1Department of Midwifery, Sekolah Tinggi Ilmu Kesehatan Sukabumi, Jawa Barat 43122, Indonesia
2School of Nursing and Applied Science, Lincoln University College, Wisma Lincoln, No. 12- 18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor Darul Ehsan, Malaysia
*Corresponding Author’s Email: susilawati@dosen.stikesmi.ac.id
Keywords: Anemia Prevention; mHealth Application; Mobile Health; Pregnancy; Qualitative Study
Anemia during pregnancy is a persistent public health issue, especially prevalent in low- and middle-income countries (LMICs). In these settings, where healthcare access is frequently constrained, mHealth technologies offer a promising and innovative solution to address this challenge. It is a major contributor to maternal morbidity, adverse pregnancy outcomes, and neonatal complications (WHO, 2019). Iron deficiency is the leading cause of anemia in pregnancy, affecting approximately 40% of pregnant women worldwide (Owais et al., 2021). This condition poses heightened risks for preterm birth, low birth weight, and perinatal mortality, highlighting the urgent need for effective prevention and management strategies (Garzon et al., 2020). Despite advancements in healthcare, barriers such as limited awareness, restricted access to medical services, and poor adherence to iron supplementation programs continue to impede progress in reducing the burden of anemia (Al-Marzouqi, Al-Za’abi & Al- Dhoani, 2024).
Mobile health (mHealth) technologies, particularly mobile applications, have shown great promise in improving healthcare delivery and outcomes across diverse populations (Gopalakrishnan et al., 2020). These platforms offer interactive tools for education, reminders, and behavioral support, effectively promoting health-related behaviors such as better dietary practices and improved medication adherence. In maternal healthcare, mHealth applications have proven effective in increasing antenatal care attendance, fostering healthy behaviors, and enhancing awareness of pregnancy-related complications (Ameyaw, Amoah & Ezezika,2024). However, there is a notable lack of focus on mobile applications specifically designed to address anemia prevention among pregnant women, leaving a critical gap in the existing body of research (Vellakkal & Singh, 2021).
The success of mHealth interventions depends largely on a thorough understanding of user needs, preferences, and contextual factors. Qualitative research is instrumental in uncovering these aspects, enabling the development of interventions that align with the target population’s beliefs, challenges, and cultural contexts (Bilal et al., 2024). Studies emphasise the importance of involving end-users and healthcare providers in the co-design process to improve usability, accessibility, and cultural relevance of mHealth solutions (Mbunge & Sibiya, 2024). This collaborative approach ensures the creation of practical and scalable interventions, particularly for resource-limited settings.
Despite the growing interest in mHealth for maternal health, critical gaps persist. Most existing mHealth tools focus broadly on maternal health or antenatal care without specifically addressing the prevention and management of anemia (Vellakkal & Singh, 2021). Additionally, there is limited qualitative research examining the barriers and facilitators that influence the adoption of mHealth solutions among pregnant women, especially in low- and middle-income countries (Al-Marzouqi, Al-Za’abi & Al-Dhoani, 2024). While mHealth tools such as mobile applications for antenatal care attendance have been developed, few have directly targeted iron deficiency anemia prevention, despite its known burden on maternal and neonatal health. Addressing these gaps is essential for designing user-centered applications tailored to the unique challenges of anemia prevention during pregnancy.
In Indonesia, cultural beliefs and low family involvement significantly affect anemia prevention among pregnant women. Misconceptions—such as avoiding iron-rich foods or skipping supplements—remain common and hinder adherence (Babah et al., 2024). Family support, particularly from husbands, has been shown to improve compliance with iron supplementation and diet (Juniarti, Yuriah & Sepriani, 2020). Thus, mHealth applications must be culturally sensitive and include educational content for both pregnant women and their families. This study aims to co-create a user-centered mobile application by exploring the perspectives of pregnant women and healthcare providers, thereby addressing a critical gap in mHealth research. These findings aim to bridge gaps in mHealth research by enhancing the effectiveness of digital tools for maternal and child health.
This study adopted a descriptive qualitative design to explore the specific needs for developing a mobile application aimed at preventing anemia in pregnant women. The descriptive qualitative approach was selected for its capacity to provide an in-depth exploration of participants' experiences, perceptions, and requirements within a naturalistic context, aligning with the methodological recommendations of Sandelowski (2000).
This qualitative study was conducted in Sukabumi, West Java—an area noted for its high prevalence of anemia and diverse healthcare settings. The research aimed to explore the perspectives of pregnant women, healthcare providers, and community health workers. Participants were selected using purposive sampling, with eligibility criteria including pregnant women aged 18 to 45, healthcare providers with a minimum of two years of experience, and actively serving community health workers. A total of fifteen interviews were conducted, with data collection continuing until saturation was reached, in line with the guidelines of Guest, Bunce and Johnson (2006).
The study employed a semi-structured interview guideline developed through an extensive review of the literature and consultation with experts in maternal health and mobile application development. This iterative process ensured the questions were both relevant and clear. To refine the guideline, a pilot test was conducted with two participants, allowing for adjustments based on their feedback. The content validity of the interview guideline was evaluated by three experts in qualitative research and maternal health. Using the Content Validity Index (CVI), each question achieved a score exceeding 0.80, meeting the threshold for strong validity as per (Polit & Beck, 2008). This process ensured the guideline was a reliable tool for gathering meaningful data.
The interview guideline comprised a range of questions tailored to gather detailed insights: 1) Opening Questions: Participants were asked about their current understanding of anemia prevention during pregnancy to establish context. 2) Main Questions: Questions explored challenges in accessing information, desired features for a mobile application, and perceptions of healthcare providers' roles in anemia prevention. 3) Closing Questions: Participants were invited to share additional thoughts or suggestions regarding the development of the mobile application, ensuring all perspectives were captured.
Interviews were conducted in private, comfortable settings—either in participants’ homes or health centers—to ensure confidentiality. Healthcare providers were interviewed at their workplace at convenient times. Informed consent was obtained after participants were briefed on the study. Interviews followed a flexible semi-structured format, lasting 30–60 minutes, and were audio-recorded and transcribed verbatim.
Data were analysed using Braun and Clarke, (2006) thematic analysis, including familiarisation, coding, theme identification, review, and definition. Manual coding allowed in-depth interpretation based on context. To ensure reliability, multiple coders analysed the data independently and resolved discrepancies through discussion.
Verbatim transcripts were returned to participants for member checking, allowing them to verify accuracy and clarify responses. This step enhanced credibility, minimised researcher bias, and fostered a collaborative research environment by positioning participants as active contributors.
The researchers obtained ethical clearance from the Institutional Review Board (IRB) of STIKes Sukabumi, Indonesia with approval number 033/ETIK/VIII2024 on 8th August, 2024.
The study involved 15 participants, including pregnant women, healthcare providers, and community health workers. Pregnant women (n=5) were aged 18–45 years, distributed across various trimesters of pregnancy. Healthcare providers (n=5) had a minimum of two years of experience in maternal health services, and community health workers (n=5) were actively engaged in anemia prevention initiatives. The demographic characteristics of the participants are presented in Table 1.
Table 1: Demographic Characteristics of Participants
Participant Category | n | Age Range (Years) | Key Characteristics |
Pregnant women | 5 | 18–45 | Various trimesters of pregnancy |
Healthcare providers | 5 | 30–50 | ≥ 2 years of experience in maternal health |
Community health workers | 5 | 25–55 | Actively engaged in anemia prevention |
Total | 15 |
Three main themes emerged from the data: understanding of anemia prevention, challenges and needs in anemia prevention, and suggestions for mobile application development (Table 2).
Table 2: Themes, Categories and Codes
Theme | Category | Code |
Understanding of Anemia Prevention | Awareness |
|
Cultural beliefs about nutrition |
| |
Challenges and Needs in Anemia Prevention | Barriers to access |
|
Desired mobile application features |
|
Role of healthcare providers |
| |
Suggestions for Mobile Application Development | Feedback and recommendations |
|
This theme included two categories: awareness and cultural beliefs.
Awareness
Participants had varying knowledge about anemia. Some pregnant women recognised the term but lacked understanding of its risks or the importance of prevention.
"I’ve heard of anemia, but I’m not really sure what it does to me or my baby."
Healthcare providers showed deeper understanding but noted that many women underestimated its severity.
"Many women know the term, but not how it affects pregnancy outcomes." Community health workers observed confusion between anemia and general fatigue. "Some think anemia just means being tired, so they ignore it."
Knowledge of iron-rich foods and supplements also varied. Misconceptions about frequency and purpose were common.
"They gave me iron pills, but I didn’t know I had to take them every day."
Providers emphasised consistency, while community workers called for culturally relevant education.
"Some women think supplements alone are enough, not realising a balanced diet matters too."
Cultural Beliefs
Food taboos and traditional advice strongly influenced behavior. "My aunt said bananas make babies too big, so I avoid them." "There’s a belief that iron tablets make the baby grow too large."
Elders often guided dietary choices, sometimes contradicting medical advice.
"My mother-in-law won’t let me eat eggs. She says it makes the baby smell after birth."
This theme comprised access barriers, desired app features, and provider roles.
Barriers to Access
Reliable information was hard to access. Conflicting advice and unclear materials created confusion.
"Sometimes I hear different things from the midwife and my family." Low supplement adherence was linked to forgetfulness and side effects. "The tablets upset my stomach, so I stopped taking them."
Community health workers struggled with follow-up due to limited resources.
"Without a system to track them, it’s hard to ensure compliance."
Desired Mobile App Features
Users wanted a simple, low-data app.
"It should be easy to use and not need much storage." Reminders for pills and check-ups were highly valued. "A daily reminder would help me remember my pills."
Tailored content was requested to match local diets and explain symptoms.
"I want advice on affordable foods, not just general tips."
Role of Healthcare Providers
Participants appreciated proactive engagement.
"I feel more motivated when the nurse checks on me."
Providers saw apps as tools to send reminders and monitor progress. "Apps could help us track patient progress and personalise support." Theme 3: Suggestions for Mobile App Development
This theme focused on cultural integration and technical improvements.
Cultural Content
Participants wanted traditional foods and practices reflected in the app.
"If it suggests spinach soup or herbal drinks, it feels made for us."
Use of local visuals and simple language was preferred. "Avoid medical terms—explain like a mother would talk." Multilingual Support and Voiceovers
Language inclusion was key for broader reach.
"My mother-in-law doesn’t understand Indonesian. Local language would help."
Voice features were suggested for users with low literacy.
"It’s easier if the app talks in our language."
Ongoing Feedback and Updates
Users wanted options to give feedback and receive updates.
"A simple survey in the app could help improve it."
Content should reflect the latest health guidance.
"If new tips come out, the app should tell us so we don’t miss out."
This study investigated the perspectives of pregnant women and healthcare providers to identify essential components for developing a mobile application focused on anemia prevention during pregnancy. Thematic analysis revealed three central themes: (1) understanding of anemia prevention, (2) challenges and needs in anemia management, and (3) user-driven recommendations for mobile app development. These findings contribute significantly to the limited but growing body of research on mHealth design tailored for maternal health, particularly in low- and middle-income countries (LMICs) such as Indonesia.
Participants expressed a general awareness of anemia and its consequences during pregnancy. However, the depth of understanding varied, with many women relying on health workers or family advice rather than evidence-based sources. These results reinforce earlier studies emphasising the link between knowledge gaps and poor adherence to iron supplementation (Charanthimath et al., 2021). A lack of accessible and understandable health information contributes to underestimation of anemia risks and weakens motivation to comply with preventive behaviors (Babah et al., 2024). Importantly, healthcare providers recognised this issue and highlighted the necessity of structured, culturally appropriate educational tools to empower pregnant women. This aligns with existing evidence underscoring education and health literacy as critical determinants of successful anemia prevention strategies (Iyawa, Dansharif & Khan, 2021). Therefore, improving health education through mobile technology presents a feasible solution to address this gap.
Several barriers to effective anemia prevention were identified, including limited access to antenatal care, misconceptions regarding iron supplementation, and the influence of sociocultural beliefs. These challenges reflect broader findings in LMICs where contextual factors such as digital literacy, network connectivity, and trust in technology hinder mHealth adoption (Bhattarai et al., 2023; Charanthimath et al., 2021). In this study, pregnant women reported concerns about side effects of iron tablets, dietary taboos, and irregular clinic visits due to logistical and economic constraints. Family involvement emerged as both a barrier and an opportunity. Some participants noted a lack of support from spouses or extended family, which impacted their health decisions. Yet, how family encouragement enhanced their willingness to adhere to health advice. This dynamic emphasises the importance of integrating family-centered features into mHealth applications, such as modules designed for spouses or caregivers, to increase program effectiveness.
Participants offered valuable insights for designing a mobile application that addresses their needs. Recommended features included interactive educational content, daily reminders for iron supplementation, diet tracking, and a direct line to healthcare providers. These suggestions are supported by previous research highlighting that personalisation, visual appeal, and ease of use are critical for mobile health app engagement (Anyanwu et al., 2024). Furthermore, the study found strong support for incorporating culturally relevant content and language customisation, reflecting the local dialect and values. Such cultural alignment has been shown to significantly improve the acceptance and effectiveness of mHealth interventions in diverse populations (Lindayani et al., 2025). The app's potential to serve as an educational platform not just for pregnant women but for their families and health workers represents a scalable solution for anemia prevention at the community level.
Clinically, integrating culturally and linguistically appropriate content into mHealth apps can enhance engagement and adherence to anemia prevention strategies. Real-time feedback, interactive features, and collaboration with providers ensure accuracy and support behavior change (Patel, Volpp & Asch, 2018). Interprofessional collaboration—enabled through digital platforms—also improves care delivery and patient outcomes (Carron et al., 2021; Meyerhoff et al., 2023). Effectiveness of mHealth tools must be evaluated through cost-effectiveness, scalability, and barriers to adoption. User-centered design can overcome issues such as low digital literacy, privacy concerns, and limited access to smartphones or internet services. Addressing these factors is critical to ensure widespread use and improved health outcomes for pregnant women (Banke-Thomas et al., 2020; Bossman, Johansen & Zanaboni, 2022; Wong et al., 2019).
While the study reinforces many existing findings, it also fills a critical gap in the literature by focusing specifically on mHealth design for anemia prevention—a relatively underexplored area in maternal health interventions. The Results section of this study provides a concrete foundation for developing a user-centered, culturally tailored application by identifying key behavioral, environmental, and technological determinants. However, the initial draft of the Discussion did not sufficiently articulate how these findings inform practical application design. By directly linking thematic findings with actionable app features—such as incorporating reminder systems to address forgetfulness, myth-busting videos to correct misconceptions, and family-focused modules to enhance support—the study offers a roadmap for effective digital intervention. Furthermore, the findings point toward the importance of collaborative content development with midwives and nurses to ensure clinical accuracy and local relevance (Rahayu et al., 2025; Vadsaria et al., 2025).
This study has clear implications for nursing practice, particularly in community and maternal health settings. Nurses play a pivotal role in delivering health education, counseling, and continuous support for pregnant women. By leveraging mobile technology, nurses can extend their reach and impact beyond clinical settings, delivering consistent and personalised messages that encourage healthy behaviors. Incorporating mHealth tools into antenatal care workflows can also support task-sharing among healthcare teams and streamline follow-up processes. Real-time data tracking and automated alerts can enhance care coordination and improve adherence monitoring. Such digital integration not only supports nurses in providing evidence-based care but also improves maternal outcomes at scale (Meyerhoff et al., 2023).
Several limitations should be acknowledged. The qualitative design limits the generalisability of findings to broader populations. Additionally, the sample was drawn from a specific geographic area, which may not reflect the diverse socio-cultural contexts of other regions. Future research should incorporate quantitative methods and include diverse populations to validate these findings. Moreover, this study focused on user needs without addressing the technical feasibility and cost-effectiveness of developing such mobile applications.
This study highlights the urgent need for innovative, user-centered mobile applications to support anemia prevention during pregnancy. The identified themes—understanding anemia prevention, challenges and needs, and suggestions for application development—offer actionable insights for designing effective digital health interventions. Future research should explore the integration of advanced technologies such as artificial intelligence and machine learning to provide personalised recommendations and adaptive interventions. Additionally, there is a need to evaluate the long-term effectiveness of these applications in diverse populations and settings to ensure broad applicability and equity. Investigating the role of cultural, social, and behavioral factors in the design and implementation of such technologies could further enhance their acceptance and impact. Collaboration between healthcare professionals, technology developers, and end-users is essential to refine these tools and address barriers to adoption. Expanding the focus to include preventive strategies for related health conditions could also provide a more holistic approach to maternal health.
The authors have no conflicts of interest to declare.
The authors sincerely acknowledge the support of STIKes Sukabumi, West Java, Indonesia, for sponsoring this research.
Al-Marzouqi, Z., Al-Za’abi, R., & Al-Dhoani, A. (2024). Health-care professionals’ barriers to anemia prevention among pregnant women in Oman. Advances in Biomedical and Health Sciences, 3(2), 62-71. https://doi.org/10.4103/abhs.abhs_98_23
Ameyaw, E. K., Amoah, P. A., & Ezezika, O. (2024). Effectiveness of mHealth apps for maternal health care delivery: systematic review of systematic reviews. Journal of Medical Internet Research, 26. https://doi.org/10.2196/49510
Anyanwu, E. C., Maduka, C. P., Ayo-Farai, O., Okongwu, C. C., & Daraojimba, A. I. (2024). Maternal and child health policy: A global review of current practices and future directions. World Journal of Advanced Research and Reviews, 21(2), 1770-1781. https://doi.org/10.30574/wjarr.2024.21.2.0306
Babah, O. A., Beňová, L., Hanson, C., Abioye, A. I., Larsson, E. C., & Afolabi, B. B. (2024). Screening and treatment practices for iron deficiency in anaemic pregnant women: A cross- sectional survey of healthcare workers in Nigeria. Plos One, 19(11). https://doi.org/10.1371/journal.pone.0310912
Banke-Thomas, A., Abejirinde, I. O. O., Ayomoh, F. I., Banke-Thomas, O., Eboreime, E. A., & Ameh, C. A. (2020). The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: A systematic review. BMJ Global Health, 5(6). https://doi.org/10.34172/ijhpm.2020.104
Bhattarai, S., Yadav, S. K., Thapaliya, B., Giri, S., Bhattarai, B., Sapkota, S., ... & Morrison, J. (2023). Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: A mixed methods process evaluation. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16195-5
Bilal, A. M., Pagoni, K., Iliadis, S. I., Papadopoulos, F. C., Skalkidou, A., & Öster, C. (2024). Exploring user experiences of the Mom2B mHealth research app during the perinatal period: qualitative study. JMIR Formative Research, 8. https://doi.org/10.2196/53508
Bossman, E., Johansen, M. A., & Zanaboni, P. (2022). mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review. Frontiers in Global Women's Health, 3. https://doi.org/10.1186/s12913-020-05778-2
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Carron, T., Rawlinson, C., Arditi, C., Cohidon, C., Hong, Q. N., Pluye, P., ... & Peytremann- Bridevaux, I. (2021). An overview of reviews on interprofessional collaboration in primary care: effectiveness. International Journal of Integrated Care, 21(2), 31. https://doi.org/10.5334/ijic.5588
Charanthimath, U., Katageri, G., Kinshella, M. L. W., Mallapur, A., Goudar, S., Ramadurg, U., ... & Payne, B. A. (2021). Community health worker evaluation of implementing an mHealth application to support maternal health care in rural India. Frontiers in Global Women's Health, 2. https://doi.org/10.3389/fgwh.2021.645690
Garzon, S., Cacciato, P. M., Certelli, C., Salvaggio, C., Magliarditi, M., & Rizzo, G. (2020). Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Medical Journal, 35(5). https://doi.org/10.5001/omj.2020.108
Gopalakrishnan, L., Buback, L., Fernald, L., Walker, D., Diamond-Smith, N., & Consortium, I. A. to T. C. A. S. E. (2020). Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries. PloS One, 15(1). https://doi.org/10.1371/journal.pone.0227451
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82.https://doi.org/10.1177/1525822X05279903
Iyawa, G. E., Dansharif, A. R., & Khan, A. (2021). Mobile apps for self-management in pregnancy: A systematic review. Health and Technology, 11(2), 283-294.https://doi.org/10.1007/s12553-021-00523-z
Juniarti, S., Yuriah, S., & Sepriani, P. (2024) Women’s empowerment model in treatment of pregnant women at risk of anemia in Indonesia: Literature review. International Journal of Health Sciences, 8(S1), 1680–1689. https://doi.org/10.53730/ijhs.v8nS1.15357
Lindayani, L., Nurdina, G., Anggraini, D., Herdiman, H., Darmawati, I., & Mutiar, A. (2025). Effect of telemonitoring and nurse-led collaboration on self-management and quality of life in heart failure patients in West Java. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 11(1), 174-180. https://doi.org/10.33755/jkk.v11i1.808
Mbunge, E., & Sibiya, M. N. (2024). Mobile health interventions for improving maternal and child health outcomes in South Africa: A systematic review. Global Health Journal, 8(3), 103- 112. https://doi.org/10.1016/j.glohj.2024.08.002
Meyerhoff, J., Kruzan, K. P., Reddy, M., Mohr, D. C., & Lattie, E. G. (2023). Preparing a workforce of care coordinators to address patient mental health needs in the digital age: training and needs identification. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231173279
Owais, A., Merritt, C., Lee, C., & Bhutta, Z. A. (2021). Anemia among women of reproductive age: an overview of global burden, trends, determinants, and drivers of progress in low-and middle-income countries. Nutrients, 13(8). https://doi.org/10.3390/nu13082745
Patel, M. S., Volpp, K. G., & Asch, D. A. (2018). Nudge units to improve the delivery of health care. New England Journal of Medicine, 378(3), 214-216.https://doi.org/10.1056/NEJMp1912062
Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins, Philadelphia, US.
Rahayu, S., Said, M. S. M., Sansuwito, T. B., & Mulyono, S. (2025). Validating a mobile application for anemia prevention: Insights from expert feedback on AneMia_Prev®. Jurnal Keperawatan Padjadjaran, 13(1), 74-83. https://doi.org/10.24198/jkp.v13i1.2365
Sandelowski, M. (2000). Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed‐method studies. Research in Nursing & Health, 23(3), 246-255. https://doi.org/10.1002/1098-240X(200006)23:3%3C246::AID-NUR9%3E3.0.CO;2-H
Vadsaria, K., Nuruddin, R., Mohammed, N., Azam, I., & Sayani, S. (2025). Efficacy of a personalized mHealth app in improving micronutrient supplement use among pregnant women in Karachi, Pakistan: Parallel-group randomized controlled trial. Journal of Medical Internet Research, 27. https://doi.org/10.2196/67166
Vellakkal, S., & Singh, A. (2021). Impact of public health programs on maternal and child health services and health outcomes in India: A systematic review. Social Science & Medicine, 274. https://doi.org/10.1016/j.socscimed.2021.113795
World Health Organization (WHO). (2019). Prevalence of anaemia in pregnant women (aged 15–49) (%). Global Health Observatory. Retrieved from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia- in-pregnant-women-%28-%29. Accessed on 18th February, 2024.
Wong, A., Goh, G., Banks, M. D., & Bauer, J. D. (2019). Economic evaluation of nutrition support in the prevention and treatment of pressure ulcers in acute and chronic care settings: a systematic review. Journal of Parenteral and Enteral Nutrition, 43(3), 376-400.https://doi.org/10.1089/pop.2024.0222