February 2007

MOBILE PHONE BASED PREGNANCY SUPPORT

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Being pregnant can be very challenging for mothers especially if they are expecting for the first time. Many rely on informal information that is passed down from one to another, which may not be accurate as experience from each pregnancy can be different from the other. Matters are made worse when information passed down is concocted with cultural taboo. However in this ICT age, accurate health information pertaining to pregnancy support system can be effectively addressed by the mobile phone technology.

Here we present the framework and prototype of mobile phone based pregnancy system, based on the preliminary study conducted among the pregnant mothers and their spouses, in a local private hospital and few maternity clinics. Mobile phone based pregnancy support can position itself as a major breakthrough approach by educating women on pregnancy, monitoring pregnant women and their fetus' progress, and providing follow up with medical checkups, critical updates and post delivery support through mobile phone. This can reduce the anxiety andstress among pregnant mothers. Women in rural areas can benefit through thissystem greatly while preparing forchild birth and post delivery.

The mobile age

In 2005, the number of users of mobile phone in the world was 2.2 billion, as compared to 1 billion Internet users (ITU, 2006). This phenomenal growth in mobile phone usage has created the opportunity for localised mobile content development to reach a wider public. With high speed and affordable rate, mobile phone subscribers are now able to get multimedia content such as movie clips and news. Availability of technology such as SmartFit, to reduce the size of the content for mobile display (Access, 2007), allows accurate health information to be easily delivered to even rural areas, where transportation and medical services are limited.

There are lots of pregnancy related information widely available in printed form, but usually the information is too general, lengthy and complicated. One of the many easy and fast ways to access information about pregnancy is the Internet. However, the information is generally focused on pregnancy in a western world setting. There are very few available pregnancy resources for population in other parts of the world. Other impediment towards accessing such cyber information is the lack of English language proficiency and computer literacy among a vast majority of people. Current trend in healthcare sector is to link patients, physicians and hospitals to provide optimized care to all patients. Greater importance is given to preventive care than curative medicine. This reduces cost, improves the quality of treatment and promotes knowledge sharing with physicians.

Mobile phone based pregnancy support can position itself as a major breakthrough approach by educating women on pregnancy, monitoring pregnant women and their foetus ' progress, and providing follow up with medical checkups, critical updates and post delivery support

InfoDev (2006), in its framework paper has highlighted that health-based websites has improved knowledge, behaviour and slowed the health decline among the users. Studies conducted in Peru, Egypt and Uganda have showed that the use of ICT has avoided maternal deaths. In South Africa, mobile phones were used to provide timely reminders to patients with tuberculosis (Infodev, 2006).

According to the Malaysian Health Facts, there are 122 government hospitals, 6 special medical institutions, 6 non government hospitals and 222 private hospitals for maternity and nursing. There are only 20,105 doctors in Malaysia with the doctor to population ratio being a not so encouraging 1 to 1,300 (MOH 2006). Thus it comes as no wonder that with 25 million population, Malaysia has a fairly high infant mortality rate of 10 in every 1000 births [UNICEF, 2005]. 

To reduce the infant mortality and morbidity issues, mobile phone based pregnancy support system can be an effective alternative to the Internet in Malaysia. By the third quarter of 2006, there were 21,853,000 cellular phone subscribers in Malaysia (MCMC, 2006), thanks to the rapid development of the local IT and telecommunication infrastructure as well as the competitiveness of mobile service providers. Though this number is inclusive of those subscribers with multiple phones and 6.3 percent of non Malaysian subscribers, which is a small group, there is no denying the fact that mobile phone has emerged as the most effective, easiest, simplest and popular mode of communicating and delivering of information in Malaysia.

The survey

A survey was conducted as a preliminary fact-finding method, among the pregnant ladies and their spouses, at a local private hospital and two maternity clinics in Petaling Jaya, Malaysia. Fifteen couples volunteered to participate in this survey.

The objectives of this survey were to find out the readiness of the pregnant mothers and their spouses to use mobile phone as a tool, to receive support during the pregnancy, and also the types of support expected. A conceptual model for the content development framework and suitable network architecture were drawn to facilitate the personalized pregnancy support. A prototype application for mobile phone was developed and tested, based on the initial findings.

Smart-Fit Rendering (Access, 2007) is one of the technologies available to adjust the contents and images according to the screen size. This is convenient and avoids unnecessary horizontal or vertical scrolling to see the full content for mobile phone models, which have smaller screen size.



The survey revealed that all the respondents used mobile phones and were interested in receiving pregnancy related health care information. 17 out of 30 respondents comprised of pregnant mothers, and the spouses used Internet as the source to seek pregnancy related information. The respondents were interested in getting information about medication during pregnancy, information about due date calculator, diet, health, stages of pregnancy, prenatal care, doctor check up reminders, and the nearest maternity clinics or hospital location.

A conceptual model is being formulated, based on the preliminary study conducted. The support system is divided into the following six modules as shown in the figure 1. The six modules are:

(i) Health Care

This module provides general healthcare information to pregnant mothers. This is to help them on what they should or should not do if they have fever, headache, stomach ache, common cold, etc. during the pregnancy period. This is necessary as the pregnant mothers should be careful of the common drugs that they take during pregnancy, which may harm the growing fetus in the womb. In addition, they can key in any illnesses that they have, such as asthma, diabetics, high blood pressure, etc. to allow the system to send information related to these during pregnancy. Drug and disease alerts that are harmful to pregnant ladies, based on their medical profile, can be posted from time to time. 

(ii) Emergency Care and Alerts

Sudden fall or accident can cause emergency situation during pregnancy. Emergency care information such as contact for hospital emergency unit or ambulance service is useful during panic state. The available clinics and hospitals that are located around the user's place can be traced. System allows the user to key in the numbers of the spouse, close relatives or friends, so that alert with special tone can be sent to them during emergency, with just one click. Health alerts affecting pregnancy from Ministry of Health and World Health Organisation (WHO), can be sent through this mode to create awareness, and also for preventive care.

(iii) Stages of Pregnancy

Due date calculator provides the stage of the pregnancy information to the expecting mother and the spouse, at set intervals, selected by the users of this system as shown in figure 3. It tracks the countdown days to the due date and advises the pregnant mother on the progress and changes happening to the child and her self. The stages are shown with graphics of the growing fetus in the womb, as shown in the figure 2.

(iv) Pregnancy Calendar and Diary

Pregnancy calender and diary is to keep track of the follow up appointments with doctor, reminders, record of weight gain during pregnancy and notes of events. This is also to assist the pregnant mother to take note of any abnormal changes and seek advise on time. In addition, ultrasound images captured through camera phone, music, tones and images related to pregnancy, can be stored if there is enough storage space in the phone.

(v) Nutrition and Exercise

This is important to mothers who normally have confusing statements from people stating certain food is good and certain others are harmful. General nutrition and hygiene information is provided for healthy pregnancy, and details can be obtained through query or website. Illustrative graphics are shown for simple exercise positions during pregnancy.

(vi) Post Delivery Support

Post delivery support is very important to all mothers as they need to cope with the new born baby and their recovery after the delivery. Caring for the new born can be tiring and frustrating to first time mothers, who are not sure on how to react or what to do when the baby cries.

Prototype of Pregnancy Support System

A prototype of pregnancy support system as in figure 4 was developed for mobile phone, based on the content model discussed above. Prototype was tested on the following mobile phone models:

1. Nokia 6670 and Nokia 7210 mobile phone models run on symbian operating system (OS). The content display was good and details of the graphical content were clear to view. However, the users need to scroll up and down to  see full images.

2. Sony Ericsson K750i mobile phone model has smaller screen size that does not allow left to right scrolling. Thus, the images could not be viewed fully.

Smart-Fit Rendering (Access, 2007) is one of the technologies available to adjust the contents and images according to the screen size. This is convenient and avoids unnecessary horizontal or vertical scrolling to see the full content for mobile phone models, which have smaller screen size. Images  which are larger than the screen width are adjusted according to the screen width. Tables larger than the screen are fragmented into small sizes vertically (Access, 2004).
Network Architecture

This system is accessed mainly through phone. The mobile application was developed to interact with mobile Internet platform, to send and receive short messages and alerts as shown in the figure 5. Current mobile messaging gateways support Enhanced Messaging Service (EMS), Multimedia Messaging Service (MMS) and Wireless Application Protocol (WAP). A web portal is developed to support the system with updates and provide more content rich information which can be accessed through Internet.

Pregnancy is not only challenging to mothers but it is stressful to fathers as well. Mobile phone based pregnancy support can position itself as a personalized approach to educate women on pregnancy, monitor their own and child's progress,and help them to follow up with medical checkups, critical updates and post delivery support through mobile phone.

With the availability of good mobile network infrastructure and mobile phone technologies, a support system that is available anytime and anywhere will help to reduce the stress and anxiety related to pregnancy and its complications. The system will assist the pregnant mother and her spouse to be aware of changes during pregnancy, and facilitate them to take necessary actions to prevent the unforeseen. Women in rural areas can benefit through this system greatly, while preparing for child birth and post delivery.

However, this is not the end of the story. Efforts to build on existing prototype and develop personalized content for pregnancy and healthcare in Malaysia will continue.  

References

1. Access (2004). Netfront for series 60: A whole lot of internet on your mobile phone, Access Systems Europe GmbH.

2. Access (2007). Smart-Fit Rendering, Access Co Ltd. http://www.access-lcompany.com/products/netfrontmobile/contentviewer/mcv_tips.htm

3. Bental DS, Cawsey A, Jones R (1999). Patient information systems that tailor to the individual. Patient Educ Couns., 36:171

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