Although we live in an information and connected society, lack of access to verified information to prevent pregnancy complications continues to contribute to maternal deaths around the world, while the excess of unvalidated information, which has multiplied since the emergence of the internet, further aggravates the situation.
The Zero Mothers Die App (ZMD App) aims to tackle this issue by directly providing validated pre- and post-natal information directly to pregnant women and new mothers, localized to their language and cultural contexts by local healthcare professionals, and tailored according to their week of pregnancy or age of newborn to ensure relevancy of the information.
To bring the ZMD App to Brazil, the Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (Fernandes Figueira National Institute of Woman, Child and Adolescent Health), a public reference hospital for medium and high complexity/high fetal risk pregnancies, performed a cross-cultural adaptation of the ZMD App and a qualitative study on this adaptation.
The study was performed by a multidisciplinary research group composed of thirteen researchers: a pharmacist, a food engineer, a physiotherapist, a pediatrician, an obstetrician, a pediatric surgeon, a psychologist, a journalist, and nursing and health worker residents. Among them there were five PhD professionals, one doctoral candidate, and six were acting as preceptors in the residency courses at the hospital. The study also comprised an evaluation of the “e-pregnant woman”, their informational needs for the quality of life of both mother and baby, their installation and use of the ZMD App, which used a Grounded Theory approach. The adaptation and study ran from November 2017 to December 2018, during which data collection took place during 5 months across 109 pregnant women and mothers that agreed to download the ZMD App.
The results of the research showed that the source content of the ZMD App comprising the pre- and post-natal information were well-received by the research group and required minimal changes in order to adapt it to the Brazilian context. Adaptations that were applied related to bringing the content in line with national care guidelines, as well as changes related to HIV positive breast-feeding, Tuberculosis and umbilical cord clamping in certain scenarios.
The results of the study illustrate that the ZMD App was well received by the pregnant women in terms of content, application interface, interactivity and pregnancy and child management. On a scale of 1 to 5, with 5 representing the highest level of agreement by the respondent, the app received a mark of 4.06 for efficiency in the decision-making support, 4.0 in ease of understanding, 4.35 in ease of finding desired content in the app, 3.65 in ease of use, and 4.12 in applicability of the app’s information in the user’s daily life.
In terms of improvements, users indicated the desire to have more audiovisual and explanatory media together with the text (for example, on breastfeeding), the ability to store more information regarding their own pregnancy (such as photos, weight and frequency of kicks), community engagement (discussion groups, forum to ask questions, ability to connect and interact with other pregnant women) and reminders for pre-natal consultations. One major barrier to access was the lack of an iOS application to allow downloads on iPhones.
The Zero Mothers Die App is an open-source project that was built and is continuously expanded on through close collaboration and co-creation efforts with leading local health agencies on the ground, such as the Fundação Oswaldo Cruz (Oswaldo Cruz Foundation). All new features and content are made publicly available through free downloads of the ZMD App to give maximum access to all pregnant women, new mothers, family members and health workers that could benefit from the tool.
To find out more about the specific cross-cultural adaptation in Brazil and read about the results of the study, download the journal article here. To partner with us to bring the Zero Mothers App to your country through a co-investment approach, contact us.
SILVA, Angelica Baptista et al. Cross-cultural adaptation of the Zero Mothers Die (ZMD App) in Brazil: contributing to digital health with the approach on care centred for e-pregnant woman. Rev. Bras. Saude Mater. Infant. [online]. 2019, vol.19, n.4 [cited 2020-02-07], pp.751-762. Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292019000400751&lng=en&nrm=iso>. Epub Jan 13, 2020. ISSN 1519-3829. http://dx.doi.org/10.1590/1806-93042019000400002.