Piloting a prenatal care smartphone application and care navigation intervention at a federally qualified health center

BACKGROUND: As smartphones are widely used among reproductive aged people of all socioeconomic backgrounds, a smartphone application may be a useful supplement to routine prenatal care. OBJECTIVES: We describe the implementation of a smartphone application (app) that offers patient education, depression screening, social determinants of health (SDH) screening and care coordination as an adjunct to routine prenatal care at a federally qualified health center (FQHC). We further sought to characterize app engagement and the association of app use with pregnancy outcomes. STUDY DESIGN: The implementation of the smartphone app was a quality improvement initiative in which the app was made available to all people receiving prenatal care at a designated FQHC between December 2020-2021. Individuals who both initiated prenatal care at this site prior to 28 weeks and delivered at our institution during the above defined period were studied retrospectively after obtaining institutional approval. Summary statistics were used to describe app implementation and information regarding SDH and depression screening. Demographics and maternal and neonatal outcomes were compared between app enrollees and patients receiving prenatal care at the same site who were not enrolled in the app. Data were analyzed using two sample t-test to compare continuous variables and Chi-square test to compare categorical variables. RESULTS: Overall, 800 patients receiving prenatal care at the FQHC during the identified period were telephonically approached for enrollment in the smartphone app. 613 people (76.6%) were successfully reached and of those successfully reached, 538 individuals (87.7%) accepted enrollment in the app. 76.6% of app enrollees (n=412) completed at least one SDH screen. Of those, 29.1% (n=120) screened positive for at least one need. 54.1% (n=62) accepted referral for resources to address the identified need. 81% of app enrollees (n=443) completed at least one depression screen. Of those, 13.1% (n=58) screened positive for depression. 37.9% (n=22) of positive screens accepted a referral for behavioral health services. 483 people met inclusion criteria for retrospective review: 264 were enrolled in the smartphone app and 219 were not. App enrollees were more likely to speak English (79.9% of app group vs 61.6% of the non-app group, p < 0.0001), identify as Hispanic (52.7% vs 39.7%, p = 0.02), be privately insured (24.6% vs 15.5%, p = 0.005) and less likely to have an SDH need (10.0% vs 21.0%, p=0.01). There were no significant differences in mode of delivery and maternal and neonatal outcomes between the two groups. CONCLUSIONS: A high proportion of patients receiving care through our FQHC enrolled in and utilized the smart phone app and its associated care coordination. This could be a useful tool to screen for depression and adverse SDH in underserved communities. As individuals of higher resource background seem more likely to enroll in a smartphone app, a more targeted approach is needed to help connect patients of a higher needs background to the smartphone app and the resources it offers.