Research Article
Digital and Behavioural Nudge Interventions to Improve Postpartum Visit Attendance: A Systematic Review and Meta-analysis
Habtamu Fekadu Andeta*
Issue:
Volume 12, Issue 4, December 2026
Pages:
80-88
Received:
13 October 2026
Accepted:
28 October 2026
Published:
12 November 2026
DOI:
10.11648/j.bs.20261204.11
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Abstract: Background: Approximately 40–50% of women miss the comprehensive postpartum visit, leading to missed detection of postpartum hypertension, depression, diabetes and infection. Digital and behavioural “nudge” interventions are low-cost candidate solutions, but, to our knowledge, no systematic review has quantitatively pooled their effect on postpartum visit attendance. Methods: We searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (inception to May 2026) for randomised and controlled studies of postpartum women receiving at least one digital or behavioural nudge versus usual care. The primary outcome was comprehensive postpartum visit attendance. Study selection, data extraction and risk-of-bias assessment were performed by a single reviewer; this limitation is acknowledged. Risk of bias was assessed with Risk of Bias 2 (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), certainty with Grading of Recommendations Assessment, Development and Evaluation (GRADE), and information sufficiency with trial sequential analysis (TSA). Risk ratios (RRs) were pooled using DerSimonian–Laird random-effects meta-analysis with pre-specified subgroup and sensitivity analyses. Results: Eight studies were included in the review; five randomised controlled trials (RCTs; n = 2,208) contributed to the quantitative synthesis. Nudges increased postpartum visit attendance (pooled RR 1.33, 95% confidence interval (CI) 1.07–1.65; I2 = 52.8%; τ2 = 0.029; 95% prediction interval 0.70–2.53; p = 0.009). Results were stable across sensitivity analyses (RR 1.32–1.35). Point estimates were largest for bundled default scheduling (RR 1.82, one trial), intermediate for patient navigation (RR 1.20, one trial) and 1.25 (95% CI 0.91–1.73) for short message service (SMS) reminders (three trials). Certainty of evidence was low; TSA indicated that the accrued information size was below the required information size. Secondary maternal outcomes (depression screening, blood-pressure testing, contraception and readmission) were reported in single trials only and were not pooled. Conclusions: Digital and behavioural nudges, particularly friction-reducing strategies such as default scheduling and patient navigation, may improve postpartum visit attendance, although the evidence is of low certainty and the prediction interval crosses the null. The evidence base is small, heterogeneous and geographically skewed; a definitive multicentre trial, ideally in low- and middle-income settings, is warranted.
Abstract: Background: Approximately 40–50% of women miss the comprehensive postpartum visit, leading to missed detection of postpartum hypertension, depression, diabetes and infection. Digital and behavioural “nudge” interventions are low-cost candidate solutions, but, to our knowledge, no systematic review has quantitatively pooled their effect on postpartu...
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