Context-driven mHealth solutions to improve maternal healthcare uptake in Ethiopia: Integrating stakeholder preferences and expert priorities using qualitative and nominal group techniques
- 1School of Public Health, Arba Minch University, Arba Minch, Ethiopia
- 2Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- 3Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
Abstract
Maternal continuum of care during pregnancy, childbirth, and the postpartum period is essential for reducing maternal and child morbidity and mortality, yet access remains limited in low- and middle-income countries. In Ethiopia, only about one-quarter of women complete the continuum of maternal healthcare. Although mobile health interventions have shown promise in improving access in resource-constrained settings, successful implementation depends on cultural appropriateness and alignment with local contexts. This study explored context-driven mobile health solutions and implementation challenges in Ethiopia by integrating stakeholder preferences with expert priorities. We conducted a qualitative exploratory and consensus-prioritization study involving interviews and focus group discussions with 72 perinatal women, male partners, and key informants, complemented by a nominal group technique workshop with 14 multidisciplinary experts. Data were collected in August 2025 using semi-structured guides in Gamoththo and Amharic. Qualitative data were analyzed using reflexive thematic analysis in NVivo, and descriptive statistics summarized expert rankings. Preferred mobile health components included video-based maternal health education, short message reminders with follow-up calls, and engagement of perinatal women with their spouses or support persons. Community health workers were identified as key to developing and sharing educational videos at women’s gatherings. Participants preferred reminders between sunrise and midday on the day before appointments. Expert rankings prioritized reminders with follow-up calls (93.1%), engagement of perinatal women and their support persons (91.7%), and reminder timing between sunrise and midday (95.6%). Integrating stakeholder perspectives with expert rankings showed consensus on locally acceptable mobile health components and identified implementation challenges, including limited device access, poor network coverage, and low digital literacy. These findings provide a foundation for the co-design, feasibility testing, and pilot evaluation of contextually tailored mobile health interventions to improve maternal healthcare. Future implementation should address barriers related to device access, digital literacy, network connectivity, cost, and collaboration with telecommunications providers. Author summary: Many women in Ethiopia do not receive all the healthcare services they need during pregnancy, childbirth, and the period after birth. Mobile health interventions, such as text message reminders and educational videos, may help women access these services. However, these interventions need to reflect local cultures, preferences, and practical circumstances to be effective. We explored how mobile health could better support maternal healthcare in Ethiopia. We collected views from 72 pregnant or postpartum women, male partners, and other key informants through interviews and group discussions. We also consulted 14 experts to identify and prioritize preferred approaches. Participants favored educational videos developed and shared by community health workers, text message reminders followed by telephone calls, and involving women’s spouses or other chosen support persons. They preferred receiving appointment reminders between sunrise and midday on the day before a scheduled visit. Experts also prioritized these approaches. However, limited access to mobile devices, poor network coverage, low digital literacy, and affordability may hinder implementation. These findings provide a foundation for developing and testing mobile health interventions that reflect local needs and preferences and could help improve continued use of maternal healthcare services in Ethiopia.
Related
- Exploration of best practices in the creation and dissemination of video vignettes in mental healthcare training: a qualitative analysis of multiple stakeholder perspectives across US psychosis services
- Challenges and barriers to integrating artificial intelligence in medical education and healthcare: a qualitative exploration
- Stakeholder Priorities for Functional Foods Intended for Children: An AHP Evaluation of Sensory, Health, Family, and Product Attributes.
- Smallholder farmers' preferences for public expenditure priorities to support maize productivity: evidence from a best–worst scaling experiment in western Kenya
- Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study
BibTeX
@article{teshale2026contextdriven,
title = {{Context-driven mHealth solutions to improve maternal healthcare uptake in Ethiopia: Integrating stakeholder preferences and expert priorities using qualitative and nominal group techniques}},
author = {Manaye Yihune Teshale and Mark Spigt and Yalemzer Agegnehu and Eden Hailegiorgis and Rik Crutzen and Sarah E. Stutterheim},
journal = {PLOS Digital Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pdig.0001817},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001817},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Context-driven mHealth solutions to improve maternal healthcare uptake in Ethiopia: Integrating stakeholder preferences and expert priorities using qualitative and nominal group techniques
AU - Manaye Yihune Teshale
AU - Mark Spigt
AU - Yalemzer Agegnehu
AU - Eden Hailegiorgis
AU - Rik Crutzen
AU - Sarah E. Stutterheim
PY - 2026
DA - 2026/11/05
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001817
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001817
AB - Maternal continuum of care during pregnancy, childbirth, and the postpartum period is essential for reducing maternal and child morbidity and mortality, yet access remains limited in low- and middle-income countries. In Ethiopia, only about one-quarter of women complete the continuum of maternal healthcare. Although mobile health interventions have shown promise in improving access in resource-constrained settings, successful implementation depends on cultural appropriateness and alignment with local contexts. This study explored context-driven mobile health solutions and implementation challenges in Ethiopia by integrating stakeholder preferences with expert priorities. We conducted a qualitative exploratory and consensus-prioritization study involving interviews and focus group discussions with 72 perinatal women, male partners, and key informants, complemented by a nominal group technique workshop with 14 multidisciplinary experts. Data were collected in August 2025 using semi-structured guides in Gamoththo and Amharic. Qualitative data were analyzed using reflexive thematic analysis in NVivo, and descriptive statistics summarized expert rankings. Preferred mobile health components included video-based maternal health education, short message reminders with follow-up calls, and engagement of perinatal women with their spouses or support persons. Community health workers were identified as key to developing and sharing educational videos at women’s gatherings. Participants preferred reminders between sunrise and midday on the day before appointments. Expert rankings prioritized reminders with follow-up calls (93.1%), engagement of perinatal women and their support persons (91.7%), and reminder timing between sunrise and midday (95.6%). Integrating stakeholder perspectives with expert rankings showed consensus on locally acceptable mobile health components and identified implementation challenges, including limited device access, poor network coverage, and low digital literacy. These findings provide a foundation for the co-design, feasibility testing, and pilot evaluation of contextually tailored mobile health interventions to improve maternal healthcare. Future implementation should address barriers related to device access, digital literacy, network connectivity, cost, and collaboration with telecommunications providers. Author summary: Many women in Ethiopia do not receive all the healthcare services they need during pregnancy, childbirth, and the period after birth. Mobile health interventions, such as text message reminders and educational videos, may help women access these services. However, these interventions need to reflect local cultures, preferences, and practical circumstances to be effective. We explored how mobile health could better support maternal healthcare in Ethiopia. We collected views from 72 pregnant or postpartum women, male partners, and other key informants through interviews and group discussions. We also consulted 14 experts to identify and prioritize preferred approaches. Participants favored educational videos developed and shared by community health workers, text message reminders followed by telephone calls, and involving women’s spouses or other chosen support persons. They preferred receiving appointment reminders between sunrise and midday on the day before a scheduled visit. Experts also prioritized these approaches. However, limited access to mobile devices, poor network coverage, low digital literacy, and affordability may hinder implementation. These findings provide a foundation for developing and testing mobile health interventions that reflect local needs and preferences and could help improve continued use of maternal healthcare services in Ethiopia.
SN - 2767-3170
ER -