(521) Acceptability of a smartphone application with prenatal care at a federally qualified health center

Objective: We describe the implementation and acceptability of a smartphone application (app) that offers patient education, screening for depression and social determinants of health (SDH), and care coordination as an adjunct to routine prenatal care at a federally qualified health center (FQHC). We also sought to determine the characteristics of the patients for whom this intervention was acceptable.

Study Design: The smartphone app was made available to all women receiving prenatal care at an FQHC at a large urban medical center from December 2020-2021 in both English and Spanish language versions. Women who both received prenatal care at the site and delivered at the institution during this time were studied retrospectively. Demographics of app enrollees were compared to those not enrolled in the app. Data were analyzed using descriptive statistics, two sample t-test and Chi-square test.

Results: 800 women were outreached for app enrollment. 87.7% of the 613 women who were successfully outreached accepted enrollment. 76.6% of app enrollees (n=412) completed at least one SDH screen, and of those, 29.1% (n=120) screened positive for at least one need. Of those who screened positive, 54.1% (n=65) accepted referral for resources to address the identified need. 60% (n=483) of patients enrolled in prenatal care also delivered at the institution; of those, 264 women enrolled in the app and 219 did not. Within that group, app enrollees were more likely to speak English or Spanish (79.9% vs 61.6%, 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 report deficits in SDH (10.0% vs 21.0%, p=0.01). 

Conclusion: The smartphone app was highly acceptable in our patient population. It is a novel approach to screening for SDH. However, within the cohort, women of a higher resource background were more likely to enroll in the app. A more targeted approach should be considered to engage higher needs patients for optimal benefit from this intervention.