A tailored mHealth intervention for improving antenatal care seeking and its determinants among pregnant adolescent girls and young women in South Africa: pilot randomized controlled trial (Preprint)

BACKGROUND Adolescent pregnancy is of public health concern in low- and middle-income countries due to the high rates of pregnancy-related complications and lower antenatal attendance rates among adolescent girls and young women (AGYW). Mobile health (mHealth) interventions have the potential to improve health behaviours during pregnancy and thereby birth outcomes. OBJECTIVE This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant AGYW in South Africa. METHODS The ‘Teen MomConnect’ intervention entailed both fixed and two-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviours. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS’s to pregnant women in South Africa. Pregnant AGYW aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session from a trained research assistant. Questionnaires were administered at baseline and at follow-up after the end of the participants’ pregnancies. Appointment attendance data was obtained from clinic records. ANOVA, ANCOVA and logistic regression models assessed the differences in appointments attended, awareness of HIV status and the psychosocial determinants of antenatal attendance between the control and experimental groups. RESULTS 412 AGYW were enrolled of which 254 (62%) completed the post-test survey (64% control, 59% intervention). Patient record data was obtained for 222 of the 412 participants (54%; in both control and intervention). 84% and 72% rated the intervention messages highly in terms of the value of the content and their motivational nature for behaviour change respectively. Participants responded to an average of 20% of the interactive messages they received. The mean number of appointments attended did not differ significantly between the experimental group (4.86, SD:1.76) and control group (4.79, SD:1.74) (p=0.791). Appointment attendance was higher among intervention participants who responded to ≥50% of messages (“high-responders”) (5.08, SD:1.66) than intervention participants who responded to fewer messages (4.82, SD:1.79) and control group participants (4.79, SD:1.74) (p=0.855). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD: 3.17) than the control group (0.7, SD: 2.73) (β=1.50, p=0.045). CONCLUSIONS Engagement with the intervention’s two-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherences. CLINICALTRIAL Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 INTERNATIONAL REGISTERED REPORT RR2-10.2196/43654