Navigating Digital and Geographic Divides: A Qualitative Exploration of Mobile Health Reminders and Antenatal Care Engagement in Lake Victoria’s Island Communities

{ "background": "Antenatal care attendance remains critically low in remote island communities of Lake Victoria, Uganda, due to geographic isolation and limited health infrastructure. Mobile health (mHealth) interventions, such as SMS reminders, are increasingly deployed to bridge this gap, yet their real-world impact and reception in such marginalised, resource-constrained settings are poorly understood.", "purpose and objectives": "This study aimed to explore the lived experiences of pregnant women and healthcare workers regarding a mobile-based maternal health reminder system, and to understand its perceived impact on antenatal care engagement in these hard-to-reach island settings.", "methodology": "A qualitative, community-based study was conducted using purposive sampling. Data were generated through 24 in-depth interviews with pregnant and postpartum women and 8 focus group discussions with community health workers and midwives. Thematic analysis was employed to analyse the data.", "findings": "While reminders improved intention to attend, a dominant theme was the 'double burden of access', where digital prompts highlighted care obligations but could not overcome physical and economic barriers to travel. Approximately two-thirds of participants reported feeling increased anxiety when unable to act on reminders due to lack of boat transport or funds. Healthcare workers noted the system improved record-keeping but strained client relationships when logistical support was absent.", "conclusion": "Mobile reminders alone are insufficient to improve antenatal care attendance in isolated island communities, as they can inadvertently exacerbate stress without addressing the fundamental geographic and economic constraints to service access.", "recommendations": "Programmes must integrate mHealth initiatives with tangible transport solutions and financial support mechanisms. Community health worker roles should be formally expanded to include logistical coordination and counselling to mitigate digital anxiety.", "key words": "mHealth, antenatal care, digital divide, island communities, qualitative research, Uganda, access to healthcare", "contribution statement": "This study provides novel empirical evidence on the unintended psychosocial consequences of mHealth in isolated settings, arguing for a 'hybrid connectivity' model that pairs digital tools with physical access solutions in African