Table 1.

Summary of included articles on mHealth interventions to increase use of antenatal care, postnatal care, and childhood immunization, classified by methods used.

First author, year	Title	Health issue(s) studied	Intervention studied and tools used	Intervention frequency	Key study outcomes	Methods used	Sample size	Study location	Study quality1
Randomized controlled trials (RCTs)
Fedha, 2014 [14]	“Impact of Mobile Telephone on Maternal Health Service Care: A Case of Njoro Division”	Antenatal care attendance	Text message reminders and educational messages for mother delivered to mobile phone. No specific mHealth tools mentioned	Appointment reminders every two weeks. Frequency of educational messages not specified	7.4% of women receiving SMS had less than 4 antenatal visits while 18.6% of those not receiving SMS had less than 4 visits (P = 0.002)	Clinic attendance and antenatal service uptake compared for intervention and control groups	Intervention group: 191 Control group: 206 Total: 397	Health facilities in Kenya	RCT with low risk of bias
Lund, 2014 [15]	“Mobile Phones Improve Antenatal Care Attendance in Zanzibar: A Cluster Randomized Controlled Trial”	Antenatal care attendance	Text message reminders and educational messages for mother delivered to mobile phone and mobile vouchers to contact health workers. Tools used: custom Wired Mothers software	Two messages per month before gestational week 36 and two messages per week after week 36	44% of women in the intervention group received the recommended four or more antenatal visits, compared with 31% in the control group. The odds for receiving four or more antenatal care visits were 2.39 (1.03–5.55) for women benefitting from the mobile phone intervention. 59% of intervention women stated that received text messages influenced the number of times they attended antenatal care	Clinic attendance was compared for cluster randomized intervention and control groups	Intervention group: 1311 Control group: 1239 Total: 2550	Urban and rural healthcare facilities in Zanzibar	RCT with low risk of bias
Studies with nonrandomized control group or before/after design
Adanikin, 2014 [16]	“Role of Reminder by Text Message in Enhancing Postnatal Clinic Attendance”	Postnatal care attendance	Text message reminders for mother delivered to mobile phone. No specific mHealth tools mentioned	Two messages sent for each appointment: two weeks prior and 5 days prior	Patients who received an SMS reminder were 50% less likely to fail to attend (FTA) their postnatal appointment (relative risk of FTA 0.50; 95% CI, 0.32–0.77; P = 0.002)	Clinic attendance compared for intervention group and historic control group (from previous 6 months)	Intervention group: 1126 Control group: 971 Total: 2097	Teaching hospital in Nigeria	7/9
Fang and Li, 2010 [27] from Corpman, 2013 [17]	“Mobile Health in China: A Review of Research and Programs in Medical Care, Health Education, and Public Health”	Antenatal care attendance	Text message appointment reminders and antenatal health advice. No specific mHealth tools mentioned	Four appointment reminders per pregnancy. Frequency of health advice not specified	The intervention group received 5.7 ± 1.8 antenatal visits, compared to 3.2 ± 1.1 antenatal visits in the control group (P < 0.01)	Clinic attendance compared for intervention group and historic control group (from previous year).	Intervention group: 609 Control group: 637 Total: 1246	China	Unable to determine as not all info. on study design is available in English
Kaewkungwal, 2010 [18]	“Application of Smart Phone in “Better Border Healthcare Program”: A Module for Mother and Child Care”	Antenatal care attendance and childhood immunization (EPI)	Smartphone application used by health workers to update antenatal and immunization status when outside clinic and SMS reminders for both health workers and mothers. Tools used: custom Mother and Child Care Module (MCCM)	Appointment reminders a few days prior to scheduled appointment	58.68% of pregnant women came to ANC on time after implementation as compared to 43.79% before (P < 0.001). After adjusting for personal characteristics, sending appointment message increased odds of on-time visit by 2.97 (1.60–5.54). 44.22% of children received scheduled vaccines on time after implementation as compared to 34.49% before (P < 0.001). After adjusting for personal characteristics, follow-up cases and updating immunization data on cell phones increased odds of on-time EPI by 2.04 (1.66–2.52). Sending appointment reminder increased odds of on-time EPI by 1.48 (1.09–2.03)	Clinic attendance for ANC and EPI were compared before and after MCCM implementation	ANC group: 280 EPI group: 544	Rural border area in Thailand, near Myanmar	8/9
Lau, 2014 [19]	“Antenatal Health Promotion via Short Message Service at a Midwife Obstetrics Unit in South Africa: A Mixed Methods Study”	Antenatal care attendance	Text messages with antenatal health information. No specific mHealth tools mentioned	Varied from three messages per week to daily messages	92% of participants in the intervention group reported not missing more than two antenatal visits. A focus group of intervention participants reported that they had improved health related behaviors, including attending the clinic regularly, as a result of the text messages. No statistically significant difference in knowledge was seen between the intervention and control groups at the exit interview	Baseline questionnaire and exit interview were administered to convenience-sampled intervention and control groups to assess knowledge of antenatal health and clinic procedures. A focus group was conducted with a further convenience sample of the intervention group	Intervention group: 102 but 45 were lost to follow-up Control group: 104 but 43 were lost to follow-up Total: 206 recruited, 118 included in analysis	Urban primary care facility in Cape Town, South Africa	4/9
Studies with no control group
Crawford, 2014 [20]	“SMS versus Voice Messaging to Deliver MNCH Communication in Rural Malawi: Assessment of Delivery Success and User Experience”	Antenatal care attendance, postnatal care attendance, and childhood immunization	Text (SMS) or voice message reminders and educational messages for mother delivered to mobile phone or retrieved by calling a toll-free hotline. Tools used: Village-Reach custom application (SMS) and INTELLIVR software (voice messages)	Once (voice) or twice (SMS) per week	91% of SMS enrollees surveyed reported that they had already changed or intended to change their behavior based on the messages, including attending more ANC/PNC or bringing their child for vaccines. SMS enrollees were significantly more likely to report intended or actual behavior change than voice enrollees	Phone based surveys of participants. Participants in the pushed SMS and pushed voice groups were randomly sampled but participants in the retrieved voice group were convenience sampled	Pushed SMS: 96 Pushed voice: 30 Retrieved voice: 140 Total: 266	Rural health centers in Malawi	2/9
Mbabazi, 2014 [21]	“Innovations in Communication Technologies for Measles Supplemental Immunization Activities: Lessons from Kenya Measles Vaccination Campaign, November 2012”	Childhood immunization	Smartphone application used by volunteers to update immunization records when canvassing door-to-door and to provide text message and phone call reminders to caretakers. Tools used: EpiSurveyor	Varied/as needed	In precampaign house-to-house visits, 25% of households had no plans to bring their children for the measles supplemental dose if they had not been contacted by the volunteers. Of the children found in the postcampaign house visits, 96% reported to have received a measles supplemental immunization dose, although only 92% had confirmation (finger mark) of vaccination	Precampaign household canvassing and data collection for entire target population, followed by postcampaign verification of vaccine coverage	Precampaign: 164,643 households with 161,695 children Postcampaign: 17,627 households with 17,993 children	Urban areas in Kenya	5/9
Ngabo, 2012 [22]	“Designing and Implementing an Innovative SMS-based Alert System (RapidSMS-MCH) to Monitor Pregnancy and Reduce Maternal and Child Deaths in Rwanda”	Antenatal care attendance	Electronic registration of pregnant women through text messages by community health workers (CHWs) and reminder text messages for antenatal care sent to CHWs' mobile phones. Tools used: customized version of RapidSMS	As needed for upcoming antenatal visits and estimated delivery date	81% of the estimated annual pregnancies in the district were registered in the system. Reporting compliance among CHWs was 100%. CHWs reported being more proactive in finding new pregnant women and following up registered pregnant women as a result of reminders forwarded to their mobile phones	Reporting compliance, system usage patterns, and error rates were monitored and feedback sessions were held with CHWs	CHWs: 432	Rural district of Rwanda	N/A, only process outcomes were studied
Wakadha, 2013 [23]	“The Feasibility of Using Mobile-Phone Based SMS Reminders and Conditional Cash Transfers to Improve Timely Immunization in Rural Kenya”	Childhood immunization	Text message reminders for mother delivered to mobile phone and free airtime or mobile cash transfers for mothers that brought child in on time. Tools used: customized version of RapidSMS and mPESA	Three days before vaccine due date and on due date	91% of mothers reported that the SMS reminders influenced their decision to come in for vaccination	Enrolled mothers were randomized to receive either mMoney or airtime for on-time vaccinations. Questionnaires were administered in home follow-up visits	mMoney group: 48 Airtime group: 24 Total: 72	Rural district of Kenya	4/9

¹Quality score assigned using the Cochrane Risk of Bias Assessment Tool (for RCTs) or the Newcastle-Ottawa Quality Assessment Scale (for observational studies). For RCTs, a low risk of bias is the best possible score and for observational studies the highest possible score is 9. Please see Section 2 for more details.