The review protocol was registered in the PROSPERO database (PROSPERO ID: CRD42019137331). This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guideline for preparing protocols of systematic reviews and network meta-analysis[17] (additional file PRISMA-P). We will report the study findings according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guideline[18].
Study eligibility criteria
The study eligibility criteria are defined in the following PICOS framework (P-Participants/study population, I-interventions, C-Comparator, O-Outcomes, and S-Study design/settings). We will include studies if the study meets the following criteria:
1) Population:
We will include studies if the study population is pregnant women aged 10-49 years.
2) Intervention:
All types of TBIs (e.g., eHealth intervention, mHealth intervention, and telehealth intervention) will be considered for this review.
3) Comparison:
We will include studies if the study compares the effectiveness of any form of technology-based healthcare interventions with usual care or non-TBIs. We will also include a study if it compares different form of TBIs.
4) Outcome:
We intend to include studies that reported perinatal healthcare utilization such as ANC visits, institutional delivery, skilled birth attendance at the time of delivery, proportion of birth preparedness, proportion of post-natal care utilization both for mother and newborn. We will also include studies if they reported any adverse maternal and birth outcomes that occurred during the perinatal period.
5) Types of study:
We will consider all randomized controlled trials (RCTs), cluster RCTs, quasi RCTs, and quasi experimental studies (controlled before and after studies) in this review. We will exclude qualitative studies, case studies, cross-sectional studies, review studies, discussion papers, case reports, commentaries, editorials, expert opinions, and ongoing research with insufficient PICOS information.
6) Settings:
We will include studies conducted in low-and middle-income countries (LMICs) based on World Bank categories. A country will be categorized as a low- or middle-income country based on the World Bank country income category at the time of the study.
Outcome variables
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Primary outcome variables:
number of ANC visits from skilled health provider, institutional delivery, and skilled birth attendance at the time of delivery, birth preparedness, number of PNC visits from skilled provider for both mother and newborn.
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Secondary outcome variables:
(a) Health outcomes due to poor care: number of maternal and early neonatal deaths, proportion of women with gestational diabetes and hypertension, low birth weight, and preterm births.
(b) Other outcomes: reported increases in women’ access to digital and mobile technologies, engagement of men and/or significant others in care pathway; impact on gender equality and any adverse outcomes.
Search strategy
We will search the following eight electronic databases: British Nursing Index, CINAHL PLUS, Cochrane Library, EMBASE, POPLINE, PsycINFO, PubMed, and Web of Science. We will also check the reference lists of included articles and relevant systematic review studies including reference snowballing, citation tracking, grey literature searching and handsearching in key journals. Search terms will consist of Medical Subject Headings, title/abstract, text words and other relevant field tag depending on the databases. We will also search WHO’s international Clinical Trials Registry Platform, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials, using appropriate search terms, as presented in Table 1. The search will not be limited by publication status, date or language of production.
Table 1
Keywords used in electronic search strategy
SL
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Query
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1.
|
expectant mother OR pregnant women OR pregnant mother OR pregnancy
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2.
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computer OR tablet OR phone OR mobile OR mobile phone OR mobile device OR smartphone OR smart-phone OR cell phone OR cellphone OR cellular phone OR web OR website OR Internet OR online OR on-line OR technology OR digital technology OR mobile technology OR health technology OR wireless technology OR wireless device OR iPhone OR i-Phone OR iPad OR i-Pad OR iPod OR i-Pod
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3.
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SMS OR short message service OR short messaging OR mobile phone messaging OR MMS OR multimedia message service OR multi-media message OR SMS advice OR SMS reminder OR text message OR text messaging OR texting
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4.
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mobile call OR mobile calling OR mobile communication OR voice call OR voice calling OR voice message OR video conference
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5.
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mobile applications OR mobile apps OR mobile app OR smartphone app OR app OR apps OR email OR e-mail OR personal digital assistant OR PDA
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6.
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#2 OR #3 OR #4 OR #5
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7.
|
eHealth OR e-Health OR electronic health OR digital health OR telehealth OR telemedicine OR telecommunication OR mHealth OR m-Health OR mobile health OR mobile medicine OR mcare OR m-care OR mobile care OR mHealth messaging OR mobile telehealth OR mobile telehealth care OR m-Edu OR medu OR m-education OR mobile education OR mLearning OR eLearning
|
8.
|
#6 AND #7
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9.
|
#1 AND #8
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Selection of the study
Following the search strategy, all articles extracted from the eight electronic databases will be stored in EndNote and duplicates will be identified and excluded. After removing the duplicates, the combined articles will be screened through Rayyan QCRI tool. In the first stage, two reviewers will independently screen titles and abstracts based on the inclusion and exclusion criteria. In the second stage of screening, both reviewers will then independently review full texts of selected studies to assess eligibility. Any discrepancies between the reviewers at the two stages will be resolved through discussion.
Data extraction
A coding framework will be developed and piloted prior to undertaking data extraction for all included studies using EPPI Reviewer 4 software. For eligible studies, two reviewers will independently extract data on author information, year of publication, survey year, country, region, settings, study design, type of intervention, sample size, frequency/rate of ANC visits, institutional delivery, skilled birth attendance, and post-natal care visits by different household, individuals or health provider characteristics. Inter-coder reliability will be tested to ensure moderate agreement, until Cohen’s kappa reaches 0.41 or above[19], and the review team are satisfied that screeners are making consistent decisions. Disagreements will be solved through discussion. When the information is unclear or full-text articles not available, we will contact the corresponding or co-authors to collect our required information. For articles written in languages other than English (Spanish, Chinese, German, Italian and others), data will be extracted with the assistance of colleagues who are native speakers in these languages.
Missing data
If the study does not contain sufficient data such as means and standard deviations to calculate effect size estimates, the authors will be contacted for further information. If sufficient data cannot be obtained, the study will be excluded from the meta-analysis but presented in a narrative synthesis. In cases where data is missing due to attrition rates of more than 20%, the studies will be included with sensitivity analysis conducted to measure its impact on analysis. In studies with results of both 'intention to treat' and 'as treated' analysis presented, the 'intention to treat' will always be preferred.
Study quality assessment
We will use the Cochrane Collaboration’s Tool to assess the study quality[20]. The tool consists of the following domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and other bias. Non-randomized studies will be coded using Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I)[21]. We will classify the studies having high, low and unclear risk of bias based on their guideline[20]. The quality of interventions will be assessed based on the degree of implementation fidelity (adherence, intervention complexity, facilitation strategies, quality of intervention delivered, quality of delivery, and participant responsiveness)[22]. Additionally, we will assess certainty of evidence by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for our primary outcomes[23]. Two reviewers will independently assess the study quality, which will be cross-checked by two other authors. Any discrepancy will be solved through discussion.