@Article{info:doi/10.2196/60855, author="M{\"a}{\"a}tt{\"a}nen, Sini and Koivusalo, Saila and Ylinen, Hanna and Heinonen, Seppo and Kyt{\"o}, Mikko", title="The Effect of a Mobile App (eMOM) on Self-Discovery and Psychological Factors in Persons With Gestational Diabetes: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2025", month="Jun", day="4", volume="13", pages="e60855", keywords="self-discovery", keywords="self-management", keywords="motivation", keywords="self-determination theory", keywords="self-tracking", keywords="gestational diabetes", keywords="mobile apps", keywords="mixed methods study", keywords="diabetes", keywords="support", keywords="women", keywords="pregnancy", keywords="maternal", keywords="apps", keywords="glucose", keywords="nutrition", keywords="physical activity", keywords="psychological", keywords="well-being", keywords="interview", keywords="questionnaire", keywords="usability", keywords="depression", keywords="stress", abstract="Background: Gestational diabetes is a type of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life. The rising prevalence of gestational diabetes mellitus (GDM) highlights the need for more comprehensive treatment strategies, with a particular emphasis on supporting maternal self-management. We showed recently that a mobile app, eMOM, where glucose, nutrition, and physical activity are combined within a single app, significantly improves multiple clinical outcomes among persons with gestational diabetes. Objective: This study aims to explore the effects of the eMOM on maternal self-discovery and learning, autonomous motivation to manage GDM, and psychological well-being. Additionally, we examine the correlation between improved maternal clinical outcomes and change in autonomous motivation. We also assess the acceptance and usability of the eMOM app. Methods: Building upon the original randomized controlled trial (RCT), in which the intervention arm used a mobile app (eMOM), we conducted a mixed methods study that included an investigation of eMOM log files, semistructured interviews on self-discovery, and an examination of questionnaires assessing motivation (Treatment Self-Regulation Questionnaire and Perceived Competence Scale), depression (Edinburgh Postnatal Depression Scale), technology use and acceptance (Unified Theory of Acceptance of Use of Technology questionnaire), and usability (modified Software Usability Measurement Inventory). Additionally, we monitored participants' stress levels using wearable electrocardiographic devices (FirstBeat Bodyguard 2). A total of 148 individuals participated in the original RCTs, with 76 in the intervention arm and 72 in the control arm. From the intervention arm, 18 participants were randomly selected for interviews in this study. Results: Results show that the use rate of eMOM was high, and novel visualization supported self-discovery in persons with GDM. Most participants (17/18, 94\%) indicated that the eMOM app helped to find the associations between their daily activities and glucose levels. Especially having nutrition visualized together with glucose was highly appreciated. Participants also reported learning about the associations between physical activity and glucose levels. No differences were observed between the intervention and control arms in autonomous motivation, depression, or stress. Furthermore, there were no correlations between improved clinical outcomes and changes in motivation. Accessibility and usability ratings were consistently high throughout the intervention. Conclusions: The eMOM mobile app combining data from continuous glucose monitor, food diary, and physical activity tracker supports maternal self-discovery related to GDM without contributing to depression or adding extra stress. This encourages the use of such mobile apps in maternity care. Notably, motivational factors did not correlate with the positive outcomes observed in our prior RCT, suggesting that self-discovery has a greater impact on clinical results. Trial Registration: ClinicalTrials.gov NCT04714762; https://www.clinicaltrials.gov/study/NCT04714762 ", doi="10.2196/60855", url="https://mhealth.jmir.org/2025/1/e60855", url="http://www.ncbi.nlm.nih.gov/pubmed/40466096" } @Article{info:doi/10.2196/60690, author="Kim, Sun-Hee and Jung, Sun-Young and Park, Jin-Hwa and De Gagne, C. Jennie", title="Internet-Based Interventions for Preventing Premature Birth in Preconceptional Women of Childbearing Age: Systematic Review", journal="J Med Internet Res", year="2025", month="Jun", day="3", volume="27", pages="e60690", keywords="contraception", keywords="health promotion", keywords="high-risk behavior", keywords="internet-based interventions", keywords="preconception", keywords="premature birth", keywords="reproductive health", keywords="self-efficacy", keywords="systematic review", abstract="Background: Preconception health is essential for preventing premature birth, yet engagement in preconception care remains low. Internet-based interventions offer scalable solutions, but their effectiveness in this context is underexplored. Objective: This systematic review aimed to describe the characteristics and designs of studies on internet-based interventions and evaluate their effectiveness in preventing premature birth among preconceptional women of childbearing age. Methods: We searched MEDLINE, Embase, CINAHL, and the Cochrane Library for randomized controlled trials and quasi-experimental studies on internet-based interventions targeting premature birth prevention, covering publications up to December 2023 with no language or geographic restrictions. The search, conducted initially in February 2023 and updated in March 2024, followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021277024). Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the revised Cochrane Risk of Bias tool. Due to heterogeneity in populations, interventions, and outcomes, a narrative synthesis was performed instead of a meta-analysis. Results: From 3437 articles identified across 2 searches, 9 studies were included after excluding duplicates and ineligible papers. Studies, primarily from high-income countries (eg, 4/9, 44\% from the United States), varied in design (4/9, 44\% randomized controlled trials; 5/9, 56\% quasi-experimental) and timing (5/9, 56\% post 2020). The overall risk of bias was high in 6/9 (67\%) studies, with only 1/9 (11\%) rated low risk. Interventions, delivered via websites (4/9, 44\%), conversational agents (3/9, 33\%), or other platforms, significantly improved reproductive health knowledge in 3/9 (33\%) studies but showed no consistent impact on self-efficacy (no effect in 2/3 [67\%] studies assessing it). Behavioral outcomes, such as folic acid use and contraception initiation, were inconsistent across 5/9 (56\%) studies, with significant effects in short-term (eg, 2/9, 22\%) but not long-term interventions (eg, 2/4, 50\% at 12 months). No studies directly measured premature birth as an outcome. Conclusions: Internet-based interventions showed mixed effectiveness across reproductive health outcomes pertinent to premature birth prevention, with notable gains in knowledge but limited success in altering behaviors. Given the small number of studies and the prevalent high risk of bias, these findings warrant cautious interpretation. Future research, including robust clinical trials, is essential to develop, evaluate, and disseminate effective and safe internet-based interventions for preconception care. Trial Registration: PROSPERO CRD42021277024; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021277024 ", doi="10.2196/60690", url="https://www.jmir.org/2025/1/e60690" } @Article{info:doi/10.2196/70151, author="Milan, Giulia and Lee, Victoria and Gadaleta, Matteo and Ariniello, Lauren and Faksh, Arij and Quer, Giorgio and Ajayi, Toluwalase", title="Using the PowerMom Digital Health Platform to Support Prenatal Mental Health and Maternal Health Outcomes: Observational Cohort Study", journal="JMIR Ment Health", year="2025", month="May", day="22", volume="12", pages="e70151", keywords="perinatal", keywords="mental health", keywords="postpartum depression", keywords="technology", keywords="mobile health", abstract="Background: Mental health disorders such as anxiety and depression are common among individuals of childbearing age. Such disorders can affect pregnancy and postpartum well-being. This study aims to study the impact of prenatal mental health on the pregnancy journey and highlights the use of mobile health technologies such as PowerMom for symptom tracking and screening. Objectives: We collected data in a decentralized digital trial using the PowerMom platform to investigate the impact of maternal mental health throughout pregnancy. The goal was to understand how anxiety and depression influence pregnancy-related symptoms, pregnancy outcomes, and postpartum well-being. Methods: Survey data were collected via PowerMom, a bilingual mobile research platform that integrates patient-reported outcomes, wearable data, and electronic health records. Participants were divided into 2 cohorts: those who reported receiving treatment for anxiety or depression during pregnancy (n=571) and those who reported not receiving treatment (n=1505). We compared self-reported symptoms, prepregnancy conditions, complications from past pregnancies, delivery outcomes, and postpartum mental health between cohorts, using the Fisher exact test and the Kruskal-Wallis test for statistical analysis. Results: Participants receiving treatment for anxiety or depression reported higher instances of physical symptoms than those untreated, with significant differences for 13 symptoms including fatigue (80.2\% vs 65.4\%; adjusted P<.001), nausea and vomiting (69.7\% vs 52.7\%; adjusted P<.001), and stomach cramping and abdominal pain (64.0\% vs 50.4\%; adjusted P<.001). Participants receiving treatment also had a higher prevalence of several conditions prior to pregnancy than those not receiving treatment, with significant differences noted in 4 out of 10 conditions: endometriosis (14.0\% vs 8.8\%; adjusted P=.007), hypertension (10.9\% vs 3.9\%; adjusted P<.001), eating disorder (7.7\% vs 3.1\%; adjusted P<.001), and heart disease (2.8\% vs 0.5\%; adjusted P<.001). Participants receiving treatment also reported a higher prevalence of complications in past pregnancies than those not receiving treatment, with significant differences noted in 2 out of 7 complications: high blood pressure (9.9\% vs 5.8\%; adjusted P=.016) and preeclampsia (9.2\% vs 5.5\%; adjusted P=.021). No significant differences were observed in mode of delivery, epidural use, stillbirth, and miscarriage rates between the 2 cohorts. Postpartum, treated participants reported significantly higher mental health composite scores, indicating more severe mental health symptoms. A higher percentage of treated participants were at high risk for having perinatal mood disorder (38/83, 45.8\%) than untreated participants (36/196, 18.4\%; P<.001). Conclusions: The PowerMom platform demonstrated its value in facilitating remote, scalable data collection for maternal mental health research. Pregnant individuals reporting treatment for anxiety or depression experienced more physical symptoms and worse postpartum mental health outcomes than untreated individuals. These findings underscore the potential for mobile health technologies to support future interventional studies aimed at improving maternal mental health outcomes during pregnancy. ", doi="10.2196/70151", url="https://mental.jmir.org/2025/1/e70151" } @Article{info:doi/10.2196/64075, author="Waring, E. Molly and McManus-Shipp, E. Katherine and Field, M. Christiana and Bhusal, Sandesh and Perez, Asley and Shapiro, Olivia and Gaspard, A. Sophia and Dennis, Cindy-Lee", title="Exposure to and Engagement With Digital Psychoeducational Content and Community Related to Maternal Mental Health by Perinatal Persons and Mothers: Protocol for a Web-Based Survey With Optional Follow-Up", journal="JMIR Res Protoc", year="2025", month="Apr", day="30", volume="14", pages="e64075", keywords="social media", keywords="podcasts", keywords="blogs", keywords="perinatal mental health", keywords="maternal mental health", keywords="digital health", keywords="engagement", abstract="Background: Leveraging digital platforms may be an effective strategy for connecting perinatal persons and mothers with evidence-based information and support related to maternal mental health and peers. Momwell is a mom-centered model of care that provides psychoeducational content through several digital platforms, including social media, a podcast, and a blog. The aims of this project were to describe how perinatal persons and mothers engage with Momwell's psychoeducational content and community; describe the perceived benefits of exposure to and engagement with content and community; examine associations between engagement with digital psychoeducational content and maternal mental health, parenting attitudes, and interparental relationships; and examine changes in mental health and parenting attitudes and concurrent engagement with Momwell's digital psychoeducational content and community over 2 to 3 months. Objective: This paper aims to describe the design of a study of perinatal persons and mothers who are exposed to or engage with Momwell's psychoeducational content and community and describe sample characteristics. Methods: Adults who engaged with Momwell on any of their digital platforms were recruited to complete a web-based survey in July 2023 to September 2023. Participants completed either a longer or shorter survey. Participants who provided permission to be recontacted were invited to complete a second survey 2 to 3 months later. The surveys included validated psychological measures, study-specific quantitative questions, and open-ended questions that assessed participant demographics, exposure to and engagement with Momwell's psychoeducational content and community, maternal mental health, parenting relationships, parenting self-efficacy, and additional psychosocial and health measures. We outline planned analyses to achieve the aims of the project. Results: Data collection occurred from July 2023 to September 2023 (N=584). A subset of participants completed the optional second survey in October 2023 to December 2023 (N=246). Participants were >99\% mothers (582/584, 99.7\%); 45.5\% (266/584) perinatal (59/584, 10.1\% pregnant; 210/584, 36\% post partum); and, on average, aged 32.4 (SD 3.9) years. In total, 59.1\% (345/584) were from the United States, 35.6\% (208/584) were from Canada, and 5.3\% (31/584) were from other countries. The vast majority (552/584, 94.5\%) followed Momwell on Instagram, 44.2\% (258/584) listened to the Momwell podcast, and 41.1\% (240/584) received their newsletter. Most participants had been exposed to Momwell's psychoeducational content for at least 6 months across the different platforms (range 16/36, 44\% on TikTok to 480/552, 87\% on Instagram). Conclusions: Data from this study will provide insights into how pregnant persons and mothers use digital psychoeducational content and peer communities to support their mental health throughout the perinatal period and into the early years of motherhood. Leveraging digital platforms to disseminate evidence-based digital psychoeducational content related to maternal mental health and connect peers has the potential to change how we care for perinatal persons and mothers. International Registered Report Identifier (IRRID): DERR1-10.2196/64075 ", doi="10.2196/64075", url="https://www.researchprotocols.org/2025/1/e64075" } @Article{info:doi/10.2196/64882, author="Chua, Xin Joelle Yan and Choolani, Mahesh and Chee, Ing Cornelia Yin and Yi, Huso and Lalor, Gabrielle Joan and Chong, Seng Yap and Shorey, Shefaly", title="A Mobile App--Based Intervention (Parentbot--a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="17", volume="27", pages="e64882", keywords="perinatal", keywords="mobile app", keywords="app use", keywords="survey response", keywords="parents", keywords="randomized controlled trial", keywords="artificial intelligence", keywords="AI", abstract="Background: Mobile app--based interventions are viable methods of delivering perinatal care support to parents. A mobile app--based intervention entitled Parentbot--a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants' use and the components that are appreciated by them. Objective: This study aims to examine the (1) relationship between participants' characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants' characteristics and the time taken to respond to the surveys (survey response timing). Methods: This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50\% mothers and n=118, 50\% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents' characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants' sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants' sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes. Results: The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents' anxiety ($\beta$=--0.48, 95\% CI --0.94 to --0.009; P=.046), parent-child bonding ($\beta$=--0.10, 95\% CI --0.19 to --0.01; P=.03), social support ($\beta$=0.31, 95\% CI 0.08-0.54; P=.01), and parenting satisfaction ($\beta$=0.57, 95\% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents' age, ethnicity, grouping, and number of children were found to be related to the survey response timing. Conclusions: As the viewing of PDA's educational materials was linked to improvements in parents' perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents' well-being, future interventions could explore alternative activities to better engage parents. Future mobile app--based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study. ", doi="10.2196/64882", url="https://www.jmir.org/2025/1/e64882" } @Article{info:doi/10.2196/57583, author="Parry, Monica and Huang, Tony and Clarke, Hance and Bj{\o}rnnes, Kristin Ann and Harvey, Paula and Parente, Laura and Norris, Colleen and Pilote, Louise and Price, Jennifer and Stinson, N. Jennifer and O'Hara, Arland and Fernando, Madusha and Watt-Watson, Judy and Nickerson, Nicole and Spiteri DeBonis, Vincenza and Hart, Donna and Faubert, Christine", title="Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="17", volume="12", pages="e57583", keywords="digital health", keywords="chatbot", keywords="women", keywords="cardiac pain", keywords="usability testing", keywords="self-management", keywords="artificial intelligence", keywords="AI", abstract="Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90\%) were well educated. In total, 50\% (5/10) were employed full or part time, and 60\% (6/10) earned >CAD \$70,000 (US \$48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90\% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100\%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092 ", doi="10.2196/57583", url="https://humanfactors.jmir.org/2025/1/e57583" } @Article{info:doi/10.2196/70149, author="Ajayi, Toluwalase and Kueper, Jacqueline and Ariniello, Lauren and Ho, Diana and Delgado, Felipe and Beal, Matthew and Waalen, Jill and Baca Motes, Katie and Ramos, Edward", title="Digital Health Platform for Maternal Health: Design, Recruitment Strategies, and Lessons Learned From the PowerMom Observational Cohort Study", journal="JMIR Form Res", year="2025", month="Apr", day="7", volume="9", pages="e70149", keywords="maternal health research", keywords="digital health platforms", keywords="pregnancy monitoring", keywords="decentralized clinical trials", keywords="participant engagement", keywords="health disparities", abstract="Background: Maternal health research faces challenges in participant recruitment, retention, and data collection, particularly among underrepresented populations. Digital health platforms like PowerMom (Scripps Research) offer scalable solutions, enabling decentralized, real-world data collection. Using innovative recruitment and multimodal techniques, PowerMom engages diverse cohorts to gather longitudinal and episodic data during pregnancy and post partum. Objective: This study aimed to evaluate the design, implementation, and outcomes of the PowerMom research platform, with a focus on participant recruitment, engagement, and data collection across diverse populations. Secondary objectives included identifying challenges encountered during implementation and deriving lessons to inform future digital maternal health studies. Methods: Participants were recruited via digital advertisements, pregnancy apps, and the PowerMom Consortium of more than 15 local and national organizations. Data collection included self-reported surveys, wearable devices, and electronic health records. Anomaly detection measures were implemented to address fraudulent enrollment activity. Recruitment trends and descriptive statistics from survey data were analyzed to summarize participant characteristics, assess engagement metrics, and quantify missing data to identify gaps. Results: Overall, 5617 participants were enrolled from 2021 to 2024, with 69.8\% (n=3922) providing demographic data. Of these, 48.5\% (2723/5617) were younger than 35 years, 14\% (788/5617) identified as Hispanic or Latina, and 13.7\% (770/5617) identified as Black or African American. Geographic representation spanned all 50 US states, Puerto Rico, and Guam, with 58.3\% (3276/5617) residing in areas with moderate access to maternity care and 16.4\% (919/5617) in highly disadvantaged neighborhoods based on the Area Deprivation Index. Enrollment rates increased substantially over the study period, from 55 participants in late 2021 to 3310 in 2024, averaging 99.4 enrollments per week in 2024. Participants completed a total of 17,123 surveys, with 71.8\% (4033/5617) completing the Intake Survey and 12.4\% (697/5617) completing the Postpartum Survey. Wearable device data were shared by 1168 participants, providing more than 378,000 daily biometric measurements, including activity levels, sleep, and heart rate. Additionally, 96 participants connected their electronic health records, contributing 276 data points such as diagnoses, medications, and laboratory results. Among pregnancy-related characteristics, 28.1\% (1578/5617) enrolled during the first trimester, while 15.1\% (849/5617) reported information about the completion of their pregnancies during the study period. Among the 913 participants who shared delivery information, 56.1\% (n=512) had spontaneous vaginal deliveries and 17.9\% (n=163) underwent unplanned cesarean sections. Conclusions: The PowerMom platform demonstrates the feasibility of using digital tools to recruit and engage diverse populations in maternal health research. Its ability to integrate multimodal data sources showcases its potential to provide comprehensive maternal-fetal health insights. Challenges with data completeness and survey attrition underscore the need for sustained participant engagement strategies. These findings offer valuable lessons for scaling digital health platforms and addressing disparities in maternal health research. Trial Registration: ClinicalTrials.gov NCT03085875; https://clinicaltrials.gov/study/NCT03085875 ", doi="10.2196/70149", url="https://formative.jmir.org/2025/1/e70149" } @Article{info:doi/10.2196/63570, author="Plouvier, Pauline and Marcilly, Romaric and Robin, Geoffroy and Benamar, Chaymae and Robin, Camille and Simon, Virginie and Piau, Sophie Anne and Cambay, Isabelle and Schiro, Jessica and Decanter, Christine", title="Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="24", volume="12", pages="e63570", keywords="mobile apps", keywords="mHealth", keywords="mobile health", keywords="assisted reproductive technologies", keywords="evaluation", keywords="satisfaction", keywords="reproduction", keywords="fertility", keywords="ovarian stimulation", keywords="ease of use", keywords="usability", keywords="midwives", keywords="obstetrics", keywords="gynecology", abstract="Background: Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR). Objective: This study aimed to evaluate the patients' and midwives' levels of satisfaction with the connected mobile app. Methods: We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users' opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives. Results: Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app's ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors. Conclusions: The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team's workload, the time savings provided by the app constitute a nonnegligible advantage. ", doi="10.2196/63570", url="https://humanfactors.jmir.org/2025/1/e63570" } @Article{info:doi/10.2196/56230, author="Hassdenteufel, Kathrin and M{\"u}ller, Mitho and Abele, Harald and Brucker, Yvonne Sara and Graf, Johanna and Zipfel, Stephan and Bauer, Armin and Jakubowski, Peter and Pauluschke-Fr{\"o}hlich, Jan and Wallwiener, Markus and Wallwiener, Stephanie", title="Improving Maternal Mental Health and Weight Control With a Mindfulness Blended Care Approach: Insights From a Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Feb", day="24", volume="27", pages="e56230", keywords="peripartum mental health", keywords="digital intervention", keywords="depression", keywords="anxiety", keywords="personal coaching", keywords="ehealth", keywords="pregnancy", keywords="maternal mental health", keywords="weight gain", keywords="mindfulness-based intervention", keywords="coaching", keywords="randomized controlled clinical trial", keywords="postpartum", keywords="treatment", keywords="electronic", keywords="effectiveness", keywords="women", abstract="Background: Perinatal maternal mental health problems, such as depression and anxiety, are highly prevalent during pregnancy and post partum. Electronic mindfulness-based interventions (eMBIs) are a promising treatment option, which can be provided in a low-threshold, cost-effective manner. However, research underscores the fact that face-to-face coaching sessions are more effective than solely digital methods. A blended care approach (eMBI with direct face-to-face coaching) could amplify the therapeutic impact on maternal mental health and weight gain during the perinatal period. Objective: We investigated whether combining an eMBI intervention with face-to-face personal support significantly improves maternal mental health, and whether the intervention can influence weight gain in affected women during pregnancy. Methods: A community-based sample of 460 pregnant women with a singleton pregnancy who screened positive for depression was enrolled in a multicenter randomized controlled trial (RCT) including the University Hospitals of Heidelberg and T{\"u}bingen as well as more than 200 gynecological practices within the state of Baden-W{\"u}rttemberg in Germany between February 2019 and October 2020. Participating women were randomized 1:1 to the control group (CG) or intervention group (IG) that received access to an 8-week pregnancy-adapted eMBI between the 29th and 36th gestational week. In a subanalysis, we grouped participants in those receiving only the initial face-to-face coaching session at recruitment (no personal coaching) and those with ?2 personal coaching sessions. Primary outcome measures were severity of depressive symptoms using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, the Pregnancy-Related Anxiety Questionnaire, the Freiburg Mindfulness Inventory, and the Patient Health Questionnaire; secondary outcome measure, BMI. Results: In the final sample, 137 CG women and 102 IG women received only one coaching session, whereas 37 CG women and 40 IG women received at least 2 (mean 2.3, SD 0.7) coaching sessions. The analyses were adjusted for significant confounders. The IG's mindfulness scores increased significantly (F1.873,344.619=4.560, P=.01, $\eta${\texttwosuperior}=0.024, $\omega${\texttwosuperior}=0.012) regardless of coaching frequency. Both general anxiety (F12,129=2.361, P=.01, $\eta${\texttwosuperior}=0.0180, $\omega${\texttwosuperior}=0.100) and depression symptoms (F4.758, 699.423=3.033, P=.01, $\eta${\texttwosuperior}=0.020, $\omega${\texttwosuperior}=0.009) were significantly lower in the group that received ?2 coaching sessions than in the no-personal-coaching group. In the group receiving ?2 coaching sessions, BMI generally was lower in the IG than in the CG (F3.555,444.416=4.732, P=.002, $\eta${\texttwosuperior}=0.036, $\omega${\texttwosuperior}=0.013). Conclusions: Adding a minimal amount of PC to the digital eMBI increased mindfulness and decreased birth-related anxiety, symptoms of depression, and anxiety in at-risk pregnant women. Favorable effects on gestational weight gain were found in the respective IGs, the strongest effect being within the PC group. This blended digital health approach amplifies the effectiveness of the digital intervention. Trial Registration: German Clinical Trials Register DRKS00017210; https://www.drks.de/search/de/trial/DRKS00017210 ", doi="10.2196/56230", url="https://www.jmir.org/2025/1/e56230", url="http://www.ncbi.nlm.nih.gov/pubmed/39992700" } @Article{info:doi/10.2196/60038, author="Fitzgerald, Haley and Frank, Madison and Kasula, Katelyn and Krans, E. Elizabeth and Krishnamurti, Tamar", title="Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="13", volume="8", pages="e60038", keywords="substance use disorder", keywords="substance use screening", keywords="mHealth", keywords="mobile health apps", keywords="pregnancy", keywords="technology", abstract="Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75\%) and Medicaid insured (26/28, 93\%), with an annual household income of