Pregnant women's experiences with an integrated diagnostic and decision support device for antenatal care in Ghana

I.O. Abejirinde*, R.H. Douwes, Azucena Bardají, Rudolf Abugnaba-Abanga, M.B.M. Zweekhorst, Jos van Roosmalen, Vincent De Brouwere

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Quality antenatal care (ANC) is recognised as an opportunity for screening and early identification of pregnancy-related complications. In rural Ghana, challenges with access to diagnostic services demotivate women from ANC attendance and referral compliance, leading to absent or late identification and management of high-risk women. In 2016, an integrated diagnostic and clinical decision support system tagged ‘Bliss4Midwives’ (B4M), was piloted in Northern Ghana. The device facilitated non-invasive screening of pre-eclampsia, gestational diabetes and anaemia at the point-of-care. This study aimed to explore the experiences of pregnant women with B4M, and its influence on service utilisation (“pull effect”) and woman-provider relationships (“woman engagement”).

Through an embedded study design, qualitative methods including individual semi-structured interviews and non-participant observation were employed. Interviews were conducted with 20 pregnant women and 10 health workers, supplemented by ANC observations in intervention facilities. Secondary data on ANC registrations over a one-year period were extracted from health facility records to support findings on the perceived influence of B4M on service utilisation.

Women’s first impressions of the device were mostly emotive (excitement, fear), but sometimes neutral. Although it is inconclusive whether B4M increased ANC registration, pregnant women generally valued the availability of diagnostic services at the point-of-care. Additionally, by fostering some level of engagement, the intervention made women feel listened to and cared for. Process outcomes of the B4M encounter also showed that it was perceived as improving the skills and knowledge of the health worker, which facilitated trust in diagnostic recommendations and was therefore believed to motivate referral compliance.

This study suggests that mHealth diagnostic and decision support devices enhance woman engagement and trust in health workers skills. There is need for further inquiry into how these interventions influence maternal health service utilization and women’s expectations of pregnancy care.
Original languageEnglish
Article number209
Pages (from-to)1-11
Number of pages11
JournalBMC Pregnancy and Childbirth
Issue number1
Publication statusPublished - 5 Jun 2018


The Bliss4Midwives proof-of-concept was funded by the Life Sciences and Health for Development (LS&H4D) grant: Number-LSH14GH16, from the Dutch Ministry of Foreign Affairs (RVO). The LS&H4D grant, as well as the Erasmus Mundus Joint Doctorate Fellowship Specific Grant Agreement 2015–1595, which IOA is a beneficiary of, financed data collection activities. Funding agencies had no role in study design, analysis, or preparation of the manuscript.

FundersFunder number
Life Sciences and Health for DevelopmentNumber-LSH14GH16
Ministerie van Buitenlandse Zaken


    • Antenatal
    • Clinical decision support
    • Ghana
    • MHealth
    • Prenatal screening
    • Woman-provider interaction


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