{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:17:51Z","timestamp":1777972671895,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,1]]},"group-title":"Public and Global Health","reference-count":75,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Ugandan women and their children suffer from high maternal and perinatal mortality, often due to low antenatal care (ANC) and skilled birth usage. We partnered with community members, women and the Ugandan Ministry of Health to formatively develop an intervention (\n                    <jats:italic>Support-Moms app<\/jats:italic>\n                    ) to improve health education, engage social support networks, and augment access to ANC and delivery by a formal health care provider (HCP) for pregnant women in rural Uganda.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We conducted a type 1 hybrid effectiveness-implementation trial to test the effectiveness of the\n                    <jats:italic>Support-Moms<\/jats:italic>\n                    intervention. We enrolled 824 pregnant women (&lt;20 weeks gestation) living in Southwestern Uganda and randomized them (1:1) to standard of care or\n                    <jats:italic>Support-Moms<\/jats:italic>\n                    intervention. The primary effectiveness outcome was completion of a HCP-led skilled birth (discharge card) and was analyzed as intention-to-treat. Secondary outcomes included number of ANC visits, institution-based delivery, social support, quality-of-life, mode of infant delivery, pre-term birth, birth weight, obstetric complications and deaths (maternal, fetal, newborn).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    A total of 1,216 women were screened, and 824 pregnant women enrolled (mean age \u223c28 years; gestation at enrolment \u223c13 weeks). Complete outcomes were available for 818 (99%). The\n                    <jats:italic>Support-Moms<\/jats:italic>\n                    intervention increased HCP-led skilled births compared to standard of care (93% vs 84%; OR 2.51, 95% CI 1.57\u20134.03, p&lt;0.001). Women in the intervention group were more likely to achieve \u22654 ANC visits (84.1% vs 75.1%; OR 1.76, 95% CI 1.24\u20132.50, p=0.001) and less likely experience postpartum hemorrhage (9.1% vs 22.7%, OR 0.34, 95% CI 0.22\u20130.52, p&lt;0.001) or for their neonates to require resuscitation (9.8% vs 13.7%, OR 0.69, 95% CI 0.45\u20130.99, p=0.001). Initiation of breastfeeding within an hour was higher (97.1% vs 71.7%, OR 1.76, 95% CI 1.15\u20133.44, p=0.001) and postnatal depression decreased (20.1% vs 27.1%, OR 0.68, 95% CI 0.49\u20130.94, p=0.019). More intervention participants reported adequate support, were birth-prepared and had a birth companion. There were no maternal deaths or differences in term births, birthweight, mode of delivery, perinatal mortality or other obstetric complications.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In rural Uganda, the Support-Moms mHealth-based, social-support intervention significantly increased HCP-led skilled births compared with routine care, while also improving ANC attendance, early breastfeeding initiation, birth preparedness, perceived social support and higher presence of companion at birth. Less women experienced PPH, neonatal resuscitation, and postnatal depression. Further evaluation should focus on the cost effectiveness and sustainability of this program.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/Clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05940831\">NCT05940831<\/jats:ext-link>\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.28.26351943","type":"posted-content","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T14:45:14Z","timestamp":1777646714000},"source":"Crossref","is-referenced-by-count":0,"title":["An mHealth-based social support program to improve antenatal care engagement and facility-based births in Uganda: A type I hybrid effectiveness-implementation clinical trial"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-0138","authenticated-orcid":false,"given":"Esther C","family":"Atukunda","sequence":"first","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9703-3877","authenticated-orcid":false,"given":"Godfrey R","family":"Mugyenyi","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Haberer","sequence":"additional","affiliation":[{"name":"Department of Medicine and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-3571","authenticated-orcid":false,"given":"Van T","family":"Nghiem","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, School of Public Health, Department of Health Care Organization and Policy, AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elly B","family":"Atuhumuza","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Waiswa","sequence":"additional","affiliation":[{"name":"Makerere University, School of Public Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angella","family":"Musiimenta","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micheal","family":"Kanyesigye","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celestino","family":"Obua","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3506-842X","authenticated-orcid":false,"given":"Mark J","family":"Siedner","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"},{"name":"Department of Medicine and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Africa Health Research Institute, KwaZulu-Natal, South Africa"},{"name":"University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-6328","authenticated-orcid":false,"given":"Lynn T.","family":"Matthews","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"},{"name":"Yale School of Medicine, Yale University, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026050502001229000_2026.04.28.26351943v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69381-1"},{"key":"2026050502001229000_2026.04.28.26351943v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12681"},{"key":"2026050502001229000_2026.04.28.26351943v1.3","unstructured":"WHO. WHO recommendations on Antenatal Care for a positive Pregnancy Experience. Geneva: World Health Organisation, 2016."},{"key":"2026050502001229000_2026.04.28.26351943v1.4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.2001.0150s1001.x"},{"key":"2026050502001229000_2026.04.28.26351943v1.5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0154664"},{"key":"2026050502001229000_2026.04.28.26351943v1.6","unstructured":"Ministry of Health U. Data Driven Response: Bridging Health System Gaps for better Maternal and Perinatal Outcomes. In: Health MaN , editor. Kampala, Uganda: Ministry of Health; 2023."},{"key":"2026050502001229000_2026.04.28.26351943v1.7","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0652-7"},{"key":"2026050502001229000_2026.04.28.26351943v1.8","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6596394"},{"key":"2026050502001229000_2026.04.28.26351943v1.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0017155"},{"key":"2026050502001229000_2026.04.28.26351943v1.10","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9914027"},{"key":"2026050502001229000_2026.04.28.26351943v1.11","unstructured":"WHO. Maternal Mortality: Key facts. . Geneva. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality: World Health Organisation, 2019."},{"key":"2026050502001229000_2026.04.28.26351943v1.12","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2014.929763"},{"key":"2026050502001229000_2026.04.28.26351943v1.13","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.06.010401"},{"key":"2026050502001229000_2026.04.28.26351943v1.14","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-016-0326-z"},{"key":"2026050502001229000_2026.04.28.26351943v1.15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0158600"},{"key":"2026050502001229000_2026.04.28.26351943v1.16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0045053"},{"key":"2026050502001229000_2026.04.28.26351943v1.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-017-1440-7"},{"key":"2026050502001229000_2026.04.28.26351943v1.18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-162"},{"key":"2026050502001229000_2026.04.28.26351943v1.19","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-08768-3"},{"key":"2026050502001229000_2026.04.28.26351943v1.20","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2013.872722"},{"key":"2026050502001229000_2026.04.28.26351943v1.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.12.042"},{"key":"2026050502001229000_2026.04.28.26351943v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2013.12.002"},{"key":"2026050502001229000_2026.04.28.26351943v1.23","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1559-7"},{"key":"2026050502001229000_2026.04.28.26351943v1.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100417"},{"key":"2026050502001229000_2026.04.28.26351943v1.25","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooac081"},{"key":"2026050502001229000_2026.04.28.26351943v1.26","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v9i1.1455"},{"key":"2026050502001229000_2026.04.28.26351943v1.27","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1361-1"},{"key":"2026050502001229000_2026.04.28.26351943v1.28","doi-asserted-by":"publisher","DOI":"10.2196\/19552"},{"key":"2026050502001229000_2026.04.28.26351943v1.29","doi-asserted-by":"publisher","DOI":"10.2196\/preprints.36619"},{"key":"2026050502001229000_2026.04.28.26351943v1.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-002371"},{"key":"2026050502001229000_2026.04.28.26351943v1.31","doi-asserted-by":"publisher","DOI":"10.2196\/29214"},{"key":"2026050502001229000_2026.04.28.26351943v1.32","doi-asserted-by":"publisher","DOI":"10.2196\/36619"},{"key":"2026050502001229000_2026.04.28.26351943v1.33","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182408812"},{"key":"2026050502001229000_2026.04.28.26351943v1.34","doi-asserted-by":"publisher","DOI":"10.2196\/67049"},{"key":"2026050502001229000_2026.04.28.26351943v1.35","unstructured":"Dayaratna, Winfrey WB , Mcgreevey WP , Hardee K , Smith J , Mumford E , et al., editors. Reproductive health interventions: which ones work and what do they cost? 2000."},{"key":"2026050502001229000_2026.04.28.26351943v1.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.09.026"},{"key":"2026050502001229000_2026.04.28.26351943v1.37","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2015.165"},{"key":"2026050502001229000_2026.04.28.26351943v1.38","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.467"},{"key":"2026050502001229000_2026.04.28.26351943v1.39","unstructured":"Health Mo. Uganda Clinical Guidelines. In: MOH, editor. Kampala, Uganda 2016."},{"key":"2026050502001229000_2026.04.28.26351943v1.40","unstructured":"Health Mo. Uganda Clinical guidelines. Kampala, Uganda: 2016."},{"key":"2026050502001229000_2026.04.28.26351943v1.41","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S248240"},{"key":"2026050502001229000_2026.04.28.26351943v1.42","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"key":"2026050502001229000_2026.04.28.26351943v1.43","doi-asserted-by":"publisher","DOI":"10.2196\/formative.9658"},{"key":"2026050502001229000_2026.04.28.26351943v1.44","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001021"},{"key":"2026050502001229000_2026.04.28.26351943v1.45","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-004-0763-3"},{"key":"2026050502001229000_2026.04.28.26351943v1.46","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S427752"},{"key":"2026050502001229000_2026.04.28.26351943v1.47","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dem279"},{"key":"2026050502001229000_2026.04.28.26351943v1.48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202992"},{"key":"2026050502001229000_2026.04.28.26351943v1.49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0049821"},{"key":"2026050502001229000_2026.04.28.26351943v1.50","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-012-0162-9"},{"key":"2026050502001229000_2026.04.28.26351943v1.51","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198807000-00006"},{"key":"2026050502001229000_2026.04.28.26351943v1.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.02.033"},{"key":"2026050502001229000_2026.04.28.26351943v1.53","doi-asserted-by":"publisher","DOI":"10.3305\/nh.2015.31.sup3.8775"},{"key":"2026050502001229000_2026.04.28.26351943v1.54","unstructured":"ICF. UBoSUa. Uganda Demographic and Health Survey 2016: Key Indicators Report. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF. : 2017."},{"key":"2026050502001229000_2026.04.28.26351943v1.55","doi-asserted-by":"publisher","DOI":"10.7326\/M17-0046"},{"key":"2026050502001229000_2026.04.28.26351943v1.56","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2017.1280126"},{"key":"2026050502001229000_2026.04.28.26351943v1.57","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12895"},{"key":"2026050502001229000_2026.04.28.26351943v1.58","unstructured":"Karen GR, B.K ; Viswanath, K. Health Behavior and Health EDucation: Theory, Research and Practice. 4th Edition ed. San Francisco, CA: Jossey-Bass; 2008."},{"key":"2026050502001229000_2026.04.28.26351943v1.59","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.9.2.e7"},{"key":"2026050502001229000_2026.04.28.26351943v1.60","doi-asserted-by":"publisher","DOI":"10.3200\/JACH.54.1.38-44"},{"key":"2026050502001229000_2026.04.28.26351943v1.61","doi-asserted-by":"publisher","DOI":"10.1080\/14768320600603257"},{"key":"2026050502001229000_2026.04.28.26351943v1.62","doi-asserted-by":"publisher","DOI":"10.1596\/978-1-4648-0348-2_ch172016"},{"key":"2026050502001229000_2026.04.28.26351943v1.63","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.23.4.413"},{"key":"2026050502001229000_2026.04.28.26351943v1.64","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305281597"},{"key":"2026050502001229000_2026.04.28.26351943v1.65","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-015-0039-4"},{"key":"2026050502001229000_2026.04.28.26351943v1.66","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1213-5"},{"key":"2026050502001229000_2026.04.28.26351943v1.67","doi-asserted-by":"publisher","DOI":"10.17269\/cjph.107.5764"},{"key":"2026050502001229000_2026.04.28.26351943v1.68","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v17i1.27"},{"key":"2026050502001229000_2026.04.28.26351943v1.69","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153051"},{"key":"2026050502001229000_2026.04.28.26351943v1.70","unstructured":"MOH. Village Health Teams\/ Community Health Extension Workers. https:\/\/health.go.ug\/community-health-departments\/vht-community-health-extension-workers. Accessed on 25th September 2019. Kampala, Uganda: Ministry of Health, 2019."},{"key":"2026050502001229000_2026.04.28.26351943v1.71","doi-asserted-by":"crossref","unstructured":"Atukunda EC , Mugyenyi GR , Musiimenta A , Kaida A , Atuhumuza EB , Lukyamuzi EJ , et al. Structured and sustained family planning support facilitates effective use of postpartum contraception amongst women living with HIV in South Western Uganda: A randomized controlled trial. Journal of Global Health. 2021;11.","DOI":"10.7189\/jogh.11.04034"},{"key":"2026050502001229000_2026.04.28.26351943v1.72","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03380-z"},{"key":"2026050502001229000_2026.04.28.26351943v1.73","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.3779"},{"key":"2026050502001229000_2026.04.28.26351943v1.74","doi-asserted-by":"publisher","DOI":"10.1177\/1460458214540908"},{"key":"2026050502001229000_2026.04.28.26351943v1.75","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-13-00155"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.04.28.26351943","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:00:40Z","timestamp":1777971640000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.04.28.26351943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":75,"URL":"https:\/\/doi.org\/10.64898\/2026.04.28.26351943","relation":{},"subject":[],"published":{"date-parts":[[2026,5,1]]},"subtype":"preprint"}}