Conclusion
mHealth interventions have potential to resolve some of the difficulties of providing health care in remote areas, but we found that contextual readiness needs to be thoroughly evaluated before intervention implementation. Where necessary, network and population capacity to use devices should be improved before testing the effect of a virtual mHealth intervention, and/or extensive field-based support should be integrated into intervention design. Multicomponent interventions are recommended in contexts of intrahousehold and gender inequalities to address the barriers to use of mobile devices for women, and a flexible approach is recommended whereby an access assessment could reveal those who would benefit most from a home visit instead of a VC intervention. Whilst health workers and many women were positive about the VC, hard-to-reach women were more likely to experience challenges in access than other women and therefore a targeted home visit approach may be preferable to a VC intervention in similar contexts.