Connected Health and Mobile Apps in Obstetrics and Gynecology

The Menstrual Cycle as a Vital Sign: a comprehensive review

Some medical professional organizations have advocated for including the menstrual cycle as a vital sign in adolescence, but not in adulthood. However, documenting menstrual cycle patterns is not routine clinical or research practice. Vital signs are used to predict health outcomes, indicate needed treatment, and monitor a clinical course. They can help identify pathologies, affirm wellness, and are responsive to exposures. Here we review the scientific evidence showing how the menstrual cycle meets these criteria and should therefore be treated as a vital sign. Using key words and controlled vocabulary terms, we carried out multiple literature searches, prioritizing the inclusion of systematic reviews, meta-analyses, and clinical practice guidelines. This review describes how the menstrual cycle is a health indicator, can cyclically impact health conditions, and its associations with long-term post-menopausal health outcomes. We review exposures influencing the menstrual cycle, evidence underlying its use to optimize wellness, and available tools for documenting cycles. Supplementary materials include patient handouts on menstrual cycle tracking, and an index of related clinical practice guidelines and reviews by subject. The menstrual cycle is a vital sign from menarche through menopause, an underutilized but powerful tool for understanding gynecological and general health.

Developing and testing a mobile application for imparting knowledge: the positive birth experience guideline to midwifery students

BACKGROUND

Given the importance of the care provided during labour and childbirth and its impact on the childbirth experience, as well as the fact that proper training of midwives can improve the quality of care, this study aims to design World Health Organization guideline for positive childbirth experience in the form of a mobile application (Phase One) and examine its effectiveness in imparting knowledge among midwifery students (Phase Two).

METHODS

This study employed a research and development methodology. In the initial phase, the "Positive Birth Experience Application" was designed based on the WHO recommendations for the intrapartum period. The second phase utilized a one-group pretest-posttest design. After one month of using the application, 30 midwifery students from Tabriz University of Medical Sciences in Tabriz, Iran completed knowledge (posttest) and evaluation questionnaires. The data was analyzed using SPSS Version 24 software. A Paired Samples T-test was conducted to assess the students' knowledge before and after the intervention.

RESULTS

The results of the pilot study showed a statistically significant difference (P < 0.001) in the mean knowledge scores of the students regarding the WHO guideline before and after the intervention. After the intervention, the students had higher knowledge scores compared to before using the application [(Mean Difference = 4.75; (95% Confidence Interval = 3.56 to 5.93)]. The analysis for the evaluation of the application indicated that the highest mean (SD = Standard Deviation) scores were observed for the information quality and system quality subscales, which were 50.7 (8.03) and 47.9 (11.6), respectively. In contrast, the lowest mean (SD) scores were associated with the service quality and user satisfaction subscales, which were 23.9 (7.43) and 25.6 (6.62), respectively.

CONCLUSIONS

The positive birth experience application can be used as an educational method to increase students' knowledge of the recommendations of the WHO regarding intrapartum care. The evaluation of this application by the students demonstrated that it can provide valuable and high-quality information related to intrapartum care, thus enhancing their knowledge in this area.

Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study

BACKGROUND

Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR).

OBJECTIVE

This study aimed to evaluate the patients' and midwives' levels of satisfaction with the connected mobile app.

METHODS

We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users' opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives.

RESULTS

Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app's ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors.

CONCLUSIONS

The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team's workload, the time savings provided by the app constitute a nonnegligible advantage.

Self-management eHealth solutions for menopause - a systematic scoping review

OBJECTIVE

The purpose of this scoping review was to highlight the current scientific evidence on eHealth-based information tools for menopause in terms of quality, requirements and previous intervention outcomes.

METHODS

We systematically searched electronic databases (Embase, CINAHL, Cochrane Library, Global Health Database [Ovid], Web of Science, ClinicalTrials.gov [NLM], LIVIVO Search Portal [ZB MED] and Google Scholar) from 1974 to March 2022 for relevant records.

RESULTS

Our search yielded 1773 records, of which 28 met our inclusion criteria. Thirteen of 28 selected studies were cross-sectional with qualitative content analysis of websites about menopause; 9 studies were cohort studies examining the impact of an eHealth intervention; two studies were randomized controlled trials comparing eHealth tools with conventional ones; and four studies were non-systematic literature reviews.

CONCLUSION

This scoping review highlights the potential of eHealth-based information tools for the management of menopause and shows that most eHealth-based information tools are inadequate in terms of readability and the balanced view on information. Providers of eHealth-based information tools should pay attention to a participatory design, readability, balance of content and the use of multimedia tools for information delivery to improve understanding.

Acceptability of Gynecologic e-Health Modalities by Hispanic/Latina Women of Reproductive Age

Introduction

Electronic health (e-Health) modalities effectively address healthcare access limitations; however, there are limited data on their adoption by Hispanic/Latina women who are disproportionally affected by health disparities.

Methods

We conducted a cross-sectional study by disseminating an anonymous electronic questionnaire via social media to assess the perception of Hispanic/Latina women of reproductive age regarding facilitators and barriers for using e-Health modalities, including telemedicine and mobile apps, to monitor gynecologic health.

Results

The questionnaire was completed by 351 Hispanic/Latina participants with high levels (98.3%) of advanced technological expertise. Current use of a gynecologic mobile app was reported by 63.8%, primarily for menstruation (85.1%) and ovulation (46.3%) tracking. While only 17.6% of participants were offered the option of a gynecologic consultation via telemedicine, the majority (90.5%) would agree to one. Higher education and advanced technological expertise correlated with acceptance of telemedicine for gynecological consults. Being younger (<29 y/o), a student, not having a preferred gynecologist and having a lower income significantly correlated with gynecologic mobile app acceptability.

Conclusions

We showed that e-Health modalities are highly acceptable for Hispanic/Latina women of reproductive age to facilitate gynecological care and documented factors that are significantly associated with e-Health acceptability. These findings are relevant to public health emergencies that cause access to care limitations disproportionally affecting this already underserved population.

Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study

BACKGROUND

Women's menstrual cycle is an important component of their overall health. Physiological cycles and associated symptoms can be monitored continuously and used as indicators in various fields. Menstrual apps are accessible and can be used to promote overall female health. However, no study has evaluated these apps' functionality from both consumers' and health care providers' perspectives. As such, the evidence indicating whether the menstrual apps available on the market provide user satisfaction is insufficient.

OBJECTIVE

This study was performed to investigate the key content and quality of menstrual apps from the perspectives of health care providers and consumers. We also analyzed the correlations between health care provider and consumer evaluation scores. On the basis of this analysis, we offer technical and policy recommendations that could increase the usability and convenience of future app.

METHODS

We searched the Google Play Store and iOS App Store using the keywords "period" and "menstrual cycle" in English and Korean and identified relevant apps. An app that met the following inclusion criteria was selected as a research app: nonduplicate; with >10,000 reviews; last updated ≤180 days ago; relevant to this topic; written in Korean or English; available free of charge; and currently operational. App quality was evaluated by 6 consumers and 4 health care providers using Mobile Application Rating Scale (MARS) and user version of the Mobile Application Rating Scale (uMARS). We then analyzed the correlations among MARS scores, uMARS scores, star ratings, and the number of reviews.

RESULTS

Of the 34 apps, 31 (91%) apps could be used to predict the menstrual cycle, and 2 (6%) apps provided information pertinent to health screening. All apps that scored highly in the MARS evaluation offer a symptom logging function and provide the user with personalized notifications. The "Bom Calendar" app had the highest MARS (4.51) and uMARS (4.23) scores. The MARS (2.22) and uMARS (4.15) scores for the "Menstrual calendar-ovulation & pregnancy calendar" app were different. In addition, there was no relationship between MARS and uMARS scores (r=0.32; P=.06).

CONCLUSIONS

We compared consumer and health care provider ratings for menstrual apps. Continuous monitoring of app quality from consumer and health care provider perspectives is necessary to guide their development and update content.

Evaluation of mobile health applications for cervical cancer in the digital marketplace

Objective

To assess the quality of mobile health (mHealth) applications (apps) for cervical cancer using the mobile app rating scale (MARS), APPLICATIONS scoring system, and app rating using specific statements.

Methods

We searched for cervical cancer apps on two major mobile operating systems (Google Play Store and Apple iTunes Store) in March 2021. Eligible apps were downloaded and assessed for quality by two independent reviewers using multimodal assessment tools.

Results

The overall quality of the MARS score was 2.61±0.795. The highest scoring app was “The American Society for Colposcopy and Cervical Pathology (ASCCP) Management Guidelines” (3.98). Overall, apps scored highest in the functionality domain, followed by information, engagement, and aesthetics domains. The mean±standard deviation of the APPLICATIONS scoring system was 8.50±1.712. The highest-rated apps were “ASCCP Management Guidelines,” “The British Society for Colposcopy and Cervical Pathology (BSCCP),” and “Cervical Cancer Guide.” Apps scored the highest in the paid subscription and price domains. By contrast, apps scored poorly in the text search, literature, and subjective presentation domains. Concerning app content, many apps infrequently provided misconceptions regarding cervical cancer. The apps’ rating using specific statements was 7.81±4.562.

Conclusion

Overall, the apps analyzed using the MARS and APPLICATIONS scoring systems demonstrated above-average quality. However, there is a need to improve the essential information conveyed by these applications. Moreover, the assessment tools have influenced different app quality rating results, confirming the lack of standardized quality assessment tools for mHealth apps.

Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores

Background

Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation.

Objective

The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy.

Methods

A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content.

Results

A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002).

Conclusions

The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals.

Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes

Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.