Digital maternal health tools hold promise, but equity question remains

March 26, 2024 - Digital maternal health tools could be a key piece of the nation’s overall maternal health improvement plan, but the industry is currently staring down serious usability and cultural competence pitfalls that could stymie their effectiveness, according to the latest from Deloitte.

The report from the Deloitte Center for Health Solutions detailed survey responses from 2,000 people who were pregnant in the previous two years and showed that digital tools do have some promise in solving the nation’s stark maternal health problems.

“While not a silver bullet, digitally enabled care and tools could help increase access to and utilization of timely and tailored care,” the report authors wrote.

Indeed, pregnant patients are using digital health tools at a fairly high rate, with 70 percent using technology to manage specific health needs. Around half use them to book appointments, and 36 percent use them to communicate with their care teams.

Another 77 percent use them to monitor their reproductive cycles, manage their weight and nutrition, support their mental health, or access maternal health patient education materials.

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Patient portals (63 percent), mobile health apps (62 percent), and online education tools (51 percent) were the most common digital health tools patients used. Far fewer used a text messaging platform (32 percent), remote patient monitoring (RPM) device (27 percent), or health-based social media influencer (26 percent)

But despite the promise digital health shows, it’s missing the mark on engaging populations of color. Overall, only a quarter of respondents said digital health tools could help with patient preferences and cultural competence.

Black (30 percent), mixed-race (24 percent), and Hispanic (23 percent) people were around twice as likely as White people to say digital tools for maternal health need to be more culturally informed.

“This could mean providing the information in different languages for comprehension, showing what conditions or risk factors might look like on different skin tones, or accounting for cultural stigma related to certain topics like mental health,” the report authors explained.

“Cultural tailoring is important for uptake and effectiveness and is likely to continue to be important in light of persistent maternal health inequities,” they continued.

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There’s a lot of potential for engaging end-user voices in the design of digital health tools, the report continued.

More than 80 percent of respondents said that people with relevant or lived experiences should be involved in the creation of digital maternal health tools. Another 87 percent said they’d be willing to fill this role during pre-development phases, 91 percent during development, and 92 percent after the tool is in market.

“When designing a tool or offering to address a specific issue, it is generally beneficial to bring in the experiences of those most impacted,” the authors stated. “For example, if the goal of a resource is to improve patient education on preeclampsia, then those at greatest risk of preeclampsia and with lived experience relative to the issues should inform the process.”

Digital tool accessibility is left wanting overall, the survey furthered. Nearly half of respondents said that reducing the cost of digital tools could improve uptake. Another quarter said interoperability stood in the way of using digital tools, while more than half of respondents said there needs to be a unified platform for maternal health information, stressing the need for integration and interoperability.

However, digital health developers need to be aware of information overload, as 44 percent of respondents said it needs to be easier to use digital maternal health tools. Meanwhile, 30 percent said there are almost too many options to choose from, limiting access.

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Of course, there are some tools patients trust more than others, and these mostly align with the tools patients are most likely to use.

More than 70 percent think the information in a patient portal is both accurate and unbiased. Similar proportions feel the same about RPM tools, virtual health/telehealth, and wearables.

But health-based social media influencers don’t have much trust from the public, with only about a quarter of respondents saying as much, and faith in online educational tools is also low (47 percent think the information is accurate, 40 percent think it’s unbiased).

Improving governance within an organization will likewise be key to improving the uptake of digital maternal health tools, the report authors said. Traditionally, consumer-facing tools fall under marketing, while hospital-centric tools are managed under IT, which can cause fragmentation.

“Leveraging various departments and roles to account for applicable intersections is important, however, organizations should break siloes and clarify roles and shared ownership,” the report authors said.

Of course, digital maternal health tools are not a panacea, and there needs to be a change in the overall patient experience for pregnant people. Even though about three-quarters of respondents said their care teams often or always treated them fairly and justly, there are serious limitations to the maternity care experience, especially for racial/ethnic minorities.

Between 27 and 37 percent of respondents said their care teams did not always treat them fairly or justly, listen to their needs, believed what they were saying, or integrated their preferences into their care plans. Of all respondents, Black people were more likely to report those negative experiences.

“Despite their potential, digital tools are not a cure-all for the pervasive gaps across the maternal health ecosystem,” the report authors stressed. “Instead, the focus should be on how digital tools can be used alongside and to enhance other interventions, including in-person interactions. As one interviewee said, ‘we can’t deliver a baby through a screen.’”

Moving forward, stakeholders need to look at the intersection of equity, data, privacy, and trust to tailor digital tool deployment. Additionally, personalizing resources based on an individual’s unique cultural health needs will make digital maternal health tools more usable.

Incorporating relevant voices with lived experiences, enabling cross-sector collaboration, and integrating SDOH data with patient experience and clinical data will also be integral, the Deloitte researchers suggested.

“Stakeholders both within and outside the health system can champion equity and empowerment,” they concluded. “And digital tools should be developed that are effective, bias-free, and easy to use. Such a transformative shift in the maternal health paradigm can contribute to a healthier, brighter future for all.”