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Die hohe Müttersterblichkeit in Entwicklungsländern ist zum Teil auf indirekte Faktoren wie Analphabetismus und eingeschränkten Zugang zu Gesundheitsinformationen für Mütter zurückzuführen. Während gebildete Frauen auf Gesundheitsinformationen über Online-Plattformen und mHealth-Apps zugreifen können, müssen Analphabetinnen diese in Gesundheitseinrichtungen abrufen, was aufgrund der Transportkosten oft nicht möglich ist. Mobilfunktechnologie hat in der Gesundheitsversorgung Chancen für ressourcenarme Gemeinschaften eröffnet, die sonst nicht von den digitalen Technologien profitiert hätten. Obwohl Mobilfunktechnologie in der Müttergesundheit eingesetzt wird, können die meisten Maßnahmen nicht von Analphabeten genutzt werden, verwenden Sicherheitsmodelle die nicht auf den Kontext von Entwicklungsländern zugeschnitten sind, und wurden nicht auf ihre Auswirkungen auf die Müttergesundheit hin evaluiert. In dieser Arbeit wurden zwei (Web und Mobile) Apps entwickelt, die die Übermittlung von multimedialen Nachrichten zur Müttergesundheit, Terminerinnerungen und Anrufe/Chats erleichtern. Um die Anforderungen der Nutzer zu erfassen, wurde eine Feldstudie mit halbstrukturierten Interviews und Fokusgruppendiskussionen mit schwangeren Analphabetinnen, Gesundheitsexperten und Entwicklern durchgeführt. Es folgte die Entwicklung eines Sicherheitsmodells (T2RoL) zur Sicherung der Gesundheitsinformationen in den Apps, die dann nach einem nutzerzentrierten Designansatz entwickelt wurden. Eine zweite Feldstudie in Form von halbstrukturierten Interviews und Umfragen wurde durchgeführt, um die mobile App in einer randomisierten kontrollierten Studie mit 80 schwangeren Analphabetinnen über 9 Monate zu evaluieren. Die Auswertung zeigte, dass die App akzeptiert wurde sowie einfach zu erlernen und zu benutzen war. Das Wissen über Müttergesundheit in der Interventionsgruppe verbesserte sich, was sich positiv auf gesundheitsbezogene Entscheidungen und Gesundheitsmaßnahmen auswirkte., Maternal mortality is high in developing countries partly due to indirect factors such as illiteracy and limited access to maternal health information. While literate women can access health information from online platforms, and mHealth apps, illiterate women must get it from health facilities which is often not possible due to lack of transport fees. Mobile technology has opened opportunities in maternal health care for low resource communities that would otherwise not have benefited from digital technologies. Although used in maternal health, most interventions are not usable by the illiterate, use security models that are not tailored to the developing countries’ context, and have not been evaluated to assess their impact on maternal health care. In this thesis, two (web and mobile) apps that facilitate delivery of multimedia-based maternal health messages, appointment reminders, and calls/ chats were developed. To gather user requirements, a field study in form of semi-structured interviews and focus group discussions was conducted with illiterate pregnant women, health practitioners and developers. Development of a security model (T2RoL) to secure the health information in the apps followed. The apps were then developed following a user-centered design approach. A second field study in form of semi-structured interviews and surveys was conducted to evaluate the mobile app through a randomized controlled trial with 80 illiterate pregnant women that were followed for 9 months. Overall, results show that the app was acceptable, easy to learn and use. There was improved maternal health knowledge among the intervention group which positively influenced health related decision making and health practices.

Esther C Atukunda,1 Godfrey R Mugyenyi,1 Celestino Obua,1 Angella Musiimenta,2 Josephine N Najjuma,1 Edgar Agaba,1 Norma C Ware,3 Lynn T Matthews4,5 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda; 3Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Infectious Diseases and Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; 5Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Esther C Atukunda Email estheratukunda@gmail.comBackground: Uganda’s maternal mortality remains unacceptably high, with thousands of women and newborns still dying of preventable deaths from pregnancy and childbirth-related complications. Globally, Antenatal care (ANC) attendance has been associated with improved rates of skilled births. However, despite the fact that over 95% of women in Uganda attend at least one ANC, over 30% of women still deliver at home alone, or in the presence of an unskilled birth attendant, with many choosing to come to hospital after experiencing a complication. We explored barriers to women’s decisions to deliver in a health care facility among postpartum women in rural southwestern Uganda, to ultimately inform interventions aimed at improving skilled facility births.Methods: Between December 2018 and March 2019, we conducted in-depth qualitative face-to-face interviews with 30 post-partum women in rural southwestern Uganda. The purposeful sample was intended to represent women with differing experiences of pregnancy, delivery, and antenatal care. We included 15 adult women who had delivered from their homes and 15 who had delivered from a health facility in the previous 3 months. Women were recruited from 10 villages within 20 km of a regional referral hospital. Interviews were conducted and digital