Using mHealth to Facilitate Family Planning

Authors: Lauren Thaxton, MD, MS and Rameet Singh, MD, MPH

The Importance of Contraceptive Counseling During the Antenatal Period

Addressing birth spacing and desired family size is an essential part of reproductive healthcare. Contraception empowers persons to plan and space births out, or prevent future pregnancies based on their desires. Planning and spacing pregnancies is important for many reasons. Healthy birth spacing enables persons seeking another pregnancy to replace nutrient stores, achieve physical recovery, and bond with their baby, while family units optimize financial and psychological health. The ideal time to discuss postpartum contraception is during prenatal care visits.

Antenatal contraceptive counseling using evidence-based information empowers patients to make decisions about their health after the delivery of their baby. The postpartum period is rife with sleep deprivation, breastfeeding challenges, emotional, physical, and social changes, fatigue, and learning to feed and care for a newborn. Initiating a conversation about contraception immediately after delivery or at the postpartum visit is not patient-centered. Additionally, by some estimates, as many as 40 percent of persons who have given birth do not attend a postpartum visit. Populations with limited resources and less access to healthcare have even lower attendance rates which further contributes to, and exacerbates health disparities.

Leveraging Technology to Facilitate and Support Family Planning

The current prenatal care model created several decades ago persists today with recommendations for eight to 12 visits over the course of a pregnancy. However, studies suggest alternative practice models could improve access and patient related outcomes, and reduce health disparities.

Technology applications have played a limited role in the provision of prenatal care in the US. The recent coronavirus pandemic upended the delivery of prenatal care in 2020. Suddenly, providers and practices were forced to reduce the total number of in-person visits and shift to virtual care and hybrid care options, which necessitated the incorporation of technology in multiple aspects. Prenatal care provision started meeting patients where they live their digital lives – their mobile smart devices.

A Deloitte 2018 survey of US healthcare consumers noted high rates of smartphone (86 percent) and tablet (72 percent) ownership which also held true in Medicaid program populations. The survey also confirmed people in the US use mobile technologies for healthcare purposes and are interested in trying new digital health applications.

Limited evidence suggests that mobile phone-based interventions may increase contraceptive knowledge. A series of voice messages and counsellor support improved contraceptive use among women seeking abortion services and desiring pregnancy prevention in one study. Another study showed that daily educational text messages improved the continued use of the contraceptive pill. Researchers from Columbia University Medical Center found that adolescents presenting to the emergency department were accepting of educational and motivational contraceptive health texts; 83% of participants replied to one or more texts, 94% liked the messages, 83% would recommend the program, and 46% started hormonal contraception. A randomized controlled trial in a low to middle-income country assessed the effect of unidirectional and bidirectional texting versus no intervention on exclusive breastfeeding (EBF) and early postpartum contraception; One-way and two-way SMS (short message service) improved EBF and early contraceptive use.

The Role of Patient Engagement Software in Postpartum Contraception

In a study where phone calls were used to follow-up and address teenagers’ concerns about contraception to facilitate continuation, counselors made 7.8 attempts for every completed call. On the contrary, patient engagement software can use a variety of strategies to educate and nudge women including text or voice messages, videos, links, and unidirectional or bidirectional communication. A series of messages delivered over a period of time to the patient’s mobile device offers care teams an innovative, interesting, tailored, and motivating tool to influence contraceptive knowledge and use. They can avoid bombarding patients with non-interactive, repetitive, or inconveniently timed messages. This kind of engagement can also expand access for patients who have barriers to services including geographic location, social or financial inequities, privacy concerns, and more.

Patient engagement technologies can improve contraceptive knowledge and support informed decision-making in contraceptive choice. Additionally, these platforms provide real-time data about when and how often patients are opening texts, how much time they are spending reading educational information, and how satisfied they are with the content. This data can then be used to rapidly modify engagement protocols and drive personalized outreach specifically prioritizing an individual’s preferences, values, and needs in contraceptive-related communication. Platforms that are further integrated with electronic health record systems and clinical team workflow tools could provide additional benefits including alerts and escalation when patients require intervention, links to schedule appointments, requests for prescriptions or refills, etc.

Combining the care of a trusted healthcare provider with convenient digital communication can provide women with the information and resources they need before, during, and after pregnancy, ensuring they are empowered and knowledgeable regarding their reproductive health.

Patient engagement software can bridge many gaps in women’s healthcare, giving women a close connection to the care team between in person visits. If you want to learn more, contact Twistle at info@twistle.com.

Webinar: Reducing Health Inequities

ChristianaCare’s Matthew Hoffman, MD, MPH, FACOG presents the clinical challenges among postpartum women and his research-based strategies to close gaps in healthcare disparities for women in disadvantaged communities.

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