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. 2014 Sep 2;9(9):e106383.
doi: 10.1371/journal.pone.0106383. eCollection 2014.

Developing content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study

Thomas A Odeny  1 , Maya Newman  2 , Elizabeth A Bukusi  3 , R Scott McClelland  4 , Craig R Cohen  5 , Carol S Camlin  6
Affiliations

Developing content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study

Thomas A Odeny et al. PLoS One. .

Abstract

Background: Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT) of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps.

Methods: We conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women's engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM) and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention.

Results: Findings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important "cue to action." Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women's motivation to attend clinic for childhood immunizations.

Conclusions: Applying a multi-stage content development approach to crafting text messages--informed by behavioral theory--resulted in message content that was consistent across different focus groups. This approach could help answer "why" and "how" text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial.

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Conflict of interest statement

Competing Interests: Craig R. Cohen declares the following: Financial competing interests include but are not limited to: Paid employment or consultancy: Dr. Cohen served as a paid consultant for CerMed Inc. to help them develop a barrier contraceptive/HIV prevention device. This consultancy ended in 2012. Research grants (from any source, restricted or unrestricted): Dr. Cohen has active grants from the US NIH, CDC, and Bill & Melinda Gates Foundation. Travel grants and honoraria for speaking or participation at meetings: Dr. Cohen received a travel grant to consult with Gynuity on a study they conducted to investigate infections following medical abortion in the US. Non-financial Professional interests: Acting as an expert witness: Dr. Cohen has served as an expert witness on a case in New York City involving a malpractice suit of a woman who died after delivery due to infectious complications. Membership in a government or other advisory board: Dr. Cohen was a non-paid consultant on a WHO panel to assess the risk of hormonal contraception and HIV acquisition in women. All other authors have declared that no competing interests exist. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Process of crafting and refining text message content.
HBM, Health Belief Model; FGD, Focus Group Discussion.
See this image and copyright information in PMC

References

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