Effects of postpartum mobile phone-based education on maternal and infant health in Ecuador.

OBJECTIVE: To evaluate the effects of a mobile phone-based intervention on postnatal maternal health behavior and maternal and infant health in a middle-income country. METHODS: A prospective evaluation enrolled consecutive postpartum women at two public hospitals in Quito, Ecuador, between June and August 2012. Inclusion criteria were live birth, no neonatal intensive care admission, and Spanish speaking. Intervention and control groups were assigned via random number generation. The intervention included a telephone-delivered educational session and phone/text access to a nurse for 30days after delivery. Maternal and infant health indicators were recorded at delivery and 3months after delivery via chart review and written/telephone-administered survey. RESULTS: Overall, 102 women were assigned to the intervention group and 76 to the control group. At 3months, intervention participants were more likely to attend the infant's postnatal check-up (P=0.022) and to breastfeed exclusively (P=0.005), and less likely to feed formula (P=0.016). They used more effective forms of contraception (more implants P=0.023; fewer condoms P=0.036) and reported fewer infant illnesses (P=0.010). There were no differences in maternal acute illness or check-up attendance. CONCLUSION: Mobile phone-based postnatal patient education is a promising strategy for improving breastfeeding, contraceptive use, and infant health in low-resource settings; different strategies are needed to influence postpartum maternal health behavior.

Engaging patients via mobile phone technology to assist follow-up after hospitalization in Quito, Ecuador.

OBJECTIVE: Disease management following hospital discharge is difficult in most low-resourced areas, posing a major obstacle to health equity. Although mobile phones are a ubiquitous and promising technology to facilitate healthcare access, few studies have tested the acceptability and feasibility of patients themselves using the devices for assisting linkages to healthcare services. We hypothesized that patients would use mobile phones to help manage postdischarge problems, if given a communication protocol. We developed a mobile phone-based program and investigated its acceptability and feasibility as a method of delivering posthospitalization care. SUBJECTS AND METHODS: A consecutive cohort of adult patients in a public hospital in Quito, Ecuador was enrolled over a 1-month period. A hospital-based nurse relayed patients' discharge instructions to a community-based nurse. Patients corresponded with this nurse via text messaging and phone calls according to a protocol to initiate and participate in follow-up. RESULTS: Eighty-nine percent of eligible patients participated. Ninety-seven percent of participants completed at least one contact with the nurse; 81% initiated contact themselves. Nurses completed 262 contacts with 32 patients, clarifying discharge instructions, providing preventive education, and facilitating clinic appointments. By this method, 87% of patients were successfully linked to follow-up appointments. CONCLUSIONS: High levels of patient participation and successful delivery of follow-up services indicate the mobile phone program's acceptability and feasibility for facilitating posthospitalization follow-up. Patients actively used mobile phones to interact with nurses, enabling the provision of posthospitalization medical advice and facilitate community-based care via mobile phone.