Digital Technology for Informed Choices at Childbirth in Brazil: A Randomized Controlled Trial

Abstract

Objective

To design and evaluate an information and communication intervention via a smartphone application that provides access to essential information on best practices and safety in maternity services.

Participants and Methods

A randomized controlled trial using a mobile application to recruit and deliver the intervention, conducted from October 31, 2020, through December 12, 2020. The study was offered to all users registered on the application who self-identified as women, with ages between 18 and 49 years, with at least 1 child, pregnant or interested in having children in the future. The primary outcome measured was increased participant engagement in seeking an active role and informed choices. Participants received information about best practices (intervention) or about diapers (control). The trial was registered on the Brazilian Clinical Trials Registry Platform, and the protocol was published according to CONSORT e-Health guidelines. Effect size was estimated by odds ratio, with CI and P values.

Results

In total, 20,608 users were invited to participate in the study; of 17,643 enrolled (85.6% of invited users), 13,969 (79.1% of enrolled participants) women completed the intervention stage and were included in the analyses; 7121 (50.9% of all women included) had up to high school level; and 5855 (41.9%) used both public and private services. The intervention group registered an increased engagement in seeking an active role or making informed choices (odds ratio, 2.06; P<.001). The intervention proved to be highly effective for all secondary outcomes, as well.

Conclusion

This affordable digital technology effectively promoted awareness of safer, empowered choices in childbirth care, facilitating the translation of evidence-based, rights-based knowledge from institutional guidelines and recommendations to a broader audience.

Trial Registration

Brazilian Registry of Clinical Trials Identifier: RBR-3g5f9f; WHO’s Unique Trial Identifier: UTN U1111-1255-8683.