Context-driven mHealth solutions to improve maternal healthcare uptake in Ethiopia: Integrating stakeholder preferences and expert priorities using qualitative and nominal group techniques

Maternal continuum of care during pregnancy, childbirth, and the postpartum period is essential for reducing maternal and child morbidity and mortality, yet access remains limited in low- and middle-income countries. In Ethiopia, only about one-quarter of women complete the continuum of maternal healthcare. Although mobile health interventions have shown promise in improving access in resource-constrained settings, successful implementation depends on cultural appropriateness and alignment with local contexts. This study explored context-driven mobile health solutions and implementation challenges in Ethiopia by integrating stakeholder preferences with expert priorities. We conducted a qualitative exploratory and consensus-prioritization study involving interviews and focus group discussions with 72 perinatal women, male partners, and key informants, complemented by a nominal group technique workshop with 14 multidisciplinary experts. Data were collected in August 2025 using semi-structured guides in Gamoththo and Amharic. Qualitative data were analyzed using reflexive thematic analysis in NVivo, and descriptive statistics summarized expert rankings. Preferred mobile health components included video-based maternal health education, short message reminders with follow-up calls, and engagement of perinatal women with their spouses or support persons. Community health workers were identified as key to developing and sharing educational videos at women’s gatherings. Participants preferred reminders between sunrise and midday on the day before appointments. Expert rankings prioritized reminders with follow-up calls (93.1%), engagement of perinatal women and their support persons (91.7%), and reminder timing between sunrise and midday (95.6%). Integrating stakeholder perspectives with expert rankings showed consensus on locally acceptable mobile health components and identified implementation challenges, including limited device access, poor network coverage, and low digital literacy. These findings provide a foundation for the co-design, feasibility testing, and pilot evaluation of contextually tailored mobile health interventions to improve maternal healthcare. Future implementation should address barriers related to device access, digital literacy, network connectivity, cost, and collaboration with telecommunications providers.