A m-health intervention in the maternal care pathway: protocol for the impact evaluation of hAPPyMamma (Preprint)

Background: M-health has a great potentiality in both improving quality and efficiency of care, and in increasing health literacy and empowerment of patients-users. There are several studies related to the introduction on m-health tools for supporting pregnancy and the post-natal period, with promising but not still rigorously evaluated impacts. This article contributes to the literature, by presenting an m-health intervention (the mobile app called “hAPPyMamma”) applied in the maternal and child care of a high-income country (in a pilot area of Tuscany Region, Italy) and the methods adopted for evaluating its impact. Objective: The final aim of the introduction of this m-health app in the maternal care pathway is to promote the health of pregnant women and of their children and to improve their experience of care. Methods: This study is based on a quasi-experimental design that compares two groups: women who use the app (intervention group) and women who do not use the app (control group). The data concerning the measures of the maternal health literacy and the empowerment are collected prospectively in order to be able to perform a difference in difference analysis. In the post-partum period also data on women’s experience in the maternal care pathway are collected from both groups and data on the experience of the hAPPyMamma use are collected only within the intervention group. The organisational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results: The recruitment of the two samples was carried out with the same procedure in 2017, and was subsequent: first, the control group, and after some months, the intervention group. 177 women were enrolled in the control group; out of them, 170 answered to the first web questionnaire and 114 to second one. 150 women were enrolled in the intervention group; out of them, 100 women answered the first web questionnaire and 90 the second one. Data collection was completed in April 2018. Data analysis is underway. Conclusions: This study evaluates the implementation of the m-health intervention hAPPyMamma and describes its impact at individual and organisational level, in terms of the improvement of maternal health literacy, the access to and the utilisation of healthcare services during the maternal care pathway. This study contributes to define the potential role of this m-health tool in maternal care pathway in Tuscany Region and consequently in the Italian context, and the possible extension of its implementation.