Formative Research to Inform the Development of an Innovative eHealth Application to Promote Oral Health during Prenatal Care Visits

Background: Poor oral health during pregnancy is a significant public health issue due to its prevalence and associations with early childhood caries and oral-systemic etiologies across the lifespan (e.g., adverse pregnancy/birth outcomes). Although professional guidelines exist promoting oral healthcare during pregnancy, prenatal providers report various barriers to addressing oral health during prenatal visits (e.g., lack of information, time, motivation, skills, resources).

Purpose: To conduct the formative research necessary to guide the development of an innovative eHealth application that would facilitate the translation of the prenatal oral health guidelines into practice for prenatal providers.

Methods: Guided by the Consolidated Framework for Implementation Research and Diffusion of Innovations, mixed-methods were used to assess the clinic’s current technology infrastructure, capacities, workflow processes and contextual factors that would influence adoption/integration of an eHealth application: (1) technology assessment; (2) clinic observations; and (3) interviews and focus groups (> 25 diverse clinic staff: prenatal/oral health providers; medical assistants; clinic administrators, nurse supervisors, IT personnel). 

Results: Critical information emerged, including: clinic workflow (e.g., staff roles, clinic pace, current patient data collection/documentation, clinic communication patterns, referral processes, patient wait time); intervention characteristics that would facilitate adoption (e.g., easy to use; time efficient); benefits and barriers to adopting new technology at clinic, provider and patient levels; cultural factors unique to clinic; and other internal and external system demands.

Discussion: This formative, theoretical-based, and consumer-driven research provided vital information needed prior to the development of an innovative eHealth application. Furthermore, key lessons were learned, including the importance of aligning scientific rigor with the time and workflow constraints faced by community health clinics.  Findings support the importance of gathering diverse clinic team members’ perspectives, and the unique involvement of an academic-private partnership when using eHealth to improve quality of care.