The Usability and Effectiveness of Mobile Health Technology-Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review

Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews

BACKGROUND

Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers.

OBJECTIVE

This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally.

METHODS

We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions.

RESULTS

A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%).

CONCLUSIONS

The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research.

TRIAL REGISTRATION

PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77.

The differences between adults and adolescents using a mobile health application for menstrual complaints: A usability and qualitative study

BACKGROUND

A "Menstruatie Educatie Kalender" application (Menstruation Education Calendar, (MEK-APP)) was developed for adults to evaluate menstrual complaints. The future aim of this app is to use it as a self-diagnostic instrument for menstrual abnormalities for both adults and adolescents. Early identification of the potential of an application for future use by both user groups would increase implementation success and adoption of the application.

OBJECTIVE

To compare differences in experienced usability by adults versus adolescents and to identify factors influencing future use for both age groups in one mHealth application (in this study the MEK-APP).

METHODS

This study consisted of three phases: (1) usability testing of the MEK-APP for iOS and Android by think-aloud method, (2) two-month daily use and (3) in-depth individual interview. During the think-aloud sessions, twelve tasks were performed in the application while they were thinking aloud. Usability problems were rated for their severity with Nielsen' Severity Scale. Both the think-aloud sessions and in-depth interviews were verbatim transcribed and thematically analyzed to determine the factors influencing future use for both groups. In addition, the System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI) questionnaires were filled out during the interviews.

RESULTS

Seven adults (>18 years) and seven adolescents (14-18 years) evaluated the MEK-APP. There were 14 usability issues and 16 bugs in both groups. There were no differences between adults and adolescents. In the thematic qualitative analysis, the following future use factors were identified: user-expectation, motivation, privacy, understandability, and user-experience. The user-expectation, motivation and privacy differed between both groups but did not influence usage. No differences were observed in SUS and IMI scores between both groups.

CONCLUSIONS

There are five factors influencing the future use of a menstrual-related mHealth application for both adults and adolescents. It is possible to serve different age groups with a single application.

Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework

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.

Mitigating Health-Related Uncertainties During Pregnancy: The Role of Smart Health Monitoring Technologies

Pregnancy is a time filled with uncertainties, which can be challenging and lead to fear or anxiety for expectant parents. Health monitoring technologies that allow monitoring of the vital signs of both the mother and fetus offer a way to address health-related uncertainties. But are smart health monitoring technologies (SHMTs) actually an effective means to reduce uncertainties during pregnancy, or do they have the opposite effect? Using conceptual reasoning and phenomenological approaches grounded in existing literature, this Viewpoint explores the effects of SHMTs on health-related uncertainties during pregnancy. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.Using conceptual reasoning and phenomenological approaches grounded in existing literature, the effects of SHMTs on health-related uncertainties during pregnancy are explored. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.

Treatable Traits in Pregnant Women with Asthma

BACKGROUND

Asthma is the most common chronic respiratory disease in pregnancy, affecting approximately 8-10% of pregnant women. Uncontrolled asthma is associated with adverse perinatal outcomes, including low birth weight, preterm birth, and maternal complications such as pre-eclampsia.

SUMMARY

A current approach to the management of chronic airway diseases is based on targeting treatable traits. The aim of this review was to define treatable traits in pregnant women with asthma based on recent literature and to determine personalized treatment options according to these traits. Traits addressed in this review that may improve asthma control and pregnancy outcomes are fractional exhaled nitric oxide-based asthma monitoring and treatment, medication adherence and inhalation technique, impaired lung function, smoking cessation and comorbidity including psychological conditions (depression and anxiety), obesity, rhinitis, gastroesophageal reflux disease, chronic rhinosinusitis with or without nasal polyps, and sleep apnea.

KEY MESSAGES

All the treatable traits discussed have the potential to improve asthma control and pregnancy outcomes in pregnant women with asthma. Further research is needed to determine which management approaches are best to improve asthma control during pregnancy, to identify other relevant treatable traits, and to determine whether the treatable trait approach is feasible and beneficial in pregnant women with asthma.

Mobile health apps for pregnant women usability and quality rating scales: a systematic review

OBJECTIVE

This study is to identify the apps used by pregnant women during the technology era and to choose the best app from the point of view of pregnant women and experts.

METHODS

The article is a research article that uses PRISMA flowchart. Given that there are many apps in the field of pregnancy and due to technological advances, the articles of the last 13 years that have been scientifically published in the databases of Google Scholar, PubMed, and Science Direct have been analyzed. The most widely used and, at the same time, the best app is introduced in terms of its high usability in users' attitude. Finally, Apps will be compared in terms of accuracy, precision, and usability of the dimensions of Jacob Nielsen's five principles.

RESULTS

According to the search strategy, 23 articles were identified qualitatively by reviewing both authors. Then, the types of apps were divided into three general categories, pregnant entertainment apps, pregnant information apps, and monitoring apps for mothers' physical health. Finally, 10 apps were selected and the Amila app was introduced as the best due to its high usability (Effectiveness %66.66) and users' satisfaction or women's choice (%98).

CONCLUSION

Using trusted apps to maintain their health and reduce traffic will be very important. Given that this research article was written with the aim of choosing the best app, that not only provides the required information to mothers, but also the ability to interact with doctors and specialists.

Effectiveness of smoking cessation interventions among pregnant women: An updated systematic review and meta-analysis

OBJECTIVE

To carry out a systematic review of systematic reviews with an update of the existing evidence relating to a broad range of smoking cessation interventions, including psycho-social, digital and pharmacologic interventions, for pregnant women.

DATA-SOURCES

Search was conducted in March 2022 in PubMed, EMBASE, and Cochrane in two stages: 1) a search of systematic reviews and meta-analyses, published from January 2012 through January 2022; 2) an update of those that fulfilled eligibility criteria reproducing the primary search strategy.

STUDY ELIGIBILITY CRITERIA

We selected randomized clinical trials (RCTs) that evaluated the effectiveness of pharmacological, digital, and psychosocial interventions in aged 18 years and over who were daily smokers, and compared these with routine care, less intense interventions or placebo.

STUDY APPRAISAL AND SYNTHESIS METHODS

Data from eligible studies were manually extracted by two authors and reviewed by a third. The quality of the reviews was evaluated using the AMSTAR scale, and risk of bias was measured with the Rob-2 tool and GRADE level of evidence.

RESULTS

The meta-analysis included 63 RCTs (n = 19849 women). The interventions found to be effective were: financial incentives (RR:1.77; 95%CI:1.21-2.58), counseling (RR:1.27; 95%CI:1.13-1.43) and long-term nicotine replacement therapy (NRT) (RR:1.53; 95%CI:1.16-2.01). Short-term NRT, bupropion, digital interventions, feedback, social support, and exercise showed no effectiveness. The GRADE level of evidence was moderate-to-high for all interventions, with the exception of long-term NRT.

CONCLUSIONS

Non-pharmacological interventions for smoking cessation are the most effective for pregnant women. The moderator analysis suggests that pregnant women of low socioeconomic status might benefit less from smoking cessation interventions than women of a high socioeconomic status. These women are usually heavier smokers that live in pro-smoking environments and could require more intensive and targeted interventions.

Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study

Background

Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study.

Objective

The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy.

Methods

A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective.

Results

A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated "above average" in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes.

Conclusions

Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects.

Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper

INTRODUCTION

Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers.

METHODS AND ANALYSIS

A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.

TRIAL REGISTRATION NUMBER

Clinicaltrial.gov ID: NCT05377151.

Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study

BACKGROUND

Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial.

OBJECTIVE

This study aims to verify the feasibility and usability of the Job Adjustment mobile app.

METHODS

A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale.

RESULTS

The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01).

CONCLUSIONS

The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.

App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review

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.

A mobile application for early labour support -feasibility pilot study

BACKGROUND

Use of mobile applications (apps) are increasing during pregnancy but few of these are evidence-based or evaluated in research.

AIM

To examine the feasibility, including perceived usefulness and usability, and the preliminary effects of an app based on the Confident birth method.

METHODS

A mixed-method approach, including 48 women, was used to evaluate acceptability, usability and to test study design and procedures. iPhone-users (n = 24) tested the app during pregnancy while the remaining (n = 24) formed a control group. Background characteristics and outcome measurements were collected from all women at baseline. Women in the app group received two follow-up phone calls from a midwife concerning usefulness and ease of use of the app. A follow-up questionnaire after birth were used to measure preliminary effects of the intervention as well as system usability of the app.

RESULTS

Women using the app found the app exercises simple, understandable, and useful. System usability score showed a mean score of 85.3 indicating excellent system usability. Notes from phone calls resulted in four categories: positive feedback about the app, negative feedback about the app, partners involvement, and knowledge. Preliminary effects of labour experience showed no significant differences between the two groups, in terms of early labour or childbirth experience.

CONCLUSION

The app tested in this feasibility study, was perceived as useful and appreciated by women. Areas for improvement of the app were identified. The result shows promise for further efficacy testing in a forthcoming randomised controlled trial.

A systematic review of digital interventions for smoking cessation in patients with serious mental illness

Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.

Development, validation, and usability testing of prototype mobile application for oral health promotion during pregnancy in India

Background

Oral diseases are a silent epidemic.

Objectives

The objectives of the study were to develop, validate, and assess the usability of an oral health prototype mobile application for oral health promotion among pregnant women in India.

Materials and Methods

A cross-sectional study was conducted in Tertiary Care Hospital in Delhi, India, after obtaining Ethical Clearance from the Institutional Ethical Committee Board. The study was conducted in three phases: development of the prototype app, its validation, followed by usability testing of the app. Mobile app was validated by 30 pregnant women and 30 subject experts using Heuristic Analysis Scale and usability testing by 30 pregnant women based on System Usability Scale (SUS). Data were analyzed with IBM SPSS version 21.0.

Results

Majority (over 90%) of pregnant women and subject experts strongly acknowledged that the app educated the users using positive motivation strategies, instilling comprehensive knowledge and faced no issues with the appropriate functionality of the app. The prototype app scored 73.75 on SUS, indicating high usability.

Conclusion

This study holistically explored various dimensions of oral health care in pregnant women. Its novelty is proven by the fact that the content of the prototype application has been phase wise developed and validated by pregnant women and subject experts. Usability testing of the app indicated its high acceptability and ease of use among pregnant women in India.

Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review

BACKGROUND

The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations.

OBJECTIVE

This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe.

METHODS

In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies.

RESULTS

Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity.

CONCLUSIONS

This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery.

Improving Engagement in Antenatal Health Behavior Programs-Experiences of Women Who Did Not Attend a Healthy Lifestyle Telephone Coaching Program

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.

Midwifery learning and forecasting: Predicting content demand with user-generated logs

Every day, 800 women and 6700 newborns die from complications related to pregnancy or childbirth. A well-trained midwife can prevent most of these maternal and newborn deaths. Data science models together with logs generated by users of online learning applications for midwives can help improve their learning competencies. In this work, we evaluate various forecasting methods to determine the future interest of users for the different types of content available in the Safe Delivery App, a digital training tool for skilled birth attendants, broken down by profession and region. This first attempt at health content demand forecasting for midwifery learning shows that DeepAR can accurately anticipate content demand in operational settings, and could therefore be used to offer users personalized content and to provide an adaptive learning journey.

The effects of social media (Snapchat) interventions on the knowledge of oral health during pregnancy among pregnant women in Saudi Arabia

BACKGROUND

There is growing interest in using social media to improve pregnant women's well-being. This study aimed to evaluate the effects of social media (Snapchat) dissemination of health-promoting interventions on knowledge of oral health during pregnancy among pregnant women in Saudi Arabia.

MATERIALS AND METHODS

Using a single-blinded parallel group randomized controlled trial design, 68 volunteers were assigned to either a study group (SG) or a control group (CG). The SG received information about oral health during pregnancy via Snapchat, while the CG received the same information using WhatsApp. The participants were assessed three times: T1 prior to the intervention, T2 immediately following the intervention, and T3 as a follow-up 1 month later.

RESULTS

A total of 63 participants completed the study in the SG or CG. According to paired t-test, total knowledge scores in the SG and CG increased significantly from T1 to T2 (p < 0.001) and from T1 to T3 (p < 0.001), but there was no significant change from T2 to T3 in either the SG or CG (p  =  0.699 and p  =  0.111, respectively). Using t-test, no significant differences were found between the SG and CG at T2 (p  =  0.263) or T3 (p  =  0.622). Also using t-test, no significant differences were found in the scores of the SG and CG from T2 to T1 (p  =  0.720), T3 to T2 (p  =  0.339), or T3 to T1 (p  =  0.969).

CONCLUSIONS

Using social media (e.g., Snapchat and WhatsApp) as a health-promoting intervention is a promising method for improving women's knowledge about oral health during pregnancy for short term. However, further studies are needed to compare social media with conventional standard lecturing methods. also, to assess the longevity of the impact (short or long term).

Systematic review on the cost and cost-effectiveness of mHealth interventions supporting women during pregnancy

OBJECTIVES

The increased integration of digital health into maternity care-alongside growing use of, and access to, personal digital technology among pregnant women-warrants an investigation of the cost-effectiveness of mHealth interventions used by women during pregnancy and the methodological quality of the cost-effectiveness studies.

METHODS

A systematic search was conducted to identify peer-reviewed studies published in the last ten years (2011-2021) reporting on the costs or cost-effectiveness of mHealth interventions used by women during pregnancy. Available data related to program costs, total incremental costs and incremental cost-effectiveness ratios (ICERs) were reported in 2020 United States Dollars. The quality of cost-effectiveness studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

FINDINGS

Nine articles reporting on eight studies met the inclusion criteria. Direct intervention costs ranged from $7.04 to $86 per woman, total program costs ranged from $241,341 to $331,136 and total incremental costs ranged from -$21.16 to $1.12 million per woman. The following ICERs were reported: $2168 per DALY averted, $203.44 per woman ceasing smoking, and $3475 per QALY gained. The full economic evaluation studies (n = 4) were moderate to high in quality and all reported the mHealth intervention as cost-effective. Other studies (n = 4) were low to moderate in quality and reported low costs or cost savings associated with the implementation of the mHealth intervention.

CONCLUSIONS FOR PRACTICE

Preliminary evidence suggests mHealth interventions may be cost-effective and "low-cost" but more evidence is needed to ascertain the cost-effectiveness of mHealth interventions regarding positive maternal and child health outcomes and longer-term health service utilisation.

Impact of a Health Education Intervention on the Incidence of Influenza-Like Illnesses (ILI) During Hajj via Smartphone Application

This study was aimed at demonstrating the impact of a health education intervention on reducing the incidence of influenza-like illnesses symptoms among Malaysian Hajj pilgrims. This study utilizes a quasi-experimental study in the evaluation of the impact of the intervention. Participants were recruited during Hajj orientation courses organized by private Hajj companies. Participants from two companies were assigned to an intervention group and control group, respectively. The intervention group received a smartphone-based health education intervention guided by the Health Belief Model (HBM), while the control group received a regular Hajj guide intervention smartphone application before departure to Hajj. Data on the incidence of influenza-like illnesses (ILI) were collected from participants from two Hajj companies before and after returning from Hajj. Data analysis was conducted using SPSS with descriptive analysis, and analytical tests were conducted at 5% significance level. A total of 102 pilgrims completed the study in both intervention and control groups. The incidence of ILI and Non-ILI symptoms were statistically significant when the intervention and control groups (p = 0.049) were compared. In conclusion, health education has an impact on reducing the incidence of ILI and non-ILI among Hajj pilgrims.

Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study

BACKGROUND

A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys.

OBJECTIVE

This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app.

METHODS

Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability.

RESULTS

During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3).

CONCLUSIONS

Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation.

Exploring the Needs and Expectations of Expectant and New Parents for an mHealth Application to Support the First 1000 Days of Life: Steps toward a Co-Design Approach

To improve maternal and child health, it is essential to adhere to health-promoting and preventive measures. However, reliable information as well as effective tools are not easy to identify in this field. Our cross-sectional study investigated the needs and expectations of expectant and new mothers and fathers as potential primary users of a hypothetical application supporting the first 1000 days of life. Between May and August 2022, we recruited expectant and new parents by administering an 83-item 5-point Likert scale questionnaire related to the content, functionalities, and technical features of the hypothetical app. We stratified responses using sociodemographic characteristics and then performed ward hierarchical clustering. The 94 women and 69 men involved in our study generally agreed with the proposed content, but expressed low interest in certain app functionalities or features, including those related to the interaction mechanism and interactivity. Women were generally more demanding than men. Our findings, resulting from the engagement of end-users, may be useful for designers and technology providers to implement mHealth solutions that, in addition to conveying reliable information, are tailored to the needs and preferences of end-users in the first 1000 days of life.

Quality assessment of pre- and postnatal nutrition and exercise mobile applications in the United States and China

Background

Mobile applications (apps) are becoming increasingly prevalent as tools for improving maternal health behaviors. However, the recently updated content and quality of these apps remain unknown. This research investigated the fundamental characteristics, functional modules, and overall quality of maternal apps available in the United States and China to reveal critical nutrition and physical activity gaps.

Methods

A systematic search was performed in Android and iOS app stores (China and the United States). Apps were eligible if they targeted pregnant or postpartum women, focused on nutrition or physical activity, and had interfaces in English or Chinese. The basic characteristics, functional modules, and overall quality of the apps were evaluated, and differences between apps available in China or the United States were determined using analysis of variance and chi-square tests. Pearson correlations were utilized to investigate links between objective quality and user rating.

Results

A total of 65 maternity-related nutrition and physical activity apps (34 from China and 31 from the United States) were eligible. Among them, 68% (21/31) of US apps and 56% (19/34) of Chinese apps did not provide supporting evidence for their content. A greater number of Chinese apps provided app-based general education modules, namely food nutrition knowledge (n = 0, 0% in the United States vs. n = 30, 88.2% in China). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 21, 67.7% in the United States vs. n = 2, 5.9% in China). The overall app quality rating in the United States was lower than it was in China (mean: 3.5, SD: 0.6 in China vs. mean: 3.4, SD: 0.7 in the United States). There was no relationship between the overall app quality rating and the user rating in either country (rho = 0.11 in China and rho = -0.13 in the United States).

Conclusion

The characteristics and functional modules of in-store apps for maternal nutrition and physical activity differed between the United States and China. Both countries' apps, especially Chinese apps, lacked evidence-based information, and there was no correlation between app quality and user rating. The results therefore suggest that user ratings cannot be used as an objective indicator of app quality and that it is necessary to improve the empirical basis and credibility of apps in both countries.

Knowledge, attitudes and behaviours surrounding preconception and pregnancy health: an Australian cross-sectional survey

OBJECTIVE

To understand Australian women's knowledge, attitudes and behaviours surrounding preconception and pregnancy health and their preferences for information about these periods.

DESIGN

Cross-sectional survey.

SETTING

Making healthy changes can optimise preconception and pregnancy outcomes. Clinical practice guidelines inform preconception and pregnancy care in Australia. Women often have access to multiple sources of information on reproductive and pregnancy health.

PARTICIPANTS

Women of reproductive age were asked to complete a web-based survey. The survey development was informed by preconception guidelines, consensus statements and the national pregnancy care guidelines. The survey was distributed through social media, local and national networks from 2017 to 2018.

RESULTS

Completed surveys were received from 553 women.The majority (80.4%) had high educational attainment. Checking immunisation status and ensuring good mental health were rated as equally important actions both preconception (65%) and during pregnancy (78%). Limiting sedentary activities was not rated as an important action to take either preconception (36%), or during pregnancy (38%). Although women have good knowledge about the impact of weight on their own health outcomes (eg, gestational diabetes), there was less knowledge about adverse outcomes for babies like stillbirth and preterm birth. Women access many sources for reproductive health information, however, the most trusted source was from healthcare professionals.

CONCLUSION

Most women of reproductive age in Australia have knowledge of the key health recommendations for preconception and pregnancy. However, there are gaps related to lifestyle behaviours particularly connected to weight gain and outcomes for babies. There is a strong preference to receive trusted information from healthcare providers through multiple resources.

What do hospital-based health professionals need and expect from an mHealth app to support the first 1000 days of life? Results from a cross sectional study

BACKGROUND

Several attempts have been made to introduce mHealth solutions to support maternal, newborn, and child health (MNCH). However, most of the available apps do not meet the needs of end-users, underscoring the urgency of involving them in the co-design of telehealth interventions.

OBJECTIVE

With this in mind, we investigated the needs and expectations of hospital-based health professionals (i.e., secondary users) providing care to pregnant women and new mothers with their babies for a hypothetical mHealth app to support the first 1000 days of life.

METHODS

From November 2021 to March 2022, we surveyed health professionals using a questionnaire that explored the perceived importance of specific content, functionalities, and technical features of the proposed app. We also collected sociodemographic information from secondary users. We performed descriptive analysis and then used Ward hierarchical clustering method to classify respondents according to their response patterns.

RESULTS

We recorded the needs and expectations of 145 hospital-based health professionals from obstetrics/gynecology, nursery/neonatology, and pediatrics. We found general agreement with the proposed content of the app, particularly general information about health during pregnancy (92%) and potential risky infections during pregnancy (91%). Three clusters emerged from the analysis, with the high and medium demanding clusters rating the importance of app content and technical features as very high and high, respectively, while low demanding cluster expressing more skepticism, especially about some of the proposed functionalities of the app.

CONCLUSIONS

Assessing the needs and expectations of end-users is an essential process for developing tailored and effective mHealth solutions. This study has shown that hospital-based health professionals generally recognize the value of the proposed app, suggesting their propensity to integrate such a telehealth solution into mainstream clinical practice.

Safety considerations for assessing the quality of apps used during pregnancy: A scoping review

Objective

Pregnant women are increasingly turning to apps targeting knowledge and behaviour change for supporting healthy lifestyles and managing medical conditions. Yet, there is growing concern over the credibility and safety of content within mobile health (mHealth) apps. This scoping review aimed to systematically and thematically consolidate safety considerations described in reviews evaluating pregnancy-specific apps.

Methods

PubMed, Ovid MEDLINE® and EPub, CINAHL, Web of Science, Cochrane Libraries, and SCOPUS were systematically searched to identify reviews that assessed apps targeting pregnant women. Data related to safety were extracted and thematically analysed to establish a set of relevant safety considerations.

Results

Sixteen reviews met the inclusion criteria. The included reviews assessed an average of 27 apps each and targeted pregnancy topics, such as nutrition and physical activity. Five major and 20 minor themes were identified, including information, transparency, credibility, privacy and security, and app tailoring. Information, transparency, and credibility relate to the evidence base of information within the app, privacy and security of apps relate to the protection of personal information and data, and app tailoring relates to the consideration of contextual factors, such as local guidelines and digital health literacy.

Conclusions

Results present possible safety considerations when evaluating pregnancy-specific apps and emphasise a clear need for consumer guidance on how to make informed decisions around engagement and use of mHealth apps during pregnancy.

Effectiveness of Smartphone-Based Lifestyle Interventions on Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Gestational diabetes mellitus (GDM) is a condition that causes poor glucose tolerance during pregnancy and usually resolves after birth. Having GDM impacts the mother and baby. Smartphone-based lifestyle interventions may offer innovative solutions.

Aim

To examine the effects of smartphone-based lifestyle interventions on compliance, Hemoglobin A1c (HbA1c), maternal outcomes, infant outcomes, psychological status, satisfaction, and cost effectiveness among women with GDM.

Methods

Randomized controlled trials (RCTs) of smartphone-based lifestyle interventions for women with GDM aged over 18 years were included. A systematic search of PubMed, Embase, Web of Science, CINAHL, and Cochrane Library for articles published from January 2007 to March 2022 and updated on 12 October 2022. Data were extracted independently by two researchers, and the risk of bias in individual trials was rated using the Cochrane risk-of-bias tool (RoB 2). Meta-analysis was conducted by using RevMan 5.3.

Results

Ten studies were included involving 1626 participants. The mean ages of the women were 32.42 ±4.68 years. Eight out of 10 studies were conducted in developed countries. Meta-analysis found that smartphone-based lifestyle interventions statistically improved compliance [SMD = 7.36, 95% CI = (4.05 to 10.68), P < 0.0001] and decreased the incidences of neonatal intensive care unit (NICU) admission [RR = 0.64, 95% CI = (0.47,0.86), P = 0.003], compared with controls. However, intervention effects on HbA1c, maternal outcomes, neonatal hypoglycemia, and infant birth weight were non significant. Moreover, the satisfaction of intervention is high in this review. Contrastingly, no significant effects were observed for psychological status and cost-effectiveness.

Conclusion

Smartphone-based lifestyle interventions may improve patient compliance and reduce NICU admissions. These findings may aid in developing future intervention strategies, help elucidate future research directions, and guide clinical practice for women with GDM. Future high-quality RCTs must be further studied at larger scales to examine smartphone-based lifestyle interventions' long-term effects and cost-effectiveness.

Expectant parents’ preferences for teaching by texting: a development and usability study of SmartMom (Preprint)

BACKGROUND

Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic.

OBJECTIVE

We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom.

METHODS

This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes.

RESULTS

We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that "having reliable information is the most important thing" (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality ("It was nice to have that [information] fed to you"; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom's opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities.

CONCLUSIONS

The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology-based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.

Exploring access as a process of adaptation in a self-monitoring perinatal eHealth system: Mixed-method study from a socio-material perspective (Preprint)

BACKGROUND

The development and quality assurance of perinatal eHealth self-monitoring systems is an upcoming area of inquiry in health science. Building patient engagement into eHealth development as a core component has potential to guide process evaluation. Access, 1 attribute of patient engagement, is the focus of study here. Access to eHealth self-monitoring programs has the potential to influence pregnancy health and wellness outcomes. Little is known about how pregnant users' ability to obtain resources is influenced by their own adaptive activities and the mediating activities of eHealth systems during the process of real-world testing of these systems.

OBJECTIVE

Here, we examine the patient engagement process of access occurring during the adaptation of eHealth self-monitoring use from a sociomaterial perspective.

METHODS

In this mixed methods convergent evaluation design, we interviewed women about perceptions of the adaptation process of using an eHealth self-monitoring system. Deductive analysis was conducted guided by the definition of access as an attribute of patient engagement. After initial qualitative and quantitative data collection and analysis, participants were spilt based on their level of use of the eHealth system (physical wear time of self-monitoring device). Content analysis was then conducted according to user group, using a conceptual matrix developed from ontological perspectives of sociomateriality.

RESULTS

Pregnant users' adaptive activities and the mediation activities of the eHealth system represent a cocreation process that resulted in user group-specific characteristics of accessing and using the system. The high- and low-use groups experienced different personal adaptation and eHealth mediation during this process of cocreation. Differences were noted between high- and low-use groups, with the high-use group giving attention to developing skills in recording and interpreting data and the low-use group discussing the manual adding of activities to the system and how the system worked best for them when they used it in their mother tongue.

CONCLUSIONS

A cocreation process between pregnant users and the eHealth system was identified, illustrating access as a useful core component of perinatal eHealth self-monitoring systems. Researchers and clinicians can observe reasons for why pregnant users access eHealth systems in unique ways based on their personal preferences, habits, and values. Mediation activities of the eHealth system and the different user adaptive activities represent a cocreation process between the users and the eHealth system that is necessary for the personalization of perinatal eHealth systems.

A psycho-educational intervention programme for parents with SGA foetuses supported by an adaptive mHealth system: design, proof of concept and usability assessment

Background

Technology-based approaches during pregnancy can facilitate the self-reporting of emotional health issues and improve well-being. There is evidence to suggest that stress during pregnancy can affect the foetus and result in restricted growth and preterm birth. Although a number of mobile health (mHealth) approaches are designed to monitor pregnancy and provide information about a specific aspect, no proposal specifically addresses the interventions in parents at risk of having small-for-gestational-age (SGA) or premature babies. Very few studies, however, follow any design and usability guidelines which aim to ensure end-user satisfaction when using these systems.

Results

We have developed an interactive, adaptable mHealth system to support a psycho-educational intervention programme for parents with SGA foetuses. The relevant results include a metamodel to support the task of modelling current or new intervention programmes, an mHealth system model with runtime adaptation to changes in the programme, the design of a usable app (called VivEmbarazo) and an architectural design and prototype implementation. The developed mHealth system has also enabled us to conduct a proof of concept based on the use of the mHealth systems and this includes data analysis and assesses usability and acceptance.

Conclusions

The proof of concept confirms that parents are satisfied and that they are enthusiastic about the mHealth-supported intervention programme. It helps to technically validate the results obtained in the other stages relating to the development of the solution. The data analysis resulting from the proof of concept confirms that the stress experienced by parents who followed the mHealth-supported intervention programme was significantly lower than among those who did not follow it. This implies an improvement in the emotional health not only of the parents but also of their child. In fact, the babies of couples who followed the mHealth-supported programme weigh more than the babies of couples under traditional care. In terms of user acceptance and usability, the analysis confirms that mothers place greater value on the app design, usefulness and ease of use and are generally more satisfied than their partners. Although these results are promising in comparison with more traditional and other more recent technology-based approaches.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02036-9.

Accuracy, interpretability and usability study of a wireless self-guided fetal heartbeat monitor compared to cardiotocography

Fetal Cardiography is usually performed using in-hospital Cardiotocographic (CTG) devices to assess fetal wellbeing. New technologies may permit home-based, self-administered examinations. We compared the accuracy, clinical interpretability, and user experience of a patient-administered, wireless, fetal heartbeat monitor (HBM) designed for home use, to CTG. Initially, participants had paired HBM and CTG examinations performed in the clinic. Women then used the HBM unsupervised and rated the experience. Sixty-three women had paired clinic-based HBM and CTG recordings, providing 6982 fetal heart rate measures for point-to-point comparison from 126 min of continuous recording. The accuracy of the HBM was excellent, with limits of agreement (95%) for mean fetal heart rate (FHR) between 0.72 and -1.78 beats per minute. The FHR was detected on all occasions and confirmed to be different from the maternal heart rate. Both methods were equally interpretable by Obstetricians, and had similar signal loss ratios. Thirty-four (100%) women successfully detected the FHR and obtained clinically useful cardiographic data using the device at home unsupervised. They achieved the required length of recording required for non-stress test analysis. The monitor ranked in the 96-100^th percentile for usability and learnability. The HBM is as accurate as gold-standard CTG, and provides equivalent clinical information enabling use in non-stress test analyses conducted outside of hospitals. It is usable by expectant mothers with minimal training.

Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community

Background

Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers. Furthermore, existing applications do not consider cultural differences and disparities in healthcare access, including those specific to emerging Latino communities.

Objective

To adapt and translate an English-language pregnancy mobile health app to meet the language and cultural needs of Spanish-speaking Latino immigrants living in the United States.

Methods

We use a multi-step process, grounded in implementation science frameworks, to adapt and translate the contents of an existing pregnancy app. Interviews with stakeholders (n = 12) who advocate for the needs of pregnant individuals in an emerging Latino community were used to identify domains of possible disparities in access to prenatal care. We then conducted semi-structured interviews with peripartum Spanish-speaking Latino users (n = 14) to understand their perspectives within those domains. We identified a list of topics to create educational material for the modified app and implemented a systematic translation approach to ensure that the new version was acceptable for immigrants from different countries in Latin America.

Results

The interviews with stakeholders revealed seven critical domains that need to be addressed in an adapted prenatal app: language and communication, financial concerns, social support, immigration status, cultural differences, healthcare navigation, and connection to population-specific community resources that offer Spanish language services. The interviews with peripartum Spanish-speaking Latino women informed how the existing content in the app could be adjusted or built upon to address these issues, including providing information on accessing care offered in their native language and community support. Finally, we used a systematic approach to translate the existing application and create new content.

Conclusion

This work illustrates a process to adapt an mHealth pregnancy app to the needs of an emerging Latino community, by incorporating culturally sensitive Spanish language content while focusing on addressing existing health disparities.

How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report

OBJECTIVES

This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article.

METHODS

PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores.

RESULTS

The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms.

CONCLUSIONS

To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.

EMAeHealth, a digital tool for the self-management of women's health needs during pregnancy, childbirth and the puerperium: protocol for a hybrid effectiveness-implementation study

INTRODUCTION

EHealth can help health service users take a more active role in decision-making and help health professionals guide the patient in this process. A digital tool has been designed to support maternal education (ME), and it is organised into four areas: (1) information, (2) communication, (3) health self-management and (4) clinical data. The main objective of the study is to evaluate the effectiveness of the EMAeHealth digital tool, and assess its usability and acceptability under routine conditions.

METHODS AND ANALYSIS

Hybrid implementation-effectiveness design: (1) A cluster randomised, prospective, longitudinal, multicentre clinical trial to evaluate the effectiveness of EMAeHealth in (A) improving health-related quality of life (primary outcome), (B) improving self-efficacy for labour and childbirth and self-efficacy in breast feeding and (C) reducing the number of visits to the obstetric emergency services and health centre in situations of 'non-pathological pregnancy', 'false labour pains' and 'non-pathological puerperium'. The EMAeHealth intervention plus usual care will be compared with receiving only usual care, which includes traditional ME. N=1080 participants, 540 for each study arm. Two measurements will be made throughout the pregnancy and three in the first 16 weeks post partum. (2) A mixed-method study to evaluate the usability and acceptability of the tool, barriers and facilitators for its use, and implementation in our health system: focus groups (women, professionals and agents involved) and a quantitative analysis of implementation indicators.

ANALYSIS

It will be carried out by intention to treat, using mixed models taking into account the hierarchical structure of the data and per protocol to evaluate the effectiveness of the express use of the digital tool.

ETHICS AND DISSEMINATION

Clinical Research Ethics Committee of Euskadi, Spain, (Ref: PI2020044) approved this study. The results will be actively disseminated through manuscript publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT04937049.

Technology-Based (Mhealth) and Standard/Traditional Maternal Care for Pregnant Woman: A Systematic Literature Review

The world of health has changed significantly since the advent of smartphones. Smartphones have been widely known to facilitate the search for health information in the mobile Health (mHealth) system, which is used to improve the quality of life for patients, such as communication between doctors and patients. This systematic literature review aims to identify the use of mHealth as a digital communication tool for pregnant women by comparing technology-based and standard-based pregnancy care. The method used is a systematic review of articles related to pregnancy care that utilize mHealth for pregnant women. The articles were obtained from the database based on the PICO framework; we searched articles using seven databases. The selection was adjusted to the inclusion criteria, data extraction, study quality evaluation, and results from synthesis. From the disbursement, 543 articles were obtained and 10 results were obtained after the screening. After a critical appraisal was carried out, four articles were obtained. Advantages can be in the form of increasing knowledge of pregnant women who use mHealth due to the availability of information needed by pregnant women in the mHealth application. mHealth also provides information about their babies, so the impact of mHealth is not only for mothers. mHealth is a promising solution in pregnancy care compared to the standard of maternal care.

Eating for 2: A Systematic Review of Dutch App Stores for Apps Promoting a Healthy Diet during Pregnancy

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.

Barriers and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-Management (GDM): A Systematic Literature Review of Perceptions of Healthcare Professionals and Women with GDM (Preprint)

Background

Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. eHealth technologies are proving to be successful in supporting the self-management of medical conditions. Digital technologies have the potential to improve GDM self-management.

Objective

The primary objective of this systematic literature review was to identify the views of health professionals (HPs) and women with GDM regarding the use of eHealth for GDM self-management. The secondary objective was to investigate the usability and user satisfaction levels when using these technologies.

Methods

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the search included primary papers in English on the evaluation of technology to support self-management of GDM from January 2008 to September 2021 using MEDLINE, CINAHL, Embase, ACM, and IEEE databases. The lists of references from previous systematic literature reviews, which were related to technology and GDM, were also examined for primary studies. Papers with qualitative, quantitative, and mixed methodologies were included and evaluated. The selected papers were assessed for quality using the Cochrane Collaboration tool, National Institute for Health and Care Excellence clinical guidelines, Critical Appraisal Skills Programme Qualitative Checklist, and McGill University Mixed Methods Appraisal Tool. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Narrative synthesis was used to analyze the quantitative data.

Results

A total of 26 papers were included in the review. Of these, 19% (5/26) of studies used quantitative research methodologies, 19% (5/26) used qualitative methods, and 62% (16/26) used mixed methods. In all, 4 themes were identified from the qualitative data: the benefits of using technology, engagement with people via technology, the usability of technology, and discouragement factors for the use of technology. The thematic analysis revealed a vast scope of challenges and facilitators in the use of GDM self-management systems. The challenges included usability aspects of the system, technical problems, data privacy, lack of emotional support, the accuracy of reported data, and adoption of the system by HPs. Convenience, improved GDM self-management, peer support, increased motivation, increased independence, and consistent monitoring were facilitators to use these technologies. Quantitative data showed that there is potential for improving the usability of the GDM self-management systems. It also showed that convenience, usefulness, increasing motivation for GDM self-management, helping with GDM self-management, and being monitored by HPs were facilitators to use the GDM self-management systems.

Conclusions

This novel systematic literature review shows that HPs and women with GDM encountered some challenges in using GDM self-management systems. The usability of GDM systems was the primary challenge derived from qualitative and quantitative results, with convenience, consistent monitoring, and optimization of GDM self-management emerging as important facilitators.

Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers

Purpose of the Review

Food insecurity can have a negative health impact for women during pregnancy and the postpartum period; however, there are a range of barriers to meeting nutritional guidelines during pregnancy. Food insecurity is associated with an increased risk of pregnancy complications and mental and physical health outcomes. This review aims to provide insight into programmes and interventions which have targeted food insecurity in pregnant and early postpartum women. The central research question for this review is as follows: What programmes and interventions have sought to address food insecurity among pregnant and postpartum women? A systematic search of five electronic databases including Medline, CINAHL, Global Health, Embase, and Cochrane was undertaken on August 2021. Key thematic areas searched were food insecurity, pregnancy, nutritional outcomes, and interventions or programmes. Only studies that were published since 2000 in English were considered.

Recent Findings

Eleven studies were included in this review. Studies employed a range of methods and outcomes measures. They were conducted in mostly low- and middle-income countries, and in general, focused on nutritional supplementation, with some studies also incorporating nutrition education or counselling.

Summary

The findings of this review suggest that while there are a range of possible interventions that seek to address food insecurity and hunger among pregnant and postpartum women, the limited number of robust evaluations or long-term interventions mean that evidence for any one intervention type is limited. Furthermore, the programmes and interventions that do exist are generally embedded within a single context or structure, and as such, may not be able to be widely implemented. (Prospero Registration CRD42022245787)

The Impact of Eatmarna Application Usability on Improving Performance Expectancy, Facilitating the Practice of Rituals and Improving Spirituality Feelings during Umrah Amid the COVID-19 Outbreak

The electronic tourism era has rapidly emerged during the explosive spread of the COVID-19 pandemic worldwide. The role of information technology was also evident in the religious tourism sector, and this facilitated the organization of religious events for Muslims, such as Hajj and Umrah. In the present study, we assessed the usability of a mobile application (Eatmarna) which provides permits to perform Umrah and other religious practices in Makkah and Madina in Saudi Arabia. We sought also to assess the impact of usability on the app effectiveness in improving Umrah experience. Pilgrims were asked to fill out an electronic survey distributed by the coordinators of Umrah service providers. Results showed that the perceived effectiveness was predicted by two domains of usability, namely system information arrangement (β = 0.27, 95% CI, 0.09 to 0.46, p = 0.004) and app usefulness (β = 0.52, 95% CI, 0.34 to 0.69, p < 0.0001). Both the usability domains were independently associated with all the subdomains of app effectiveness, including performance expectancy, facilitating the practice of rituals, and feelings of spirituality. The Eatmarna application was effective in providing a safe environment for pilgrims, which was accounted for by the app usability, and this facilitated the improvement of Umrah experience. National authorities can further integrate additional services in the app to improve pilgrims’ perceptions.

INFORMATION RESOURCES AMONG FLEMISH PREGNANT WOMEN: A CROSS-SECTIONAL STUDY (Preprint)

Background

There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited.

Objective

The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders.

Methods

A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses.

Results

In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03).

Conclusions

Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women.

A Comparison of Functional Features of Chinese and US Mobile Apps for Pregnancy and Postnatal Care: A Systematic App Store Search and Content Analysis

Background

Pregnancy to postpartum (PtP) applications (apps) are becoming more common tools to document everything from pregnancy and delivery to nutrient allocation, life taboos, and infant medical examinations. However, the dependability, quality, and efficacy of these apps remain unclear. This study examined the features and functions of mobile PtP care apps accessible in China and the United States and to identify the major gaps that need to be addressed.

Methods

Apps were selected by searching the Apple App Store and Android Markets (in the US and China) for the terms “pregnancy” and “postpartum” in Chinese and English. The apps' security, quality, and effectiveness were investigated, and chi-square tests and analysis of variance were performed to examine the differences in characteristics between apps available in the US and China.

Results

A total of 84 mobile PtP care apps (45 from the US and 39 from China) were included. A total of 89.7% (35/39) of Chinese mobile apps did not provide safety statements or supporting evidence. The objective app quality ratings for Chinese and US apps were 3.20 ± 0.48 (mean ± standard deviation) and 3.56 ± 0.45, respectively (p > 0.05). A greater number of Chinese apps provided app-based monitoring functions, namely recording fetal size (n = 18, 46.2% in China vs. n = 3, 6.7% in the US), contractions (n = 11, 28.2% in China vs. n = 0, 0% in the US), pregnancy weight (n = 11, 28.2% in China vs. 0, 0% in the US), and pregnancy check-up reminders (n = 10, 25.6% in China vs. n = 0, 0% in the US). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 2, 5.1% in China vs. n = 21, 46.7% in the US), pregnancy workouts (n = 2, 5.1% in China vs. n = 13, 28.9% in the US), and pregnancy meditation (n = 0, 0% in China vs. 10, 22.2% in the US) (p < 0.01). A medium security risk was identified for 40% (18/45) of apps in the US and 82.1% (32/39) of apps in China (p < 0.01).

Conclusions

The functionality and characteristics of in-store mobile apps for PtP care varied between China and the US. Both countries' apps, particularly Chinese apps, encountered issues related to a lack of evidence-based information, acceptable content risk, and program evaluations. Both countries' apps lacked proper mental health care functions. The findings suggest that the design of app features should be enhanced in both countries, and increased interaction between app creators and users is recommended.

Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review

OBJECTIVE

To investigate the roles of mobile health, or mHealth, in the psychosocial health of pregnant women and mothers.

METHODS

A systematic search was conducted in databases and grey literature including MEDLINE, Web of Science, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, SocINDEX, Central Register of Controlled Trials, The Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Health Technology Assessment, UNICEF and WHO databases. Two searches were conducted to include original research articles published in English until 15 November 2021. Several tools were used to assess the risk of bias: revised Cochrane risk of bias tool for randomised trials, Risk of Bias in Non-randomized Studies of Interventions, National Heart, Lung, and Blood Institute quality assessment tool for cohort and cross-sectional studies, Critical Appraisal Skills Program checklist for qualitative studies and Mixed Methods Appraisal Tool for mixed-methods studies. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. Due to the high heterogeneity and variability of the included studies, data synthesis was conducted narratively.

RESULTS

44 studies were included among 11 999 identified articles. Most studies reported mixed findings on the roles of mHealth interventions in the psychosocial health of pregnant women and mothers; mHealth improved self-management, acceptance of pregnancy/motherhood and social support, while mixed results were observed for anxiety and depressive symptoms, perceived stress, mental well-being, coping and self-efficacy. Furthermore, pregnant women and mothers from vulnerable populations benefited from the use of mHealth to improve their psychosocial health.

CONCLUSIONS

The findings suggest that mHealth has the potential to improve self-management, acceptance of pregnancy/motherhood and social support. mHealth can also be a useful tool to reach vulnerable pregnant women and mothers with barriers to health information and facilitate access to healthcare services. However, the high heterogeneity limited the certainty of evidence of these findings. Therefore, future studies should identify the context under which mHealth could be more effective.

Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study

BACKGROUND

Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but their effectiveness in pregnant women was limited. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy.

OBJECTIVE

This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women.

METHODS

We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app.

RESULTS

A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use.

CONCLUSIONS

The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.

Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts: A Randomized Clinical Trial

IMPORTANCE

Despite the substantial health and financial burdens of smoking and the availability of effective, evidence-based interventions in primary care settings, few smokers and physicians use these strategies for smoking cessation.

OBJECTIVE

To evaluate whether electronic outreach to smokers with embedded asynchronous care increases the number of quit attempts and explore the roles of the message sender (ie, primary care physician [PCP] vs health care system) and patient-related characteristics.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement randomized clinical trial was designed to measure 2 factors: (1) electronic outreach messaging with and without a survey link to asynchronous care and (2) messaging by a personal PCP or health system. The study was conducted within the electronic health record and portal messaging platform of a large health system in the South Central US. Participants were adult patients 18 years or older who were designated as smokers in their electronic health records. Data were collected from January 13 to February 24, 2020, with participating PCPs surveyed in July 2020.

INTERVENTIONS

Portal messages encouraging a quit attempt and offering physician assistance were sent to smokers who were randomly selected and assigned to 1 of 4 conditions (message with or without embedded asynchronous care and PCP or system as sender). Half of the messages contained an invitation to come to clinics and the other half contained a link to access asynchronous care.

MAIN OUTCOMES AND MEASURES

The primary outcome was electronic health record-documented quit attempts (1 indicates quit attempt; 0, no quit attempt), which were tracked 30 days after the electronic outreach. Secondary outcomes included physician perceptions of the electronic outreach intervention, using a 5-point scale to assess perceptions of workload, comfort with providing medication from survey information, and further interest in the program 6 months after the intervention.

RESULTS

A total of 188 participants (99 women [52.4%] and 89 men [47.3%]) with mean (SD) age of 55.2 (13.9) years were randomized to 1 of 4 conditions. Group 1 (n = 46) received a message from the PCP without a link to the survey; group 2 (n = 48) received a message from the PCP with a link to asynchronous care in the form of the survey. Group 3 (n = 47) received a message from the health system without a link to the survey; group 4 (n = 47) received a message from the health system with a link to the survey. No statistically significant difference in documented quite attempts was found among the 4 study groups. There was also no statistically significant difference in quit attempts between the group that received the asynchronous care survey link and the group that did not (odds ratio, 2.50 [95% CI, 0.72-8.72]). However, the quit attempt rate for those with asynchronous care offered (9 of 95 [9.5%]) was more than double the quit attempt rate for those with in-person care offered (4 of 93 [4.3%]).

CONCLUSIONS AND RELEVANCE

This quality improvement randomized clinical trial did not find a statistically significant difference in physician-assisted quit attempts among patients who received electronic with asynchronous care vs those who received outreach alone, regardless of whether the message source was a PCP or a health system. However, the program engaged patients in difficult-to-reach rural areas as well as younger patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05172219.

Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis

Background

Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear.

Objective

This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers.

Methods

Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool.

Results

Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials.

Conclusions

Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.

Apps on Google Play Store to assist in self-management of hypertension in Indian context: features analysis study

BACKGROUND

A large number of individuals with hypertension are turning to the Internet and m-health technologies for assistance. There is a need to study the content of smartphone applications on hypertension. The study aimed to review and investigate the functional and analytical characteristics of apps related to the self-management of hypertension available on Google Play Store.

METHODS

Search was conducted in February 2021 in India using the Google Play Store database to identify currently available Android-based apps related to self-management of hypertension/high blood pressure (BP). Keywords used were: 'Hypertension', 'High blood pressure', 'DASH diet', 'Hypertension diet', and 'Blood pressure diet'. A total of 822 apps were screened based on the duplicates, inclusion, and exclusion criteria. A total of 210 were included for further analysis.

RESULTS

Eighteen percent (n=37) of the apps had an overall rating of 4.5 or above. About 41% of the apps belonged to the medical category and 41% of the apps were characterized in the health and fitness category. Feature of logging/recording the BP measurement was seen in 73% of the apps. In-app graphing to analyze BP trends was reported in 64 % of the included apps. A few apps focused on tracking medication (n=19), sodium intake (n=2), and calorie intake (n=4).

CONCLUSIONS

The features were common across all the included apps and were focusing only on recording the BP, providing statistics and trends of BP, and providing educational information. App developers should now aim to provide other components of self-management techniques to help individuals tackle hypertension.

Evaluating the effectiveness and quality of mobile applications for perinatal depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Our objectives were to assess: (1) the effectiveness of existing mHealth apps for reducing symptoms of maternal depression and/or anxiety during the prenatal period and/or the first year postpartum, and (2) the app quality of commercially available apps targeting perinatal depression and/or anxiety.

METHODS

To address Objective 1, we searched five electronic databases (MEDLINE, CINAHL, PsycINFO, Web of Science, and Embase) from their inception until May 3rd, 2021. For the second objective, we searched Google Play and Apple App Stores in the United States, United Kingdom, Canada, and Australia until May 3rd, 2021.

RESULTS

Our search identified 3,897 articles, seven of which were meta-analyzed. mHealth apps did not improve perinatal depression (SMD, -0.39; 95% CI, -0.80 to 0.03) or anxiety (SMD, 0.01; 95% CI, -0.13 to 0.16) within the first 3 months post-intervention or at 6 months post-intervention. Our search of app stores identified 74 commercially available apps, 37 of which were evaluated via MARS tool. Current apps for perinatal anxiety and/or depression were rated to be of moderate quality on the MARS (mean, 3.6/5).

LIMITATIONS

There is a small number of overall studies in this field and the individual studies have methodological limitations. Furthermore, few apps identified in our app store search have been clinically tested.

CONCLUSION

Despite their widespread availability, mHealth apps do not appear to effectively reduce perinatal depression or anxiety, and few were subjectively rated to be of high quality. There is a need to develop higher quality mHealth apps and assess their potential to improve perinatal maternal mental health.

Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review

Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed.

Development and Validation of a Lifestyle Behavior Tool in Overweight and Obese Women through Qualitative and Quantitative Approaches

There is a paucity of effective intervention tools for overweight/obese women to assess, guide and monitor their eating behavior. This study aimed to develop a lifestyle intervention tool, assess its acceptability and usefulness, and verify its construct validity in overweight/obese women. The 6P tool (Portion, Proportion, Pleasure, Phase, Physicality, Psychology) was developed and 15 women with a body mass index (BMI) ≥ 25 kg/m2 were interviewed to assess its perceived acceptability and usefulness. Subsequently, the revised 6P tool was tested in 46 women with a BMI ≥ 25 kg/m2. The Three-Factor Eating Questionnaire (TFEQ), International Physical Activity Questionnaire-Short (IPAQ), and weight were measured at baseline and one-month. Most participants were satisfied with the presentation of the 6P tool (86.8%), and agreed it was useful in guiding healthy eating (81.6%) and raising awareness of eating behavior (97.4%). There were significant improvements in cognitive restraint (p = 0.010) and disinhibition (p = 0.030) (TFEQ), portion size (P1), pleasure behaviors (P3), and total composite 6P score (p < 0.001). However, there was no significant reduction in weight or increase in physical activity. The 6P tool is acceptable and presents with good validity for assessing lifestyle behaviors.