Yhona Paratmanitya
1,2 
, Siti Helmyati
3,4,5 , Detty Siti Nurdiati
6 , Emma C. Lewis
7 , Joel Gittelsohn
1 , Hamam Hadi
8,9* 1 Department of Nutrition, Faculty of Health Sciences, the University of Alma Ata, Indonesia
2 Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
3 Center for Health and Human Nutrition, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
4 Doctorate Study Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
5 Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
6 Department of Obstetric & Gynecology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
7 Center for Human Nutrition, Bloomberg School of Public Health, the Johns Hopkins University, Baltimore, MD, USA
8 Graduate School of Public Health, the University of Alma Ata, Indonesia
9 Director of Community-Alma Ata Partnership Through Updated Research and Education (CAPTURE), the University of Alma Ata, Indonesia
Abstract
Background: Antenatal care (ANC) is low in developing countries, with an estimated 20% of Indonesian women not initiating ANC during the first trimester. The present study sought to determine the impact of a mentoring program on the timing of the first ANC visit. Methods: This cluster randomized controlled trial was conducted in 3 subdistricts of the Bantul District, divided into 61 clusters per treatment arm, with a final sample size of 205 confirmed pregnant women. The mentoring program consisted of (1) health education, (2) monitoring, and (3) text-message reminders. The primary outcome was the timing of first ANC visit. A multilevel mixed-effect logistic regression model was used to measure the effect of the program on the likelihood of having an earlier first ANC visit, with statistical significance at α=0.05. Results: At the individual-level, the intervention group had a mean time of first ANC visit±2 days earlier than the control group (P<0.05). After adjusted for cluster and other covariates, the odds of starting the first ANC visit early (<39 days of gestation) was higher in the intervention group (adjusted odds ratio [AOR] 3.00; 95% confidence interval [CI] 1.17-7.72). Conclusion: Maternal mentoring can improve the timing of the first ANC visit. This program has the potential to be adopted by health care systems in settings where there is little education on the importance of ANC. Future research could extend the length of mentorship until delivery in order to better understand the relationship between mentorship and early ANC on pregnancy outcomes.