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Vandrevala T, Montague A, Boulton R, Coxon K, Jones CE. Exploring the implementation of an educational film within antenatal care to reduce the risk of cytomegalovirus infection in pregnancy: A qualitative study. BMC Pregnancy Childbirth 2024; 24:524. [PMID: 39127657 DOI: 10.1186/s12884-024-06715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK). METHODS An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15). FINDINGS Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified. DISCUSSION Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that 'coherence' and 'cognitive participation' between service members are vital to imbed CMV education in routine practice. 'Collective action' and 'reflexive monitoring' is required to sustain service changes.
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Affiliation(s)
- Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK.
| | - Amy Montague
- Department of Psychology, Faculty of Business and Social Sciences, Kingston University, London, UK
| | - Richard Boulton
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
- Centre for Allied Health, St George's, University of London, London, UK
| | - Kirstie Coxon
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University of Southamptonand, University Hospital Southampton NHS Foundation Trust , Southampton, UK
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McGovern L, O'Toole L, Houshialsadat Z, O'Reilly SL. Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta-synthesis. Obes Rev 2024; 25:e13761. [PMID: 38733067 DOI: 10.1111/obr.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
mHealth interventions play an increasingly important role in health behavior change for gestational diabetes or peripartum obesity management. This qualitative systematic review and meta-synthesis aims to explore women's perceptions of mHealth behavior change interventions for gestational diabetes and/or overweight/obesity management during pregnancy and the postpartum period. Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Psychological Information Database (PsycINFO) databases were searched using a Sample, Phenomenon of Interest, Design, Evaluation and Research type (SPIDER) concept framework through to February 2024. Included studies were quality assessed using the Critical Appraisal Skills Programme checklist. Study findings were evaluated using reflexive thematic analysis and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQual) checklist. We identified 29 studies, representing 604 women's views from one upper middle-income and nine high-income countries. Two themes were generated: mHealth as a supportive tool; and mHealth as a personalizable tool. Women highlighted the importance of self-monitoring, information trustworthiness, peer support, motivational tools (goal setting, risk awareness, and problem solving) and convenience in achieving behavior change using mHealth technology. They suggest mHealth programs incorporate these elements to support user engagement and improved health outcomes. Understanding what women want as mHealth users is particularly important for effective interventions in gestational diabetes, weight management, and chronic disease prevention. Creating a better, more woman-centered experience by addressing central engagement issues should result in improved maternal health outcomes.
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Affiliation(s)
- Liz McGovern
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
| | - Laura O'Toole
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Zeinab Houshialsadat
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
- Ecole Hautes Etudes en Santé Publique, Paris, France
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
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Yu H, Li M, Qian G, Yue S, Ossowski Z, Szumilewicz A. A Systematic Review and Bayesian Network Meta-Analysis Comparing In-Person, Remote, and Blended Interventions in Physical Activity, Diet, Education, and Behavioral Modification on Gestational Weight Gain among Overweight or Obese Pregnant Individuals. Adv Nutr 2024; 15:100253. [PMID: 38879168 PMCID: PMC11267029 DOI: 10.1016/j.advnut.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Despite the well-documented adverse outcomes associated with obesity during pregnancy, this condition remains a promising modifiable risk factor. OBJECTIVES The aim of this study was to ascertain the most effective treatment modalities for gestational weight gain (GWG) in pregnant women classified as overweight or obese. METHODS A systematic search was conducted across 4 electronic databases: Embase, EBSCOhost, PubMed, and Web of Science. To assess the quality of evidence, the Confidence In Network Meta-Analysis (CINeMA) approach, grounded in the Grading of Recommendations Assessment, Development, and Evaluation framework, was employed. A Bayesian network meta-analysis was conducted to synthesize the comparative effectiveness of treatment modalities based on GWG outcomes. RESULTS The analysis incorporated 60 randomized controlled trials, encompassing 16,615 participants. Modes of intervention administration were classified as remote (R: eHealth [e] and mHealth [m]), in-person (I), and a combination of both (I+R). The interventions comprised 5 categories: education (E), physical activity (PA), dietary (D), behavior modification (B), and combinations thereof. The quality of the evidence, as evaluated by CINeMA, ranged from very low to high. Compared to the control group, the I-D intervention (mean difference [MD]: -1.27; 95% confidence interval [CI]: -2.23, -0.32), I-PADB (MD: -0.60, 95% CI: -1.19, -0.00), and I-B (MD: -0.34, 95% CI: -0.57, -0.10) interventions showed significant efficacy in reducing GWG. CONCLUSIONS Preliminary findings suggest that the I-D intervention is the most efficacious in managing GWG among pregnant women who are overweight or obese, followed by I-PADB and I-B+R-B(m) treatments. These conclusions are drawn from evidence of limited quality and directness, including insufficient data on PA components used in the interventions. Owing to the absence of robust, direct evidence delineating significant differences among various GWG management strategies, it is tentatively proposed that the I-D intervention is likely the most effective approach. This study was registered with PROSPERO as CRD42023473627.
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Affiliation(s)
- Hongli Yu
- College of Physical Education, Sichuan University of Science & Engineering, Zigong, Sichuan, China.
| | - Mingmao Li
- Department of Fitness, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Guoping Qian
- Department of Fitness, Gdansk University of Physical Education and Sport, Gdansk, Poland.
| | - Shuqi Yue
- Department of Fitness, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Zbigniew Ossowski
- Department of Fitness, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Anna Szumilewicz
- Department of Fitness, Gdansk University of Physical Education and Sport, Gdansk, Poland
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Téoule J, Woll C, Ray J, Sütterlin M, Filsinger B. The effectiveness of integrated online health-coaching on physical activity and excessive gestational weight gain: a prospective randomized-controlled trial. Arch Gynecol Obstet 2024; 310:307-314. [PMID: 38217763 PMCID: PMC11168974 DOI: 10.1007/s00404-023-07296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Low levels of physical activity during pregnancy go along with increased risks for numerous health complications. We investigated whether an integrated lifestyle intervention leads to higher levels of physical activity and reduces the rate of excessive gestational weight gain (EGWG). METHODS We conducted a randomized-controlled trial on 97 pregnant women, randomly assigned to receive an additional telehealth lifestyle intervention (experimental group, EG; n = 49) or conventional antenatal care (control group, CG; n = 48). The core lifestyle intervention comprised regular video calls, providing integrated personal support and motivation to physical activity. The primary outcome was change in physical activity measured in steps per day. An additional exploratory outcome was the proportion of participants with EGWG. RESULTS The mean step count during the third trimester was 6483 steps/day (EG) and 5957 steps/day (CG), respectively (p = 0.078). Repeated-measures ANOVA revealed a significant interaction effect (p = 0.045) reflecting an overall increase of 497 steps per day in the EG vs. a decrease of 300 steps per day in the CG. The proportion of participants who met the IOM recommendation for total weight gain during pregnancy was significantly higher in the EG (p = 0.048) and the ratio of women that gained excessively was higher in the CG (p = 0.026). CONCLUSIONS We assume that the personalized online intervention supports women in increasing or at least maintaining their level of physical activity during the course of pregnancy. Additionally, it reduces the rate of excessive weight gain.
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Affiliation(s)
- Julia Téoule
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Christian Woll
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, Ludwig-Maximilians-University, Munich, Germany
- Institute of Clinical Psychology and Psychotherapy, Clinical Psychology of Children and Adolescents, Technical University Dresden, Dresden, Germany
| | - Jana Ray
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Institute of Clinical Psychology and Psychotherapy, Clinical Psychology of Children and Adolescents, Technical University Dresden, Dresden, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Barbara Filsinger
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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O'Connor H, Willcox JC, de Jersey S, Wright C, Wilkinson SA. Digital preconception interventions targeting weight, diet and physical activity: A systematic review. Nutr Diet 2024; 81:244-260. [PMID: 37845187 DOI: 10.1111/1747-0080.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
AIM Optimising preconception health increases the likelihood of conception, positively influences short- and long-term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. METHODS We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi-experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face-to-face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. RESULTS Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre-post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web-based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. CONCLUSION More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies.
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Affiliation(s)
- Hannah O'Connor
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Jane C Willcox
- Faculty of Health, Charles Darwin University, Darwin, Northwest Territories, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Charlotte Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Lifestyle Maternity, Brisbane, Queensland, Australia
- Department of Obstetric Medicine, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
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Patchen L, McCullers A, Budd SG, Blumenthal HJ, Evans WD. Protocol for Evaluating Remote Patient Blood Pressure Monitoring Adapted to Black Women and Birthing Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:603. [PMID: 38791817 PMCID: PMC11120691 DOI: 10.3390/ijerph21050603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
Cardiovascular disease is the leading cause of maternal death among Black women in the United States. A large, urban hospital adopted remote patient blood pressure monitoring (RBPM) to increase blood pressure monitoring and improve the management of hypertensive disorders of pregnancy (HDP) by reducing the time to diagnosis of HDP. The digital platform integrates with the electronic health record (EHR), automatically inputting RBPM readings to the patients' chart; communicating elevated blood pressure values to the healthcare team; and offers a partial offset of the cost through insurance plans. It also allows for customization of the blood pressure values that prompt follow-up to the patient's risk category. This paper describes a protocol for evaluating its impact. Objective 1 is to measure the effect of the digitally supported RBPM on the time to diagnosis of HDP. Objective 2 is to test the effect of cultural tailoring to Black participants. The ability to tailor digital content provides the opportunity to test the added value of promoting social identification with the intervention, which may help achieve equity in severe maternal morbidity events related to HDP. Evaluation of this intervention will contribute to the growing literature on digital health interventions to improve maternity care in the United States.
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Affiliation(s)
- Loral Patchen
- MedStar Health Research Institute, Hyattsville, MD 20782, USA; (A.M.); (S.G.B.); (H.J.B.)
| | - Asli McCullers
- MedStar Health Research Institute, Hyattsville, MD 20782, USA; (A.M.); (S.G.B.); (H.J.B.)
| | - Serenity G. Budd
- MedStar Health Research Institute, Hyattsville, MD 20782, USA; (A.M.); (S.G.B.); (H.J.B.)
| | - H. Joseph Blumenthal
- MedStar Health Research Institute, Hyattsville, MD 20782, USA; (A.M.); (S.G.B.); (H.J.B.)
| | - W. Douglas Evans
- Milken Institute School of Public Health, George Washington University, Washington, DC 20037, USA;
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Myneni S, Zingg A, Singh T, Ross A, Franklin A, Rogith D, Refuerzo J. Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework. JAMIA Open 2024; 7:ooae022. [PMID: 38455839 PMCID: PMC10919928 DOI: 10.1093/jamiaopen/ooae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Objective High-risk pregnancy (HRP) conditions such as gestational diabetes mellitus (GDM), hypertension (HTN), and peripartum depression (PPD) affect maternal and neonatal health. Patient engagement is critical for effective HRP management (HRPM). While digital technologies and analytics hold promise, emerging research indicates limited and suboptimal support offered by the highly prevalent pregnancy digital solutions within the commercial marketplace. In this article, we describe our efforts to develop a portfolio of digital products leveraging advances in social computing, data science, and digital health. Methods We describe three studies that leverage core methods from Digilego digital health development framework to (1) conduct large-scale social media analysis (n = 55 301 posts) to understand population-level patterns in women's needs, (2) architect a digital repository to enable women curate HRP related information, and (3) develop a digital platform to support PPD prevention. We applied a combination of qualitative coding, machine learning, theory-mapping, and programmatic implementation of theory-linked digital features. Further, we conducted preliminary testing of the resulting products for acceptance with sample of pregnant women for GDM/HTN information management (n = 10) and PPD prevention (n = 30). Results Scalable social computing models using deep learning classifiers with reasonable accuracy have allowed us to capture and examine psychosociobehavioral drivers associated with HRPM. Our work resulted in two digital health solutions, MyPregnancyChart and MomMind are developed. Initial evaluation of both tools indicates positive acceptance from potential end users. Further evaluation with MomMind revealed statistically significant improvements (P < .05) in PPD recognition and knowledge on how to seek PPD information. Discussion Digilego framework provides an integrative methodological lens to gain micro-macro perspective on women's needs, theory integration, engagement optimization, as well as subsequent feature and content engineering, which can be organized into core and specialized digital pathways for women engagement in disease management. Conclusion Future works should focus on implementation and testing of digital solutions that facilitate women to capture, aggregate, preserve, and utilize, otherwise siloed, prenatal information artifacts for enhanced self-management of their high-risk conditions, ultimately leading to improved health outcomes.
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Affiliation(s)
- Sahiti Myneni
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Alexandra Zingg
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Tavleen Singh
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Angela Ross
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Amy Franklin
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Deevakar Rogith
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Jerrie Refuerzo
- Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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8
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Waring ME, Arigo D, Rudin LR, Pagoto SL, Moore Simas TA, Horkachuck AB. Interest in an Instagram-delivered gestational weight gain intervention among pregnant women with pre-pregnancy overweight or obesity. Mhealth 2024; 10:12. [PMID: 38689614 PMCID: PMC11058595 DOI: 10.21037/mhealth-23-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/03/2023] [Indexed: 05/02/2024] Open
Abstract
Background Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention. Methods English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed. Results Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences. Conclusions Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.
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Affiliation(s)
- Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
| | - Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Lauren R. Rudin
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sherry L. Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
| | - Tiffany A. Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Alexa B. Horkachuck
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Brammall BR, Garad RM, Teede HJ, Baker SE, Harrison CL. OptimalMe Program: A Mixed Method Investigation into the Engagement and Acceptability of a Preconception Digital Health Lifestyle Intervention with Individual Coaching for Women's Health and Behaviour Change. Nutrients 2024; 16:572. [PMID: 38474701 DOI: 10.3390/nu16050572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
Preconception interventions, specifically addressing general health, lifestyle behaviours and weight management, are limited despite their importance in optimising women's health. The objective of this study is to evaluate the engagement and acceptability of OptimalMe, a digital preconception intervention. Participants, (n = 298) Australian women aged 18-44 with private health insurance planning to conceive within 12 months, received a standardised intervention, including access to a digital healthy lifestyle platform (educational materials, behaviour change activities, and self-monitoring resources), ongoing text messaging, and remotely delivered health coaching (two appointments) with randomised delivery methods (telephone/videoconference). Engagement and acceptability were assessed through mixed method analyses. The results show that 76.2% attended both coaching sessions, with similar participation rates for telehealth (75.2%) and videoconferencing (77.2%) (p = 0.469). All participants logged into the digital platform, with 90.6% accessing educational materials and 91.3% using behaviour change tools. Digital platform engagement declined over time, suggesting potential benefits from additional health coaching support for ongoing participation. The post-intervention evaluation (n = 217 participants) demonstrated that approximately 90% found the digital module engaging, meeting information needs, would recommend the program, and were satisfied with the support. OptimalMe demonstrated positive acceptability and engagement; however, further research is warranted to explore strategies for sustaining engagement with the digital interventions.
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Affiliation(s)
- Bonnie R Brammall
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Rhonda M Garad
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Susanne E Baker
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
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10
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Raab R, Geyer K, Zagar S, Hauner H. App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review. J Med Internet Res 2023; 25:e48853. [PMID: 37948111 PMCID: PMC10674147 DOI: 10.2196/48853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. OBJECTIVE This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app-supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. METHODS The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. RESULTS This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. CONCLUSIONS Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting.
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sophia Zagar
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Mooney J, Dahl AA. Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e50145. [PMID: 37883145 PMCID: PMC10636618 DOI: 10.2196/50145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. OBJECTIVE The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. METHODS This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. RESULTS The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. CONCLUSIONS The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. TRIAL REGISTRATION PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50145.
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Affiliation(s)
- Jan Mooney
- Department of Psychological Science, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Alicia A Dahl
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, United States
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12
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Feng Y, Shi C, Zhang C, Yin C, Zhou L. Effect of the smartphone application on caesarean section in women with overweight and obesity: a randomized controlled trial in China. BMC Pregnancy Childbirth 2023; 23:746. [PMID: 37872503 PMCID: PMC10594860 DOI: 10.1186/s12884-023-06004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/16/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The rate of caesarean section (CS) is increasing worldwide. While a CS can be life-saving when medically indicated, it can cause adverse health effects for both women and children. This trial aims to evaluate the effect of the smartphone application, which aims to control the gestational weight gain, on the rate of CS in overweight and obese women. METHODS Overweight and obese primiparas (BMI ≥ 24 kg/m2) with age between 20 and 40 years old were recruited at Beijing Obstetrics and Gynecology Hospital, and randomly assigned into the intervention group (143 cases) and the control group (138 cases). The intervention group applied the smartphone application (App) to control gestational weight gain in addition to the usual care, and the control group received the usual care. Primary outcome was cesarean section (CS) rate. Secondary outcomes included gestational hypertension, preeclampsia and eclampsia, gestational diabetes mellitus, postpartum hemorrhage, neonatal asphyxia, and macrosomia. RESULTS There was a significant difference in CS rate, with 53.3% in the intervention group and 65.4% in the control group (P = 0.044). The difference still exists in the overweight subgroup (32.6% vs. 55.6%, P = 0.04), but disappears in the obesity subgroup (63.0% vs. 69.1%, P = 0.381). The median of gestational weight gain (GWG) of the intervention group is 8.5 kg (IQR 5.5, 11.0), which is significantly less than that of the control group (median 10.0 kg, IQR [6.0, 14.0], P = 0.008). The intervention group has significantly lower rate of postpartum hemorrhage (5.19%) than the control group (12%) (P = 0.045). There were no significant differences between the groups in gestational hypertension, gestational diabetes mellitus, neonatal asphyxia, and macrosomia. CONCLUSION The smartphone assisted weight control may help reduce CS rate. The effects of the smartphone application might be via the management of gestational weight gain. TRAIL REGISTRATION This trial was registered at Chinese Clinical Trial Registry. Registration number is ChiCTR2300068845 (retrospectively registered, 01/03/2023).
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Affiliation(s)
- Yi Feng
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Beijing, 100026, China
| | - Cuixia Shi
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Beijing, 100026, China
| | - Chengyan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Beijing, 100026, China
| | - Chenghong Yin
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Beijing, 100026, China.
| | - Li Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Beijing, 100026, China.
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13
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Lee VV, Vijayakumar S, Ng WY, Lau NY, Leong QY, Ooi DSQ, Su LL, Lee YS, Chan SY, Blasiak A, Ho D. Personalization and localization as key expectations of digital health intervention in women pre- to post-pregnancy. NPJ Digit Med 2023; 6:183. [PMID: 37775533 PMCID: PMC10541409 DOI: 10.1038/s41746-023-00924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
Health behaviors before, during and after pregnancy can have lasting effects on maternal and infant health outcomes. Although digital health interventions (DHIs) have potential as a pertinent avenue to deliver mechanisms for a healthy behavior change, its success is reliant on addressing the user needs. Accordingly, the current study aimed to understand DHI needs and expectations of women before, during and after pregnancy to inform and optimize future DHI developments. Forty-four women (13 pre-, 16 during and 15 postpregnancy; age range = 21-40 years) completed a 60-minute, semistructured, qualitative interview exploring participant's experience in their current phase, experience with digital health tools, and their needs and expectations of DHIs. Interviews were audio-recorded, transcribed verbatim and thematically analyzed. From the interviews, two core concepts emerged-personalization and localization of DHI. Between both concepts, five themes and nine subthemes were identified. Themes and subthemes within personalization cover ideas of two-way interactivity, journey organization based on phases and circumstances, and privacy trade-off. Themes and subthemes within localization cover ideas of access to local health-related resources and information, and connecting to local communities through anecdotal stories. Here we report, through understanding user needs and expectations, the key elements for the development and optimization of a successful DHI for women before, during and after pregnancy. To potentially empower downstream DHI implementation and adoption, these insights can serve as a foundation in the initial innovation process for DHI developers and be further built upon through a continued co-design process.
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Affiliation(s)
- V Vien Lee
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
| | - Smrithi Vijayakumar
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Wei Ying Ng
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Ni Yin Lau
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Qiao Ying Leong
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Delicia Shu Qin Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
| | - Agata Blasiak
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Dean Ho
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Mair JL, Salamanca-Sanabria A, Augsburger M, Frese BF, Abend S, Jakob R, Kowatsch T, Haug S. Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review. Ann Behav Med 2023; 57:817-835. [PMID: 37625030 PMCID: PMC10498822 DOI: 10.1093/abm/kaad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite an abundance of digital health interventions (DHIs) targeting the prevention and management of noncommunicable diseases (NCDs), it is unclear what specific components make a DHI effective. PURPOSE This narrative umbrella review aimed to identify the most effective behavior change techniques (BCTs) in DHIs that address the prevention or management of NCDs. METHODS Five electronic databases were searched for articles published in English between January 2007 and December 2022. Studies were included if they were systematic reviews or meta-analyses of DHIs targeting the modification of one or more NCD-related risk factors in adults. BCTs were coded using the Behavior Change Technique Taxonomy v1. Study quality was assessed using AMSTAR 2. RESULTS Eighty-five articles, spanning 12 health domains and comprising over 865,000 individual participants, were included in the review. We found evidence that DHIs are effective in improving health outcomes for patients with cardiovascular disease, cancer, type 2 diabetes, and asthma, and health-related behaviors including physical activity, sedentary behavior, diet, weight management, medication adherence, and abstinence from substance use. There was strong evidence to suggest that credible source, social support, prompts and cues, graded tasks, goals and planning, feedback and monitoring, human coaching and personalization components increase the effectiveness of DHIs targeting the prevention and management of NCDs. CONCLUSIONS This review identifies the most common and effective BCTs used in DHIs, which warrant prioritization for integration into future interventions. These findings are critical for the future development and upscaling of DHIs and should inform best practice guidelines.
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Affiliation(s)
- Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
- Klenico Health AG, Zurich, Switzerland
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland
| | - Stefanie Abend
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Rhodes A, Pimprikar A, Baum A, Smith AD, Llewellyn CH. Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study. JMIR Form Res 2023; 7:e44082. [PMID: 37234026 PMCID: PMC10257111 DOI: 10.2196/44082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/19/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. OBJECTIVE The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. METHODS The intervention's development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings' objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. RESULTS Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. CONCLUSIONS This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy.
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Affiliation(s)
- Alexandra Rhodes
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Arya Pimprikar
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | | | - Andrea D Smith
- Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Clare H Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
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Fry J, Wilkinson SA, Willcox J, Henny M, McGuire L, Guthrie TM, Meloncelli N, de Jersey S. Improving Engagement in Antenatal Health Behavior Programs-Experiences of Women Who Did Not Attend a Healthy Lifestyle Telephone Coaching Program. Nutrients 2023; 15:nu15081860. [PMID: 37111079 PMCID: PMC10146126 DOI: 10.3390/nu15081860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women's expectations and goals; (2) the need for flexible, multimodal healthcare; and (3) information sharing throughout antenatal care not meeting women's information needs. Interventions to improve women's engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their individual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.
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Affiliation(s)
- Jessica Fry
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Mothers, Babies and Women's Theme, Mater Research Institute-The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jane Willcox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Impact Obesity, South Melbourne, VIC 3205, Australia
| | - Michaela Henny
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Lisa McGuire
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Taylor M Guthrie
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
- Office of the Chief Allied Health Practitioner, Metro North Health, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Susan de Jersey
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
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Waring ME, Moore Simas TA, Heersping GE, Rudin LR, Balakrishnan K, Burdick AR, Pagoto SL. Development and feasibility of a web-based gestational weight gain intervention for women with pre-pregnancy overweight or obesity. Mhealth 2023; 9:13. [PMID: 37089268 PMCID: PMC10119439 DOI: 10.21037/mhealth-22-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Excessive gestational weight gain is associated with negative maternal and infant health outcomes. Digital health approaches may help overcome barriers to participating in lifestyle interventions requiring in-person visits. The purpose of this study was to develop and examine the feasibility of a web-based gestational weight gain intervention. Methods Intervention development included feedback and input from pregnant women. We conducted a 12-week one-arm pilot study during which participants engaged in an online discussion board with coaches and other pregnant women, tracked their weight gain with an interactive graph, and accessed a list of online resources for pregnancy health. Feasibility outcomes were recruitment, retention, engagement and sustained participation, intervention acceptability, and website usability. Gestational weight gain was an exploratory outcome. Results Participants (n=12) were on average 16.8 [standard deviation (SD): 2.0] weeks gestation with average pre-pregnancy body mass index of 30.5 (SD: 4.8) kg/m2. Participant retention was 92% (n=11). Participants logged into the website a median of 21 times [interquartile range (IQR), 8-37; range, 2-98] over 12 weeks, and 58% (n=7) logged into the website during the last week of the intervention. All participants said they would be very likely or likely to participate again, and 100% said they would be very likely or likely to recommend the intervention to a pregnant friend. In post-intervention interviews, 64% (n=7) explicitly said that the website was easy to use, but 100% (n=11) mentioned usability issues. When asked their preferred intervention platform, 18% (n=2) somewhat or strongly preferred a private website, 18% (n=2) had no preference, and 64% (n=7) somewhat or strongly preferred Facebook. Seventy percent (n=7) had excessive gestational weight gain, 10% (n=1) inadequate gestational weight gain, and 20% (n=2) gained within recommended ranges. Conclusions Additional development work is needed before moving to efficacy testing. Most notably, usability issues with the investigator-developed website and participant preference suggest a switch to a commercial social media platform.
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Affiliation(s)
- Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Tiffany A. Moore Simas
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Grace E. Heersping
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lauren R. Rudin
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Kavitha Balakrishnan
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abigail R. Burdick
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sherry L. Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
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18
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Wang SCY, Kassavou A. Digital Health Behavioural Interventions to Support Physical Activity and Sedentary Behaviour in Adults after Stroke: A Systematic Literature Review with Meta-Analysis of Controlled Trials. Behav Sci (Basel) 2023; 13:62. [PMID: 36661634 PMCID: PMC9855227 DOI: 10.3390/bs13010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Background: As the global prevalence of stroke continues to rise, it becomes increasingly pressing to investigate digital health behaviour change interventions that promote physical activity and reduce sedentary behaviour for stroke patients to support active lifestyles. Purpose: The primary aim of this study is to investigate the effectiveness of digital health interventions in promoting physical activity and reducing sedentary behaviour for stroke patients. The secondary aim is to investigate the intervention components that explain intervention effectiveness to further inform intervention development and policy making. Methods: A systematic search of the literature was conducted in four databases (Scopus, MEDLINE (PubMed), Web of Science, and PsychINFO) to identify the most robust evidence in the form of randomised controlled trials of digital interventions for patients with stroke. A random-effects meta-analysis were utilized to quantify the intervention effects on behaviour change, and subgroup analyses to characterise intervention effective components. Results: In total, 16 RCTs were deemed eligible and included in the systematic review. Meta-analyses suggested significant improvements in physical activity (SMD = 0.39, 95% CI 0.17, 0.61, N = 326, p < 0.001, I2 = 0%), and reductions in time of sedentary behaviour (SMD= −0.45, 95% CI −0.76, -0.14, N = 167, p = 0.00, I2 = 0%) after stroke. The 10 m walk test for physical activity, and the timed up and go test for sedentary behaviour, were the objective outcome measures in the most effective behavioural change interventions. Subgroup analyses found that most effective interventions were underpinned by theories of self-regulation and utilised interactive functions to engage patients with the processes of behaviour change. Conclusions: Digital self-monitoring behavioural interventions are effective in promoting physical activity for stroke patients in adjunct to usual care clinical practice and rehabilitation programmes. Rigorous studies are required to provide evidence to disentangle the most effective intervention components for preventative practices and rehabilitation programs and to inform policymaking for stroke treatment.
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Affiliation(s)
- Serena Caitlin Yen Wang
- Harvard Medical School, Boston, MA 02115, USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Aikaterini Kassavou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
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19
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Lazarevic N, Lecoq M, Bœhm C, Caillaud C. Pregnancy Apps for Self-Monitoring: Scoping Review of the Most Popular Global Apps Available in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1012. [PMID: 36673768 PMCID: PMC9858738 DOI: 10.3390/ijerph20021012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Digital health tools, such as apps, have the potential to promote healthy behaviours, especially self-monitoring, which can facilitate pregnancy management and reduce the risk of associated pregnancy health conditions. While pregnancy apps are popular amongst pregnant women, there is limited information about the overall quality of their content or self-monitoring tools and the number of behaviour change techniques (BCTs) that they include. The aim of this study was thus to assess the quality of pregnancy apps for self-monitoring, and their usage of BCTs. We identified pregnancy apps by web scraping the most popular global apps for self-monitoring in the Apple App Store and Google Play Store available in Australia. The app quality was evaluated using the scorecard approach and the inclusion of BCTs was evaluated using the ABACUS tool. We identified 31 pregnancy apps that met our eligibility criteria. We found that pregnancy apps tended to score the highest in the domains of 'cost and time', 'usability', and 'technical', and lowest on 'clinical' and 'end-user requirements'. Additionally, the majority of apps contained minimal BCTs. Based on our findings, we propose a digital health scorecard visualisation that would break down app quality criteria and present them in a more accessible way to clinicians and pregnant users. We conclude that these findings highlight the shortcomings of available commercial pregnancy apps and the utility of a digital health scorecard visualisation that would empower users to make more informed decisions about which apps are the most appropriate for their needs.
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Affiliation(s)
- Natasa Lazarevic
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Marie Lecoq
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- AgroParisTech, Universite Paris-Saclay, CEDEX, 91 123 Palaiseau, France
| | - Céline Bœhm
- School of Physics, Faculty of Science, Physics Building, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Corinne Caillaud
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
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20
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The short-term effect of a mHealth intervention on gestational weight gain and health behaviors: The SmartMoms Canada pilot study. Physiol Behav 2022; 257:113977. [PMID: 36181787 DOI: 10.1016/j.physbeh.2022.113977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
Gestational weight gain (GWG) has been shown to impact several maternal-infant outcomes. Since healthcare provider guidance on weight gain and healthy behaviors alone has failed to help women to meet guidelines during pregnancy, a practical adjunctive approach is to deliver evidence-based behavior change programs through mobile interventions. The present study aimed to assess the short-term effect of the SmartMoms Canada app to promote adequate GWG and healthy behaviors. Twenty-nine pregnant women were recruited in this app-based intervention trial to test whether a higher app usage (≥ 3.8 min·week-1) between 12-20 gestational weeks and 24-28 gestational weeks improved GWG, diet, physical activity, and sleep, compared to women with a lower app usage (< 3.8 min·week-1). Two-way mixed ANOVA for repeated measures was used to estimate the effect of the app usage and time, as well as their interaction on GWG and healthy behaviors. The likelihood ratio was used to examine the association between app usage categorization and GWG classification. Cramer's V statistic was used to estimate the effect size for interpretation of the association. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity (MVPA) daily average when compared with women with a lower usage (mean difference: 17.84 min/day, 95% CI: 2.44; 33.25). A moderate effect size (28.6% vs. 15.4%; Cramer's V = 0.212) was found for the association between app categorization and rate of GWG, representing a greater adherence to the GWG guidelines in women in the higher app usage group vs. the lower app usage group. Considering other physical activity, diet, and sleep variables, no app categorization effect was observed. A short-term higher usage of SmartMoms Canada app has a positive effect on objectively-measured MVPA.
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21
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Henriksson P, Migueles JH, Söderström E, Sandborg J, Maddison R, Löf M. User engagement in relation to effectiveness of a digital lifestyle intervention (the HealthyMoms app) in pregnancy. Sci Rep 2022; 12:13793. [PMID: 35963935 PMCID: PMC9376088 DOI: 10.1038/s41598-022-17554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
Although user engagement is generally considered important for the effectiveness of digital behavior change interventions, there is a lack of such data in pregnancy. The aim of this study was therefore to examine the associations of user engagement with the HealthyMoms app with gestational weight gain, diet quality and physical activity in pregnancy. The study involved secondary analyses of participant data from the intervention group (n = 134) in a randomized controlled trial to determine the effectiveness of a 6-month mHealth intervention (the HealthyMoms app) on gestational weight gain, diet quality and physical activity. In adjusted regression models, the total number of registrations from three self-monitoring features (i.e., for weight-, diet- and physical activity) was associated with lower gestational weight gain (β = − 0.18, P = 0.043) and improved diet quality (β = 0.17, P = 0.019). These findings were mainly attributable to the associations of physical activity registrations with lower gestational weight gain (β = − 0.20, P = 0.026) and improved diet quality (β = 0.20, P = 0.006). However, the number of app sessions and page views were not associated with any of the outcomes. Our results may motivate efforts to increase user engagement in digital lifestyle interventions in pregnancy. However, additional studies are needed to further elucidate the influence of different types of user engagement in digital pregnancy interventions on their effectiveness. Trial registration: ClinicalTrials.gov (NCT03298555); https://clinicaltrials.gov/ct2/show/NCT03298555 (date of registration: October 2, 2017; date of first enrolled participant: October 24, 2017).
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Affiliation(s)
- Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Jairo H Migueles
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Johanna Sandborg
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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22
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Thomas T, Xu F, Sridhar S, Sedgwick T, Nkemere L, Badon SE, Quesenberry C, Ferrara A, Mandel S, Brown SD, Hedderson M. A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial. JMIR Form Res 2022; 6:e33929. [PMID: 35731565 PMCID: PMC9260523 DOI: 10.2196/33929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. OBJECTIVE This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. METHODS We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. RESULTS Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program "good to excellent." Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. CONCLUSIONS The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283.
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Affiliation(s)
- Tainayah Thomas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sneha Sridhar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Tali Sedgwick
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Linda Nkemere
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sarah Mandel
- The Permanente Medical Group, San Francisco, CA, United States
| | - Susan D Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- School of Medicine, University of California, Davis, Sacramento, CA, United States
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Monique Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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23
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Faessen JPM, Lucassen DA, Buso MEC, Camps G, Feskens EJM, Brouwer-Brolsma EM. Eating for 2: A Systematic Review of Dutch App Stores for Apps Promoting a Healthy Diet during Pregnancy. Curr Dev Nutr 2022; 6:nzac087. [PMID: 35711572 PMCID: PMC9197571 DOI: 10.1093/cdn/nzac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
A healthy diet during pregnancy has been associated with beneficial child and maternal health outcomes but is challenging to achieve. Recent technological advances offer new opportunities to support pregnant women in their food choices-for instance, via apps. This is already reflected by a wide availability of pregnancy-related apps, but health care professionals feel unsure about their potential. Therefore, the Dutch Google Play Store and Apple App Store were reviewed to identify existing apps on diet and pregnancy. App quality was assessed using the 1) Mobile App Rating Scale (MARS; i.e., assessing functionality, aesthetics, engagement, information quality), 2) Dutch dietary guidelines for pregnant women, and 3) App Behavior Change Scale (ABACUS). Fifty-seven unique apps were identified with an average star rating of 4.2 ± 0.6 and MARS quality score of 3.2 ± 0.3, indicating a moderate quality. Most apps scored best in terms of functionality and aesthetics (4.0 ± 0.4 and 3.3 ± 0.6), but lowest in terms of engagement (2.5 ± 0.6). Regarding nutrition information provision, most apps were incomplete or deviated from the Dutch guidelines. Folic acid supplementation (91%), hygiene (81%), caffeine (79%), and alcohol (77%) were the most commonly addressed nutrition aspects, whereas licorice (11%), iodine (19%), and soy (18%) were only addressed in a few apps. Moreover, a median of 2 out of 21 ABACUS behavior change items were identified per app, which were predominantly related to the category "knowledge and information." Thus, despite the abundance of apps supporting a healthy diet during pregnancy in the Dutch app stores, there is an urgent need for apps with complete and scientifically sound dietary information that is supported by effective behavior change techniques.
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Affiliation(s)
- Janine P M Faessen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Systematic Change Group, Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marion E C Buso
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Guido Camps
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- OnePlanet Research Center, Plus Ultra II, Wageningen, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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24
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Waring ME, Pagoto SL, Moore Simas TA, Heersping G, Rudin LR, Arcangel K. Feedback on Instagram posts for a gestational weight gain intervention. Transl Behav Med 2022; 12:568-575. [PMID: 35191497 PMCID: PMC9150071 DOI: 10.1093/tbm/ibac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lifestyle interventions can facilitate healthy gestational weight gain but attending in-person meetings can be challenging. High rates of use and the popularity of pregnancy content suggests Instagram as a possible platform for delivering gestational weight gain interventions. We assessed the logistics and acceptability of creating a private Instagram group and to obtain feedback on intervention posts. We conducted a 2-week study with pregnant women with pre-pregnancy overweight or obesity who use Instagram daily. Participants created a private Instagram account and followed other participants and a moderator who shared twice-daily posts about physical activity and healthy eating during pregnancy. Participants provided feedback through a follow-up survey and focus group/interviews. Engagement data was abstracted from Instagram. Participants (N = 11) were on average 26.3 (SD: 7.4) weeks gestation and 54% had obesity pre-pregnancy. All participants followed the moderator's account, 73% followed all other participants, participants engaged with 100% of study posts, 82% felt comfortable sharing in the group, and 73% would participate in a similar group if pregnant in the future. While participants felt the posts were visually attractive and included helpful information, they wanted more personalized content and felt reluctant to post photos they felt were not "Instagram worthy." Moderators should foster an environment in which participants feel comfortable posting unedited, authentic photos of their lives, perhaps by sharing personal photos that are relatable and represent their own imperfect lives. Results will inform further development and testing of an Instagram-delivered gestational weight gain intervention.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Sherry L Pagoto
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Grace Heersping
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Lauren R Rudin
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Kaylei Arcangel
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
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25
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Char A, Gaudel P, Kulathinal S, Kinnunen TI. Effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia - A systematic review of intervention studies. Obes Res Clin Pract 2022; 16:181-196. [PMID: 35690586 DOI: 10.1016/j.orcp.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Mobile technology has been increasingly used as part of dietary interventions, but the effects of such interventions have not been systematically evaluated in the South Asian context. The systematic review aimed to determine the effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia. METHODS Five electronic databases were searched (PubMed, Scopus, Web of Science, Global Health Library and Health Technology Assessment). Studies published in English between 1st January 2011 and 31st December 2021were included. Interventions that evaluated the effects of dietary interventions using technology on dietary outcomes and anthropometrics in adolescents or adults in the age group of 13-44 years (or a broader age group) from South Asia were eligible for inclusion. The risk of bias was assessed using the Cochrane Risk-of-bias 2 tool and ROBINS-I tool. A narrative synthesis was conducted. RESULTS Twenty-one studies met the inclusion criteria (20,667 participants). Eleven of the 17 randomised controlled trials (RCTs) had a high overall risk of bias. The four non-randomised intervention studies had a serious or critical overall risk of bias. When including studies with low risk or some concern for bias, the interventions had a beneficial effect on at least one dietary outcome in four of the six RCTs that measured changes in diet, and no effect on the anthropometric outcomes in the six RCTs that measured changes in anthropometric outcomes. DISCUSSION Technology-based dietary interventions have had some positive effects on dietary intake, but no effects on anthropometry in South Asia. More evidence is needed as the overall risk of bias was high in a majority of the studies.
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Affiliation(s)
- Arundhati Char
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pramila Gaudel
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
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26
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Goodday SM, Karlin E, Brooks A, Chapman C, Karlin DR, Foschini L, Kipping E, Wildman M, Francis M, Greenman H, Li L, Schadt E, Ghassemi M, Goldenberg A, Cormack F, Taptiklis N, Centen C, Smith S, Friend S. Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. NPJ Digit Med 2022; 5:40. [PMID: 35354895 PMCID: PMC8967890 DOI: 10.1038/s41746-022-00579-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The Better Understanding the Metamorphosis of Pregnancy (BUMP) study is a longitudinal feasibility study aimed to gain a deeper understanding of the pre-pregnancy and pregnancy symptom experience using digital tools. The present paper describes the protocol for the BUMP study. Over 1000 participants are being recruited through a patient provider-platform and through other channels in the United States (US). Participants in a preconception cohort (BUMP-C) are followed for 6 months, or until conception, while participants in a pregnancy cohort (BUMP) are followed into their fourth trimester. Participants are provided with a smart ring, a smartwatch (BUMP only), and a smart scale (BUMP only) alongside cohort-specific study apps. Participant centric engagement strategies are used that aim to co-design the digital approach with participants while providing knowledge and support. The BUMP study is intended to lay the foundational work for a larger study to determine whether participant co-designed digital tools can be used to detect, track and return multimodal symptoms during the perinatal window to inform individual level symptom trajectories.
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Affiliation(s)
- S M Goodday
- 4YouandMe, Seattle, WA, USA.
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | | | | | | | - D R Karlin
- 4YouandMe, Seattle, WA, USA
- MindMed, Inc., New York, NY, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - L Foschini
- Evidation Health Inc., Santa Mateo, CA, USA
| | - E Kipping
- Evidation Health Inc., Santa Mateo, CA, USA
| | - M Wildman
- Evidation Health Inc., Santa Mateo, CA, USA
| | | | | | | | | | - M Ghassemi
- Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
- Vector Institute, CIFAR AI Chair, Toronto, Canada
| | - A Goldenberg
- Vector Institute, CIFAR AI Chair, Toronto, Canada
- SickKids Research Institute, Department of Computer Science, University of Toronto, Toronto, Canada
| | - F Cormack
- Cambridge Cognition, Cambridge, GB, USA
- Department of Psychiatry, University of Cambridge, Cambridge, GB, USA
| | | | - C Centen
- Bodyport Inc., San Francisco, CA, USA
| | - S Smith
- Bodyport Inc., San Francisco, CA, USA
| | - S Friend
- 4YouandMe, Seattle, WA, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
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27
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Gonzalez-Plaza E, Bellart J, Arranz Á, Luján-Barroso L, Crespo Mirasol E, Seguranyes G. Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e28886. [PMID: 35166684 PMCID: PMC8889480 DOI: 10.2196/28886] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/30/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire–Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI −0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks–minutes per week vs 1386 metabolic equivalents of tasks–minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872
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Affiliation(s)
- Elena Gonzalez-Plaza
- Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Barcelona, Spain.,Department of Nursing, Public, Mental and Maternity and Child Health, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Jordi Bellart
- Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Ángela Arranz
- Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Barcelona, Spain.,Department of Nursing, Public, Mental and Maternity and Child Health, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Leila Luján-Barroso
- Department of Nursing, Public, Mental and Maternity and Child Health, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain.,Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Bellvitge Biomedical Research Institute, Catalan Institute of Oncology, Barcelona, Spain
| | - Esther Crespo Mirasol
- Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Barcelona, Spain.,Department of Nursing, Public, Mental and Maternity and Child Health, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Gloria Seguranyes
- Department of Nursing, Public, Mental and Maternity and Child Health, School of Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain.,Research Group on Sexual and Reproductive Health Care (GRASSIR), Barcelona, Spain
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Ibrahim MS, Mohamed Yusoff H, Abu Bakar YI, Thwe Aung MM, Abas MI, Ramli RA. Digital health for quality healthcare: A systematic mapping of review studies. Digit Health 2022; 8:20552076221085810. [PMID: 35340904 PMCID: PMC8943311 DOI: 10.1177/20552076221085810] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/20/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices. Methods We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining. Results A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%). Conclusion Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.
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Affiliation(s)
| | | | | | - Myat Moe Thwe Aung
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | | | - Ras Azira Ramli
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
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29
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Sanders GJ, Cooke C, Gately P. Exploring reasons for attrition among vulnerable and under-served sub-groups across an online integrated healthy lifestyles service during COVID-19. SAGE Open Med 2021; 9:20503121211054362. [PMID: 34707867 PMCID: PMC8543558 DOI: 10.1177/20503121211054362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: Reported health behaviour change intervention attrition rates vary considerably, from 10% to more than 80%, depending on the type and setting of the treatment programme. A better understanding of the determinants of programme adherence is required. Between March and August 2020, a convenience sample of 44 individual telephone interviews, as well as 42 online Qualtrics surveys took place. The objective was to explore perceived barriers, facilitators, and opportunities for participation, sustained participation as well as initial non-participation to better understand reasons for attrition in online delivery during the COVID-19 lockdown among vulnerable and under-served groups within an Integrated Healthy Lifestyle Service (IHLS). Methods: A convenience sample of 44 individual telephone interviews, as well as 42 online Qualtrics surveys resulted in a total of 86 (33 male) individuals comprising intervention clients. Clients included children and young people (n = 16), manual workers (n = 7), Black, Asian or Minority Ethnic (n = 19), physical disability (n = 8), learning disability (n = 6), and those from areas of high deprivation (n = 19), as well as Integrated Healthy Lifestyle Service practitioners (n = 11). Results: The study revealed that more resources and support are needed for Black, Asian or Minority Ethnic; manual worker; learning disability; and high-deprivation sub-groups in order to reduce attrition rates. Specifically, a lack of technological equipment and competence of using such equipment was identified as key barriers to initial and sustained attendance among these vulnerable and under-served sub-groups during the COVID-19 lockdown. Conclusion: The pattern of differences in attrition during the COVID-19 lockdown suggests that further research is required to explore how best to ensure online health behaviour change offers are scalable and accessible to all.
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Affiliation(s)
| | - Carlton Cooke
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Paul Gately
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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30
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Delaney T, Mclaughlin M, Hall A, Yoong SL, Brown A, O’Brien K, Dray J, Barnes C, Hollis J, Wyse R, Wiggers J, Sutherland R, Wolfenden L. Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review. Nutrients 2021; 13:nu13093281. [PMID: 34579158 PMCID: PMC8470016 DOI: 10.3390/nu13093281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +612-49246-499
| | - Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kate O’Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Julia Dray
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jenna Hollis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
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31
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Rhodes A, Smith AD, Llewellyn CH, Croker H. Investigating partner involvement in pregnancy and identifying barriers and facilitators to participating as a couple in a digital healthy eating and physical activity intervention. BMC Pregnancy Childbirth 2021; 21:450. [PMID: 34182953 PMCID: PMC8237776 DOI: 10.1186/s12884-021-03917-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance (dietary and physical activity) behaviours. AIMS This study aimed to investigate the role partners play in pregnant women's energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy. METHODS A qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men (n = 15) and one mini focus group (n = 3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework. RESULTS Four main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple-bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as 'ours' (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as 'hers' and economic constraints. CONCLUSIONS An opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health.
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Affiliation(s)
- Alexandra Rhodes
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, Gower Street, WC1E 6BT, London, UK.
| | - Andrea D Smith
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, Gower Street, WC1E 6BT, London, UK
| | - Clare H Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, Gower Street, WC1E 6BT, London, UK
| | - Helen Croker
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
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32
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Carolan-Olah M, Vasilevski V, Nagle C, Stepto N. Overview of a new eHealth intervention to promote healthy eating and exercise in pregnancy: Initial user responses and acceptability. Internet Interv 2021; 25:100393. [PMID: 34026565 PMCID: PMC8121697 DOI: 10.1016/j.invent.2021.100393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this project was to develop and evaluate an eHealth intervention to promote healthy lifestyle for pregnant women. The setting was a low socio-economic and multi-ethnic area in Melbourne, Australia. METHODS This paper briefly describes the development of the eHealth intervention, which was aimed at a low level of literacy, and the evaluation of the intervention by pregnant women. A basic descriptive survey was undertaken to evaluate user friendliness, usefulness and acceptability of the intervention. RESULTS The intervention was developed by a team of experts and forty pregnant women participated in the evaluation. Results indicated that participants found the intervention informative, useful and easy to navigate. They also identified some minor areas for improvement which will be addressed prior to proceeding to a formal controlled evaluation. CONCLUSION Results from this evaluation are encouraging and suggest that women found the intervention convenient, trustworthy and engaging. Most enjoyed navigating the website information. As such, it is likely to prove a useful support for delivering dietary and exercise information to pregnant women in the local low socio-economic area. Further formal evaluation will test the efficacy of the website in improving diet and exercise outcomes during pregnancy.
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Affiliation(s)
- Mary Carolan-Olah
- Victoria University, College of Health and Biomedicine, St Alban's Campus, PO Box 14228, Melbourne 8001, Australia,Corresponding author.
| | - Vidanka Vasilevski
- Research Fellow, School of Nursing & Midwifery – Western Health Partnership, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia
| | - Cate Nagle
- James Cook University and Townsville Hospital and Health Service, Townsville, QLD 4814, Australia
| | - Nigel Stepto
- Victoria University, Institute of Sport Exercise and Active Living (ISEAL), Footscray Campus, PO Box 14228, Melbourne 8001, Australia
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33
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Sandborg J, Söderström E, Henriksson P, Bendtsen M, Henström M, Leppänen MH, Maddison R, Migueles JH, Blomberg M, Löf M. Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26091. [PMID: 33704075 PMCID: PMC7995071 DOI: 10.2196/26091] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (–1.33 kg; 95% CI –2.92 to 0.26; P=.10) and completers-only analyses (–1.67 kg; 95% CI –3.26 to –0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). Conclusions Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID) RR2-10.2196/13011
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Affiliation(s)
- Johanna Sandborg
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Marja H Leppänen
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Folkhälsan Research Center, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jairo H Migueles
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Granada, Spain
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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