Effectiveness of a Reminder System in Increasing Antenatal Care Utilisation Among High-Risk Pregnant Women in Indonesia: A Quasi-Experimental Study
DOI:
https://doi.org/10.31674/mjn.2025.v16isupp2.011Abstract
Background: Antenatal care is crucial for high-risk pregnancies, but utilisation remains suboptimal in Indonesia due to barriers like limited access and low awareness. Digital interventions can improve healthcare adherence globally. Objective: To evaluate the effectiveness of a mobile-based reminder system in increasing Antenatal Care (ANC) utilisation among high-risk pregnant women in Indonesia. Methods: A quasi-experimental pretest-posttest control group design was carried out in Bekasi, Indonesia, from May to August 2024. The trial included 150 high-risk pregnant women who were randomly assigned to one of two groups: intervention (75) or control (75). The intervention group received personalised reminders via SMS and mobile app notifications, whereas the control group received conventional ANC services. ANC usage was evaluated using the World Health Organization's (WHO) ANC Quality Assessment Tool. The data was analysed using paired t-tests and ANCOVA to assess within-group changes and between-group differences. Results: The intervention group improved ANC utilisation significantly in all domains, including facility support (mean difference = 1.3, p < 0.001), routine care (mean difference = 1.5, p < 0.001), and complication management (mean difference = 1.4, p < 0.001). In contrast, no significant differences were seen in the control group. ANCOVA showed that the intervention group had significantly higher post-test scores than the control group (p < 0.001). Conclusion: The reminder system significantly improved ANC utilisation among high-risk pregnant women in Indonesia. Future research should explore long-term impacts and scalability of such interventions.
Keywords:
Antenatal Care, Digital Health Interventions, High-Risk Pregnancy, Mobile Health, Reminder SystemDownloads
References
Albarqi, M. N. (2025). The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta Analysis of Global Health Interventions. Healthcare, 13(9). https://doi.org/10.3390/healthcare13091076 .
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 .
Anitasari, D., & Andrajati, R. (2017). Effectiveness of short message service reminders and leaflets in complying with iron supplementation in pregnant women in Depok City, Indonesia. Asian Journal of Pharmaceutical and Clinical Research, 10, 42–45. https://doi.org/10.22159/ajpcr.2017.v10s5.23092.
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/10.3389/fgwh.2022.942146 .
Bulcha, G., Abdissa, H. G., Noll, J., Sori, D. A., & Koricha, Z. B. (2024). Effectiveness of a mobile phone messaging–based message framing intervention for improving maternal health service uptake and newborn care practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial. JMIR Research Protocols, 13(1). https://doi.org/10.2196/52395
Bulcha, G., Gutema, H., Amenu, D., & Birhanu, Z. (2025). Perceived acceptability, barriers and enablers in implementing mobile phone messaging-based message-framing intervention for improved maternal and newborn care in Jimma Zone, Ethiopia: a qualitative study. BMJ open, 15(5). https://doi.org/10.1136/bmjopen-2024-088342 .
Correa-de-Araujo, R., & Yoon, S. S. (2021). Clinical outcomes in high-risk pregnancies due to advanced maternal age. Journal of Women's Health, 30(2), 160-167. https://doi.org/10.1089/jwh.2020.8860 .
Dasgupta, A., Boehmer, N., Madhiwalla, N., Hedge, A., Wilder, B., Tambe, M., & Taneja, A. (2024). Preliminary study of the impact of ai-based interventions on health and behavioral outcomes in maternal health programs. arXiv preprint arXiv:2407.11973, Cornell University. Retrieved from https://arxiv.org/abs/2407.11973. Accessed on 24th June 2024.
Dewanti, L. P., Sitoayu, L., & Idarto, A. (2024). Digital tele-counseling for sustainable maternal health services in Indonesia focus on tele lactation. IAIC Transactions on Sustainable Digital Innovation (ITSDI), 6(1), 10-20. https://doi.org/10.34306/itsdi.v6i1.673.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146.
Hailemariam, T., Atnafu, A., Gezie, L. D., & Tilahun, B. (2025). Effect of short message service reminders in improving optimal antenatal care, skilled birth attendance and postnatal care in low- and middle-income countries: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 25(1). https://doi.org/10.1186/s12911-024-02836-1.
Indonesian Ministry of Health. (2022). Annual report on maternal and child health. Jakarta: Ministry of Health Publications. Retrieved from: https://oss2.dto.kemkes.go.id/artikel-web-dto/Annual%20Report%202023%20-%20DTO%20Kemenkes%20RI.pdf . Accessed on 24th June 2024.
Kachimanga, C., Ng’ambi, W. F., Kazinga, D., Ndarama, E., Amulele, M. A., Munyaneza, F., ... & Kulinkina, A. V. (2025). Impact of Mobile Health (mHealth) Use by Community Health Workers on the Utilization of Maternity Care in Rural Malawi: A Time Series Analysis. International Journal of Women's Health, 245-257. https://doi.org/10.2147/IJWH.S497100 .
Kante, M., & Målqvist, M. (2025). Effectiveness of SMS-based interventions in enhancing antenatal care in developing countries: a systematic review. BMJ open, 15(2). https://doi.org/10.1136/bmjopen-2024-089671.
Lu, T., Lin, Q., Yu, B., & Hu, J. (2025). A systematic review of strategies in digital technologies for motivating adherence to chronic illness self care. NPJ Health Systems, 2. https://doi.org/10.1038/s44401-025-00017-4.
Marfuah, D., bin Sansuwito, T., & Ayakannu, R. (2025). The impact of interactive video-based exercise on quality of life among pregnant women in Indonesia: A pilot study. Jurnal Keperawatan Padjadjaran, 13(1), 66-73. https://doi.org/10.24198/jkp.v13i1.2565.
McKelvin, G., Thomson, G., & Downe, S. (2021). The childbirth experience: A systematic review of predictors and outcomes. Women and Birth, 34(5), 407-416. https://doi.org/10.1016/j.wombi.2020.09.021.
Putri, Y. H. S., Maryati, I., & Solehati, T. (2025). Interventions to Improve Sexual and Reproductive Health Related Knowledge and Attitudes Among the Adolescents: Scoping Review. Risk Management and Healthcare Policy, 105-116. https://doi.org/10.2147/RMHP.S490395.
Susanti, A. I., Ali, M., Hernawan, A. H., Rinawan, F. R., Purnama, W. G., Puspitasari, I. W., & Stellata, A. G. (2022). Midwifery Continuity of Care in Indonesia: Initiation of Mobile Health Development Integrating Midwives’ Competency and Service Needs. International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192113893.
Vatsa, R., Chang, W., Akinyi, S., Little, S., Gakii, C., Mungai, J., Kahumbura, C., Wickramanayake, A., Rajasekharan, S., Cohen, J., & McConnell, M. (2025). Impact evaluation of a digital health platform empowering Kenyan women across the pregnancy–postpartum care continuum: A cluster randomized controlled trial. PLOS Medicine, 22(2). https://doi.org/10.1371/journal.pmed.1004527 .
Venkataramanan, R., Subramanian, S. V., Alajlani, M., & Arvanitis, T. N. (2022). Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review. Digital Health, 8. https://doi.org/10.1177/20552076221143236.
Wang, J., Tang, N., Jin, C., Yang, J., Zheng, X., Jiang, Q., ... & Zhou, X. (2025). Association of Digital Health Interventions with Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis. Journal of Medical Internet Research, 27. https://doi.org/10.2196/66580.
Widiyono, W., & Sumarni, R. N. (2025). The Artificial Intelligence Implementation in Nursing Services: Literature Review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 11(2), 244-250. https://doi.org/10.33755/jkk.v11i2.759.
World Health Organization. (2022). Improving the quality of care for maternal, newborn and child health. Geneva: WHO Publications. Retrieved from: https://iris.who.int/bitstream/handle/10665/353738/9789240043930-eng.pdf. Accessed on 24th June 2024.
Wulandari, R. D., Laksono, A. D., Rachmawati, T., & Rukmini, R. (2021). Barriers to antenatal care utilization in Indonesia. Medico-Legal Update, 21(1), 828-834. https://doi.org/10.37506/mlu.v21i1.2419.
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