Leveraging an mHealth App to Improve Maternal Outcomes in Michigan

January 22, 2024 - The United States is facing a maternal health crisis, with mortality rates that are three times the rate in most other high-income countries. Mitigating this crisis is a priority for healthcare stakeholders, including public health agencies, who are working not only to add and expand maternal health resources but also to raise awareness of these resources.

The most recent data from the Centers for Disease Control and Prevention (CDC) show that maternal deaths in the US have risen steadily over the past few years, from 754 in 2019 to 861 in 2020 to 1,205 in 2021. The maternal mortality rate jumped from 23.8 deaths per 100,000 live births in 2020 to 32.9 deaths in 2021.

Further, women of color are at an increased risk of maternal death. The maternal mortality rate for Black women was 69.9 deaths per 100,000 live births in 2021, 2.6 times the rate for White women, CDC data reveals.

Combatting this trenchant issue will require healthcare stakeholders at the national and state levels to implement interventions and provide access to maternal health-specific resources.

One such intervention is the partnership between the Michigan Department of Health and Human Services (MDHHS) and Royal Philips to provide Medicaid-eligible families access to the Philips Avent Pregnancy+ mobile application. One year after its launch, the app appears to be reaching those who need it most and boosting the use of state maternal health services.

MATERNAL HEALTH IN MICHIGAN

Like most other US states, Michigan is battling high maternal death and morbidity rates. Between 2015 and 2019, 443 maternal deaths were reported in Michigan, according to an MDHHS report. Of these, 77 were identified as pregnancy-related, with common causes including hemorrhage and sepsis, and 309 deaths were identified as pregnancy-associated, caused by accidental poisoning/drug overdose and other causes not directly related to pregnancy.

The report states that 63.6 percent of pregnancy-related deaths and 68 percent of pregnancy-associated deaths were preventable.

Further, of 100,880 live births in the state in 2022, 563 involved a maternal transfusion, and 319 involved the birthing person undergoing an unplanned operating room procedure following delivery, MDHHS data shows.

“In Michigan, as in the rest of the country, we have maternal and infant health outcomes that are not optimal, and we see disparate outcomes for many residents in our state,” said Dawn Shanafelt, MPA, BSN, RN, director of the Division of Maternal & Infant Health and director of Title V Maternal Child Health at MDHHS, in an interview with mHealthIntelligence. “Those residents identify as individuals who are Black, Hispanic, live in rural areas of the state, and our Indigenous populations, so we definitely know that there are variations.”

To improve maternal outcomes, MDHHS has implemented numerous initiatives. For instance, Michigan launched a doula initiative in January 2023 that covers doula services for Medicaid beneficiaries.

Michigan also offers a Home Visiting service, a free program that aims to provide extra support and training for parents and caregivers. Nurses, educators, and social workers work one-on-one with families in their homes or at a location of their choice.

However, Michigan residents often lack awareness of these resources. This is where the Philips Avent Pregnancy+ mobile app comes in.

“Connecting folks with information at their fingertips, providing them with links and resources that are helpful during the pre-pregnancy period and then throughout pregnancy and postpartum, is really, really important to us,” Shanafelt said.

THE PREGNANCY APP

The Pregnancy+ app provides various types of information, including 40 animated 3D models and interactive scenes relaying information about the fetus' weekly development. It also offers daily pregnancy information on diet, exercise, and labor and enables users to log medical and personal notes.

According to Dana Medema, head of personal health at Philips North America, apps are one of the most effective ways to get information into the hands of healthcare consumers, particularly younger generations.

“We just did some research around Gen Z, for example, on Gen Z women and their thoughts on health, and they are much more apt to go to TikTok and get health information than they are a doctor,” she said in an interview with mHealthIntelligence.

So, when Philips and MDHHS were in talks to make the app accessible to Medicaid-eligible birthing persons in Michigan, they decided to meet people where they are rather than redirect them elsewhere.

“Because the reality is no one's going to a government site to dig around and find information,” Medema said. “What they will do is they'll go to a site where they would've gone to anyways, whether that's a TikTok or, in our case, an app that people are aware of for information around pregnancy.”

The app is a consumer property that anybody can access through their smartphone’s app stores, but it also is customizable and can be tailored to specific institutions’ needs. For the partnership with MDHHS, Philips created content to raise awareness of the state-specific resources available for Medicaid-eligible families, including the doula and home visiting services.

Additionally, the organizations worked together to create articles on Women, Infants & Children (WIC) clinics, breastfeeding support, and vaccination recommendations.

DEPLOYMENT AND RESULTS

The organizations employed various strategies to get the customized app into Michiganders’ hands.

MDHHS let those providing home visiting services know that the app was available and encouraged them to tell their clients about it, said Shanafelt. The agency also shared the information about the app with local health departments across the state and with WIC and breastfeeding partners, including those clinicians seeing individuals during the prenatal and postpartum periods.

This word-of-mouth strategy appears to have worked, with the app reaching more than 32,000 Michigan families in the year since its launch. Of the 32,000, 12,600 were enrolled in or eligible for Medicaid. Additionally, 8,900 engaged with Michigan-specific content, and nearly 1,000 Medicaid-eligible individuals were connected to the state’s home visiting program through the app.

A user survey conducted at the 12-month mark also revealed that almost 80 percent said the app helped them become more aware of the resources available in Michigan, and 50 percent have used one or more of these resources after learning about them. Over half said they are planning to use these resources later, Shanafelt added.

MDHHS and Philips aim to increase the number of individuals using the app in Michigan by raising its visibility through community and clinical partners, such as WIC clinics. In addition, the organizations created a QR code that individuals can scan to download the app immediately.

Further, Philips hopes to raise awareness of the app and its efficacy in other states, pointing to Michigan’s experience.

“What we now have with the state of Michigan is a data point of, ‘Hey, this could work. This could help especially the most vulnerable population or populations. This could help them to ideally deliver full term, deliver healthy, both for mom and baby,’” Medema said. “What we need to have is that perfect sweet spot because in Michigan, you had a state that was passionate about it and committed to it, and then there's the passion and commitment from the Philips organization… it does take both parties wanting to come together and make this happen.”

Shanafelt believes that partnerships like this can help correct the power imbalances driven by health inequities. Ensuring apps like Pregnancy+ are tailored to and readily available for Medicaid and other vulnerable populations equips them with much-needed knowledge and access to resources.

“It really is an innovative way to improve outcomes by linking families to information, education, and services,” she said.