Maternal mHealth usability strengthened by trust, governance, and navigation

Maternal mobile health (mHealth) technologies have expanded rapidly, offering scalable tools to support education, reminders, symptom monitoring, and patient engagement across the perinatal continuum. Despite demonstrated improvements in usability and intermediate behavioral outcomes, persistent disparities in maternal morbidity and mortality highlight the limits of engagement-driven digital innovation. This Perspective advances the viewpoint that maternal mHealth effectiveness depends not only on user-centered design but on alignment with health system structures, governance practices, trust dynamics, healthcare navigation, and navigable care pathways. Drawing on behavioral science, implementation research, digital health governance scholarship, and maternal health equity literature, this paper examines (1) the promise and limits of maternal mHealth, (2) the gap between engagement and clinically meaningful impact, (3) trust as foundational infrastructure, (4) governance and transparency as structural determinants of legitimacy and sustainability, and (5) navigation as the operational bridge between digital activation and real-world maternal healthcare utilization. We propose reframing maternal mHealth as connective infrastructure rather than a feature-driven product model. Within this framework, healthcare navigation is conceptualized as a multidimensional construct comprising behavioral, technological, organizational, and relational dimensions that enable women to move effectively through fragmented healthcare systems. In this framework, usability and engagement remain essential but must be integrated with transparent governance, participatory processes, culturally responsive navigation, and system alignment to translate digital prompts into timely care utilization and equitable maternal health outcomes. Designing for both systems and users positions maternal mHealth as a structural intervention capable of advancing perinatal engagement and reducing disparities.