Using mHealth to Deliver Behavior Change Interventions Within Prenatal Care at Community Health Centers

Abstract

Purpose: To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption.

Design: A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4.

Setting: Women were recruited from six locations of federally funded health centers across three states.

Subjects: Participants (N = 335) were English- and Spanish-speaking women at up to 18 weeks gestation.

Intervention: The treatment group received three interactive sessions focused on two priority health behavior risks. The sessions offered individually tailored and stage-matched change strategies based on the transtheoretical model of behavior change. The usual care group received March of Dimes brochures.

Measures: The primary outcome was the number of behavior risks. Stage of change and continuous measures for all behaviors also were assessed.

Analysis: Data were analyzed across all time points using generalized estimating equations examining repeated measures effects.

Results: Women in the treatment group reported significantly fewer risks than those in usual care at 1 month (.85 vs. 1.20, odds ratio [OR] = .70) and 4 months postpartum (.72 vs. .91, OR = .81).

Conclusion: Healthy Pregnancy is an evidence-based and personalized program that assists pregnant women with reducing behavior risks and sustaining healthy lifestyle behaviors.

Trial registration: ClinicalTrials.gov NCT01997151.

Keywords: Fruit and Vegetable; Health Behavior; Health focus: nutrition; Manuscript format: research; Outcome measure: behavioral; Pregnancy; Prevention Research; Research purpose: intervention testing/program evaluation; Setting: clinical/health care; Smoking Cessation; Spanish speaking; Strategy: skill building/behavior change; Stress Management; Study design: randomized trial; Target population age: adults; Target population circumstance: underserved; Underserved Populations; multicultural; smoking control; stress management.