and improvement in depression symptoms, perceived stress, sleep quality, and mindfulness in postpartum women with moderate to moderately severe symptoms of PPD. |
Dol et al. [99] | 2021 | Canada | Six-week postpartum mobile phone text message program “Essential Coaching for Every Mother” to improve women’s psychosocial outcomes in the immediate postpartum period. | Acceptability of the program in terms of timing and content; perceived support from the providers. | Prospective pre-post study | 88 first time mothers aged 18 years and older between 37 weeks’ gestation or those who gave birth over a three-month period at the study clinic. | Daily access to a mobile phone with text message capabilities. | Essential Coaching for Every Mother mHealth intervention improved maternal self-efficacy and decreasing anxiety: baseline compared to follow-up |
Jayasinghe et al. [69] | 2022 | Sri Lanka | Telephone interviews providing psychological support to pregnant and postpartum women during the pandemic. | Better access to health care; selection bias | Large-scale, population-based pregnancy cohort | 1438 (42.6%) pregnant women. | Availability of mobile phone and fixed access to phones; availability of trained interviewees. | 476 (33.1%) of interviewed women used messaging apps to receive health messages such as WhatsApp, Viber, IMO, and Facebook Messenger. |
mHealth for health promotion, tracking and education (5 studies) | ||||||||
Pre-pregnancy | ||||||||
Leight et al. [100] | 2022 | Mozambique | Short text message reminders designed to encourage uptake of health facility visits for family planning counselling. | Reminder support; timely clinic visits. | Two arm randomized controlled trial | 5623 women of reproductive age who received a referral from a community health worker to visit a health clinic for a family planning consultation. | Availability of a phone number on patient record; PSI-provided smartphone to access the platform. | The effect of the text reminders were positive and statistically significant. Women who received text reminders more likely to visit a clinic, report receiving a contraceptive method at a clinic and prompt visit to a clinic (conditional on ever reporting a visit). |
During Pregnancy | ||||||||
Krishnamurti et al. [101] | 2021 | USA | Prenatal care app based intimate partner violence (IVP) self-screening tool (MyHealthyPregnancy app to encourage continuation of screening and receiving of support services. | Willingness to disclose IPV experiences through an app; social isolation; perceived support. | Quality Improvement Pilot Study | 552 pregnant women who used the app during an in-person visit. | Presence of clinical education team; availability of Apple v.1.4.7 and Android v.1.8. | App-based screening captured a distinct set of at risk IPV patients, complementing in-person assessments. Incidence of IPV slightly increased during the shelter-in-place order. |
Varnfield et al. [102] | 2021 | Australia | mHealth platform M♡THer for gestational diabetes mellitus management in pregnancy. | Acceptability of the platform by women; faster interventions. | Evaluation design | 23 women with a first-time diagnosis of gestational diabetes mellitus; between 24 and 28 weeks of gestation; at least 16 years old were recruited at a study hospital. | Ownership and ability to use a smart mobile phone | Satisfaction and ease of use of the mHealth platform, with technological challenges around wireless connectivity. |
Moulaei et al. [103] | 2021 | Iran | Mobile-based application developed using Java programming language in an Android Studio programming environment to support self-care and self-management for preeclampsia in pregnancy. | Perceived knowledge and better attitude towards COVID-19 and preeclampsia. | User centered design | 10 pregnant women (with/without preeclampsia, and with/without COVID-19 infection) and 10 doctors in affiliate hospitals and medical centers. | Availability of mobile devices with Android operating systems. | Pregnant women rated the usability of the application at a satisfactory level. |
Moulaei et al. [104] | 2021 | Iran | Smart phone-based self-care application developed to help pregnant women against the coronavirus. Educational needs provided via different methods (e.g., texts, educational videos, audios). | Perceived usability; user satisfaction with data elements, educational information needs, functions, and lifestyle information. | Descriptive applied study conducted in two phases | 36 pregnant women (> 8 weeks, gestational age 20–50); 11 had a coronavirus diagnosis and without exceptional care, partial or absolute rest recruited at affiliated hospitals. | Daily use of smartphone. | With an average score of 7.94 (out of 9), pregnant women rated the application at a satisfactory level. |
mHealth for parenting support (5 studies) | ||||||||
Pregnancy | ||||||||
Ceballos et al. [105] | 2020 | Guatemala | Text messages (SMS) reminders and phone calls to encourage individuals to visit the health center to monitor the provision of health and nutrition interventions linked to the first 1000 days of life (exclusive breastfeeding, vitamin A, powdered micronutrients, and vaccines). | Availability of health services; absence of social conflicts. | Clustered randomized controlled trial (cRCT) | 1542 households with pregnant women and children under two years old who receive key health and nutrition interventions from local public health centers. | Access to mobile phone, presence of at least one child under two years old or one pregnant woman; monthly airtime top-ups. | Response rate to phone calls was 5 times higher compared to text messages (75.8% vs. 14.4%). The cost for mobile phone call reminders were cheaper than that of SMS. |
Rhodes et al. [106] | 2020 | UK | Baby Buddy, a pregnancy and parenting app provides trusted, evidence-based information and self-care tools to help expectant and new parents through pregnancy and the first 24 weeks of parenthood (e.g., being pregnant or parenting a young baby, mood, levels of anxiety, key concerns). | Low literacy level requirements and extensive video content; accessibility to people not in education, training, or employment and those who do not speak English. | Service evaluation study | 436 expectant (n = 244, 56.0%) and recent (n = 192, 44.0%) parents age < 21- older than 45 years who were Baby Buddy app users. | Smartphone ownership: app is free to download and available in all app stores. | 97% (423/436) of respondents reported that Baby Buddy was currently helping them. Greater speed in updating digital content to reflect changes due to the pandemic. |
Wulandari et al. [107] | 2022 | Indonesia | Interactive mHealth message intervention via flyers (text, images), videos, and assistance (consultation, discussion, sharing, and question and answer) to improve safe and effective postpartum care. | Perceived easiness to understanding shared information; increased knowledge; existence of communication, interaction, social networks, and the impact of the use of social media. | Quasi-experimental design | 46 pairs of pregnant women (gestational age 28–34 weeks) and their husbands were selected purposively from data on pregnancy visits at the Community Health Center. | Availability of mobile phone with WhatsApp application | Knowledge of mothers and husbands increased on post-partum care, and so was improvement in the mother’s practices related to postpartum visits. |
Postpartum period | ||||||||
Shorey et al. [108] | 2021 | Singapore | Supportive Parenting App (SPA, iOS, and Android) development procedure to provide perinatal educational intervention for couples with healthy infants. | Adequate time; financial budgeting and team cohesion. | Multistage iterative development process, and information systems research framework | 10 new parents and research team members (app developers, clinicians, and research assistants). | Availability of smartphone with internet access. | Documented the technical details of the SPA and intervention highlights the key aspects needed for future app development. |
Quifer-Rada et al. [109] | 2022 | Not clear | Automated breastfeeding consultation system on LactApp, an mHealth Solution for breastfeeding support | Free mobile app. Self-administered tools; functionalities of breastfeeding monitoring; breastfeeding tests and personalized plans. | Observational, descriptive, and retrospective study | 137,327 active users | Availability of email of registered users, demographic factors of mother and baby. | Active users increased by 12, 092; topics of interest for consultations varied but include growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight. |
Telehealth for mental and physical wellness (2 studies) | ||||||||
Pregnancy | ||||||||
Hashemzahi et al. [110] | 2022 | Iran | Self-care training via telemedicine to help mothers familiarize with, manage, and follow up risk symptoms, and to reduce their own stress and anxiety. Audio PowerPoints turned into video content, sent through WhatsApp messenger. | Quasi-experimental study | 100 pregnant women aged 18–49 years, with gestational age of 20–28 weeks and referred to comprehensive health centers for pregnancy-related complications and COVID-19 infection. | Having a mobile phone or PC and the ability to use them for Internet access | Findings show that telemedicine COVID-19 self-care training significantly reduced perceived stress, and anxiety in pregnant women including rising awareness about coronavirus and reducing false beliefs. | |
Silva-Jose et al. [111] | 2022 | Spain | Virtual supervised exercise program to increase maternal physical activity and improve health outcomes, with classes delivered in an online format using the Zoom platform. | Greater availability of time; home confinement; perceived sense of sense of social support | Evaluation design using semi-structured interviews | 24 women between 8 and 10 and 38–39 weeks of pregnancy and attending online fitness classes during the confinement period. | Access to the Zoom platform from home. | Pregnant women were receptive to online group exercise classes and liked the accessible option to accommodating physical activity during the pandemic. |
Telehealth for health promotion, tracking and education (4 studies) | ||||||||
Pregnancy | ||||||||
Oelmeier et al. [124] | 2022 | Germany | Prenatal counseling via Telemedicine: video consultations in a tertiary center for obstetric care that was a part of the larger open Video Service project on telemedicine. | Perceived satisfaction and feasibility. | Prospective single-center trial | 75 video consultations were carried out with patients requiring prenatal or pre-pregnancy counseling. | Being a part of a larger open Video Service project on telemedicine. | Patient satisfaction was high (95%, 71/75) but technical problems occurred in 37% (29/75) of the appointments. |
Nur et al. [112] | 2020 | Indonesia | Android-based electronic technology antenatal care (e-ANC) to enhance participation of midwives and pregnant women in antenatal care (e.g., counseling, high-risk early detection on pregnancy, and monitoring of Hb and Fe tablets). | Perceived privacy and confidentiality. | Quasi-experimental study using pre- and post-test experiments | 30 pregnant women (in 2nd trimester) ages < 20- > 35, and 20 midwives at areas around the Public Health Centers. | Capacity to use Android devices with the e-ANC feature, speak Indonesian | e-ANC increased prenatal care visits particularly counseling, high-risk early detection, monitoring Hb, and provision of Tablet Fe. |
Postpartum period | ||||||||
Palmer et al. [113] | 2021 | Australia | Telehealth integration into routine antenatal care and delivered via telephone or video conferencing compared to conventionally delivered care on pregnancy outcomes. | Perceived easy of self-monitoring, perceived technology, and communication of appointments support. | An interrupted time-series analysis | 2292 women who gave birth between April 20 and July 26, 2020, across a large health service, with large numbers of births assessed in both periods. | Availability of phone or internet with video; implementation of integrated antenatal care. | Telehealth successfully integrated into antenatal care, and it enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. |
Reisinger-Kindle et al. [114] | 2021 | USA | Maintenance of telehealth as an option for prenatal and postpartum visits after state-mandated restrictions eased. | Perceive significance in choice of appointment, perceived support from providers regarding use of phone systems, and mandatory virtual meetings. | Retrospective chart review of all pre- and post-natal care visits | 558 prenatal patients and 209 postpartum patients receiving prenatal or postpartum care at a large urban academic obstetrics and gynecology practice. | Availability of video equipment for those with video telehealth capabilities, and/or availability of audio-only telephone; primary language Spanish; Availability of trained providers. | The Reach of the intervention increased from baseline. Adoption was high, with all thirty providers using telehealth, and the telehealth found to be feasible and acceptable based on uptake. Effectiveness measures suggest potential for earlier diagnosis of prenatal conditions. |