Feasibility and effectiveness of a smartphone access program for promoting engagement in care among perinatal people with substance use disorders: a pilot study.

Introduction: Pregnant and postpartum people with substance use disorders (SUD) experience high rates of morbidity and mortality, especially postpartum. For this vulnerable group, lack of access to a phone contributes to poor engagement in perinatal care. This paper describes initial work evaluating the implementation of a free smartphone program for rural pregnant patients with SUD and its effectiveness for improving participation in care.

Methods: This retrospective type I hybrid-effectiveness cohort study evaluated program effectiveness, acceptability, and feasibility of implementation in obstetric practice. Semi-structured interviews with patients, providers and obstetric staff (n = 8) explored implementation success. Data on phone utilization, engagement in care and outcomes were abstracted from electronic health records and compared among three cohorts (Cohort 1: patients with SUD who received phones; Cohort 2: patients with SUD not receiving phones; Cohort 3: Patients without SUD). Kruskal-Wallis and chi-squared/Fisher's Exact tests were utilized for comparisons.

Results: Providers, staff, and patients universally found the smartphone access program useful, perceiving that it improved patient engagement in digital and in-clinic care. From 2021 to 2024, 44 patients with SUD participated in the smartphone program for an average of 162 days. Cohort 1 entered prenatal care later, attended fewer prenatal visits, and were more likely to have psychiatric comorbidity than Cohorts 2 and 3. After receiving a smartphone, there were no differences in postpartum visits between cohorts, and higher rates of behavioral health and recovery support for Cohort 1.

Discussion: In a rural obstetric clinic, implementing a free smartphone program for perinatal patients with SUD was feasible and acceptable. Though there was no difference in prenatal care utilization, patients who received a smartphone engaged in robust postpartum care and behavioral healthcare utilization. Addressing digital disparities is an essential component of health equity.