%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67284 %T Designing a Digital Intervention to Increase Human Milk Feeding Among Black Mothers: Qualitative Study of Acceptability and Preferences %A Patchen,Loral %A Tsuei,Jeannette %A Sherard,Donna %A Moriarty,Patricia %A Mungai-Barris,Zoe %A Ma,Tony %A Bajracharya,Elina %A Chang,Katie %A Evans,William Douglas %+ Healthcare Delivery Research, MedStar Health Research Institute, 10980 Grantchester Way, 7th Floor, Columbia, MD, 21044, United States, 1 7205845076, loral.patchen@medstar.net %K health equity %K breastfeeding %K qualitative %K mobile health %K black mothers %K preferences %K cultural tailoring %K mobile phone %D 2025 %7 19.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months. Objective: Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring. Methods: We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis. Results: All participants identified as Black or African American mothers, and most interview participants (7/12, 58%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility. Conclusions: This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial. %M 40106802 %R 10.2196/67284 %U https://formative.jmir.org/2025/1/e67284 %U https://doi.org/10.2196/67284 %U http://www.ncbi.nlm.nih.gov/pubmed/40106802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51524 %T Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama “Secure Voucher” Study Cluster Randomized Controlled Trial %A Vey,Trinity %A Kinnicutt,Eleonora %A Day,Andrew G %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada, 1 613 533 2000, 16tv7@queensu.ca %K malaria prevention %K pregnant %K mHealth %K mobile health %K short message service %K behaviour change communication %K long-lasting insecticidal nets %K protozoan infections %K parasitic diseases %K vector borne diseases %K randomized controlled trial %K morbidity %K mortality %K intervention %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 40106816 %R 10.2196/51524 %U https://www.jmir.org/2025/1/e51524 %U https://doi.org/10.2196/51524 %U http://www.ncbi.nlm.nih.gov/pubmed/40106816 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67049 %T Integration of a Patient-Centered mHealth Intervention (Support-Moms) Into Routine Antenatal Care to Improve Maternal Health Among Pregnant Women in Southwestern Uganda: Protocol for a Randomized Controlled Trial %A Atukunda,Esther Cathyln %A Mugyenyi,Godfrey Rwambuka %A Haberer,Jessica E %A Siedner,Mark J %A Musiimenta,Angella %A Najjuma,Josephine N %A Obua,Celestino %A Matthews,Lynn T %+ Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda, 256 702949832, eatukunda@must.ac.ug %K social support %K intervention development %K maternal health %K antenatal care attendance %K skilled births %K Uganda %D 2025 %7 19.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) interventions that leverage social support (SS) can improve partner involvement and pregnancy experiences and promote antenatal care (ANC) attendance and skilled births. In our previous studies, we used behavioral frameworks to develop a user-centered mHealth-based, audio SMS text messaging app to support pregnant individuals to use maternity care services in rural Uganda (Support-Moms app). In our pilot study, we observed high intervention uptake, acceptability, and feasibility, as well as increased ANC attendance and skilled births. Objective: With the promising pilot data, we propose a type 1 hybrid implementation-effectiveness trial to test if this novel patient-centered automated and customized mHealth-based SS intervention is effective and cost-effective enough to warrant future large-scale implementation into Uganda’s routine maternity care. Methods: We will physically recruit 824 pregnant women at <20 weeks of gestation living in Mbarara and Mitooma districts, southwestern Uganda, and randomize them (1:1) to receive standard of care or the Support-Moms app, with at least 2 of their identified social supporters. Our primary outcome will be the proportion of skilled births. Secondary outcomes will include number of ANC visits, institution-based delivery, mode of infant delivery, preterm birth, birth weight, SS, obstetric complications, and deaths (maternal, fetal, and newborn). We will assess other implementation, service, and client outcomes through study records, the mHealth platform, and questionnaires with all women in the intervention, their social supporters, health care providers (HCPs), and managers from participating facilities. We will conduct face-to-face in-depth exit interviews with 30 purposively selected intervention participants and 15 facility HCPs and managers to explore implementation strategies for scale-up. Annual maternity resource allocations, costs, number of ANC visits, and deliveries will be assessed from facility records up to 36 months after implementation. We will estimate incremental cost-effectiveness ratios concerning cost per additional HCP-led delivery, per death averted, and per quality-adjusted life year gained as cost-effectiveness measures. Results: This study was funded in September 2023. Ethics approval was obtained in February 2024, and actual data collection started in March 2024. As of January 2025, 75% (618/824) of all projected study participants provided consent and were recruited into the study. Participants are expected to be followed up until delivery, and 15% (124/824) have so far exited. Data analysis for the trial is expected to start as soon as the last participant exits from the study. The qualitative interviews will start in April 2025, and data will be analyzed and published as soon as data collection is done, which is expected in March 2027. Conclusions: We are testing the feasibility, acceptability, and cost-effectiveness of implementing Support-Moms into routine maternity care from individual and facility perspectives. We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service use for women in rural Uganda and similar settings. Trial Registration: ClinicalTrials.gov NCT05940831; https://clinicaltrials.gov/study/NCT05940831 International Registered Report Identifier (IRRID): DERR1-10.2196/67049 %M 40105879 %R 10.2196/67049 %U https://www.researchprotocols.org/2025/1/e67049 %U https://doi.org/10.2196/67049 %U http://www.ncbi.nlm.nih.gov/pubmed/40105879 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63483 %T Preventing Premature Family Maladjustment: Protocol for a Multidisciplinary eHealth Study on Preterm Parents’ Well-Being %A Decataldo,Alessandra %A Paleardi,Federico %A Lauritano,Giacomo %A Figlino,Maria Francesca %A Russo,Concetta %A Novello,Mino %A Fiore,Brunella %A Ciuffo,Giulia %A Ionio,Chiara %+ Dipartimento di Sociologia e Ricerca Sociale, Università degli Studi Milano-Bicocca, Piazza dell'Ateneo 1, Milano, 20126, Italy, 39 0264487418, alessandra.decataldo@unimib.it %K preterm birth %K parental well-being %K sociology of health %K digital-based monitoring %K mixed methods research %K eHealth %D 2025 %7 18.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The consequences of preterm birth extend beyond the clinical conditions of the newborn, profoundly impacting the functioning and well-being of families. Parents of preterm infants often describe the experience of preterm birth and subsequent admission to the neonatal intensive care unit (NICU) as a disruptive event in their lives, triggering feelings of guilt, helplessness, and fear. Although various research examines changes in parents’ well-being and perception of self-efficacy during the stay in the NICU, there is a lack of research analyzing what happens in the transition phase at home after the baby’s discharge. Recently, scholars have advocated for the use of web-based support programs to monitor and prevent preterm family maladjustment and assist parents. Objective: This interdisciplinary research will develop a sociopsychological model focused on assessing the well-being of parents of premature infants during and after their stay in a NICU. Specifically, the study aims to (1) monitor the mental health of parents of premature infants both at the time of the child’s discharge from the NICU and in the first 6 months after discharge to prevent family maladjustment, (2) deepen our understanding of the role of digital tools in monitoring and supporting preterm parents’ well-being, and (3) study the potential impact of the relationship with health care professionals on the overall well-being of parents. Methods: This project combines mixed methods of social research and psychological support with an eHealth approach. The well-being of parents of premature infants will be assessed using validated scales administered through a questionnaire to parents of preterm infants within 6 NICUs at the time of the child’s discharge. Subsequently, a follow-up assessment of parental well-being will be implemented through the administration of the validated scales in a web application. In addition, an ethnographic phase will be conducted in the NICUs involving observation of the interaction between health care professionals and parents as well as narrative interviews with health care staff. Finally, interactions within the digital environment of the web application will be analyzed using a netnographic approach. We expect to shed light on the determinants of well-being among parents of premature infants in relation to varying levels of prematurity severity; sociodemographic characteristics such as gender, age, and socioeconomic status; and parental involvement in NICU care practices. With the follow-up phase via web application, this project also aims to prevent family maladjustment by providing psychological support and using an eHealth tool. Results: The results are expected by October 2025, the expiration date of the Project of Relevant National Interest. Conclusions: The eHealth Study on Preterm Parents’ Well-Being aims to improve preterm parents’ well-being and, indirectly, children’s health by reducing social costs. Furthermore, it promotes standardized neonatal care protocols, reducing regional disparities and strengthening collaboration between parents and health care staff. International Registered Report Identifier (IRRID): PRR1-10.2196/63483 %M 40101208 %R 10.2196/63483 %U https://www.researchprotocols.org/2025/1/e63483 %U https://doi.org/10.2196/63483 %U http://www.ncbi.nlm.nih.gov/pubmed/40101208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66580 %T Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis %A Wang,Jianing %A Tang,Nu %A Jin,Congcong %A Yang,Jianxue %A Zheng,Xiangpeng %A Jiang,Qiujing %A Li,Shengping %A Xiao,Nian %A Zhou,Xiaojun %+ Department of Maternal and Child Information Management, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chonqing, 401147, China, 86 23 6723 2442, 1186440689@qq.com %K digital health %K telemedicine %K telehealth %K mobile health %K mHealth %K mobile phone %K intervention %K meta-analysis %K pregnant women %K systematic review %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes. Objective: This study aimed to investigate the effect of digital health interventions among pregnant women and newborns. Methods: A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data. Results: We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference–0.19, 95% CI –0.25 to –0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05). Conclusions: The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful. Trial Registration: PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt %M 40085842 %R 10.2196/66580 %U https://www.jmir.org/2025/1/e66580 %U https://doi.org/10.2196/66580 %U http://www.ncbi.nlm.nih.gov/pubmed/40085842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66637 %T Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial %A Downs,Danielle Symons %A Pauley,Abigail M %A Rivera,Daniel E %A Savage,Jennifer S %A Moore,Amy M %A Shao,Danying %A Chow,Sy-Miin %A Lagoa,Constantino %A Pauli,Jaimey M %A Khan,Owais %A Kunselman,Allen %+ Department of Kinesiology, Pennsylvania State University, 378 N Burrowes, 266 Recreation Building, University Park, PA, 16802, United States, 1 814 863 0456, dsd11@psu.edu %K pregnancy %K gestational weight gain %K physical activity %K healthy eating %K overweight %K obesity %K intervention %D 2025 %7 13.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a “gold standard” intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform. Objective: The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability. Methods: This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ≥30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models. Results: Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028. Conclusions: Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women. International Registered Report Identifier (IRRID): DERR1-10.2196/66637 %M 40080809 %R 10.2196/66637 %U https://www.researchprotocols.org/2025/1/e66637 %U https://doi.org/10.2196/66637 %U http://www.ncbi.nlm.nih.gov/pubmed/40080809 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e66852 %T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study %A Asadollahi,Fateme %A Ebrahimzadeh Zagami,Samira %A Eslami,Saeid %A Latifnejad Roudsari,Robab %+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com %K pregnancy %K prenatal care %K mobile health apps %K mHealth %K women’s health %K health care providers %K quality assessment %K content evaluation %K suitability assessment %K digital health %K smartphones %K eHealth %K telehealth %K telemedicine %K health promotion %K technology %K functionality %K systematic search %D 2025 %7 13.2.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 %M 39946714 %R 10.2196/66852 %U https://apinj.jmir.org/2025/1/e66852 %U https://doi.org/10.2196/66852 %U http://www.ncbi.nlm.nih.gov/pubmed/39946714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64634 %T Metaverse Clinic for Pregnant Women With Subclinical Hypothyroidism: Prospective Randomized Study %A Zheng,Yuanyuan %A Chen,Yizhen %A Chen,Yan %A Lin,Liang %A Xue,Ting %A Chen,Chuhui %A Wen,Junping %A Lin,Wei %A Chen,Gang %+ Department of Endocrinology, Fuzhou University Affiliated Provincial Hospital, No134 East Road, Fuzhou, 350001, China, 86 059188217521, chengangfj@163.com %K metaverse %K subclinical hypothyroidism %K adverse pregnancy outcomes %K psychological health %K neurobehavioral development %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care is experiencing new opportunities in the emerging digital landscape. The metaverse, a shared virtual space, integrates technologies such as augmented reality, virtual reality, blockchain, and artificial intelligence. It allows users to interact with immersive digital worlds, connect with others, and explore unknowns. While the metaverse is gaining traction across various medical disciplines, its application in thyroid diseases remains unexplored. Subclinical hypothyroidism (SCH) is the most common thyroid disorder during pregnancy and is frequently associated with adverse pregnancy outcomes. Objective: This study aims to evaluate the safety and effectiveness of a metaverse platform in managing SCH during pregnancy. Methods: A randomized controlled trial was conducted at Fujian Provincial Hospital, China, from July 2022 to December 2023. A total of 60 pregnant women diagnosed with SCH were randomly assigned into two groups: the standard group (n=30) and the metaverse group (n=30). Both groups received levothyroxine sodium tablets. Additionally, participants in the metaverse group had access to the metaverse virtual medical consultations and metaverse-based medical games. The primary outcomes were adverse maternal and offspring outcomes, and the secondary outcomes included the neurobehavioral development of offspring and maternal psychological assessments. Results: Of the 30 participants in each group, adverse maternal outcomes were observed in 43% (n=13) of the standard group and 37% (n=11) of the metaverse group (P=.60). The incidence of adverse offspring outcomes was 33% (n=10) in the standard group, compared to 7% (n=2) in the metaverse group (P=.01). The Gesell Development Scale did not show significant differences between the two groups. Notably, the metaverse group demonstrated significantly improved scores on the Self-Rating Depression Scale and the Self-Rating Anxiety Scale scores compared to the standard group (P<.001 and P=.001, respectively). Conclusions: The use of metaverse technology significantly reduced the incidence of adverse offspring outcomes and positively impacted maternal mental health. Maternal adverse outcomes and offspring neurobehavioral development were comparable between the two groups. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300076803; https://www.chictr.org.cn/showproj.html?proj=205905 %M 39908543 %R 10.2196/64634 %U https://www.jmir.org/2025/1/e64634 %U https://doi.org/10.2196/64634 %U http://www.ncbi.nlm.nih.gov/pubmed/39908543 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62738 %T Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %K chatbot %K conversational agents %K tele-dentistry %K oral health behavior %K in-person toothbrushing %K hands-on %K children %K covid-19 %K oral health education %K development. %D 2025 %7 3.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3‐5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot’s content quality, empathetic communication, and multimedia design, but noted the intervention’s lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers’ perceptions of oral health care and improved tooth-brushing practices for children aged 6‐36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 %R 10.2196/62738 %U https://pediatrics.jmir.org/2025/1/e62738 %U https://doi.org/10.2196/62738 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60825 %T The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment %A Amhaz,Haneen %A Chen,Sally Xuanping %A Elchehimi,Amanee %A Han,Kylin Jialin %A Gil,Jade Morales %A Yao,Lu %A Vidler,Marianne %A Berry-Einarson,Kathryn %A Dewar,Kathryn %A Tuason,May %A Prestley,Nicole %A Doan,Quynh %A van Rooij,Tibor %A Costa,Tina %A Ogilvie,Gina %A Payne,Beth A %+ Women's Health Research Institute, H214-4500 Oak Street, Box 42, Vancouver, BC, V6H3N1, Canada, 1 604 875 3459, bpayne@cw.bc.ca %K digital health %K co-design %K digital strategy %K human-centered design %K eHealth %K cocreation %K codevelopment %K perinatal intervention %K quality of care %K digital tools %K pregnancy %K patient autonomy %K patient support %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. %M 39883935 %R 10.2196/60825 %U https://humanfactors.jmir.org/2025/1/e60825 %U https://doi.org/10.2196/60825 %U http://www.ncbi.nlm.nih.gov/pubmed/39883935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59461 %T Feasibility of a Mobile App–Based Cognitive-Behavioral Perinatal Skills Program: Protocol for Nonrandomized Pilot Trial %A Temkin-Yu,Andrea B %A Ayaz,Aliza %A Blicker,Ella %A Liu,Michael X %A Oh,Ace %A Siegel,Isabelle E %A Seewald,Meredith J %A Hermann,Alison D %A Givrad,Soudebah %A Baez,Lara M %A Osborne,Lauren M %A Green,Cori M %A Schier,Maddy M %A Davis,Alexandra M %A Zhu,Shasha %A Falk,Avital %A Bennett,Shannon M %+ Psychiatry Department, Weill Cornell Medicine, 525 E 68th Street, New York, NY, 10065, United States, 1 6402038301, andreabtemkin@gmail.com %K perinatal mood and anxiety disorders %K apps %K smartphones %K digital intervention %K cognitive behavioral therapy %K feasibility %K pilot trial %K mobile phones %D 2025 %7 28.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental illness is one of the top causes of preventable pregnancy-related deaths in the United States. There are many barriers that interfere with the ability of perinatal individuals to access traditional mental health care. Digital health interventions, including app-based programs, have the potential to increase access to useful tools for these individuals. Although numerous mental health apps exist, there is little research on developing programs to address the unique needs of perinatal individuals. In an effort to fill this gap, a multidisciplinary team of experts in psychology, psychiatry, obstetrics, and pediatric primary care collaborated to develop the novel Perinatal Skills Program within Maya, a flexible and customizable cognitive-behavioral skills app. Maya-Perinatal Skills Program (M-PSP) uses evidence-based strategies to help individuals manage their mood and anxiety symptoms during pregnancy and post partum. Objective: This pilot study aims to assess the feasibility, acceptability, and usability of M-PSP and explore links between program use and symptoms of anxiety and low mood. Methods: This single-arm trial will recruit 50 pregnant or postpartum individuals with mild-to-moderate anxiety or mood symptoms. Participants will be recruited from a variety of public and private insurance-based psychiatry, obstetrics, and primary care clinics at a large academic medical center located in New York City. Participants will complete all sessions of M-PSP and provide feedback. Outcome measures will include qualitative and quantitative assessments of feasibility, acceptability, and usability, passively collected program usage data, and symptom measures assessing mood, anxiety, and trauma. Planned data analysis includes the use of the grounded theory approach to identify common themes in qualitative feedback, as well as an exploration of possible associations between quantitative data regarding program use and symptoms. Results: The recruitment began on August 2023. As of October 2024, a total of 32 participants have been enrolled. The recruitment will continue until 50 participants have been enrolled. Conclusions: Digital health interventions, like M-PSP, have the potential to create new pathways to reach individuals struggling with their mental health. The results of this study will be the groundwork for future iterations of M-PSP in the hopes of providing an accessible and helpful tool for pregnant and postpartum individuals. Trial Registration: ClinicalTrials.gov NCT05897619; https://classic.clinicaltrials.gov/ct2/show/NCT05897619 International Registered Report Identifier (IRRID): PRR1-10.2196/59461 %M 39874578 %R 10.2196/59461 %U https://www.researchprotocols.org/2025/1/e59461 %U https://doi.org/10.2196/59461 %U http://www.ncbi.nlm.nih.gov/pubmed/39874578 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63564 %T LoVE4MUM Mobile App to Prevent Postpartum Depression: Protocol for a Pilot Randomized Controlled Trial %A Kamarudin,Siti Sabrina %A Idris,Idayu Badilla %A Sharip,Shalisah %A Ahmad,Norfazilah %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia, 60 91455887 ext 5888, idayubadilla.idris@ukm.edu.my %K postpartum depression %K mHealth intervention %K mobile phone %K prevention %K self-guided %K virtual engagement %K engagement %K maternal %K protocol %K randomized controlled trial %K postpartum %K depression %K maternal %K well-being %K mobile health %K preventive care %K mobile app %K mental health literacy %K postpartum care %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care. Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding & Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression. Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire. Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025. Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers. Trial Registration: ClinicalTrials.gov NCT06366035; https://clinicaltrials.gov/study/NCT06366035 International Registered Report Identifier (IRRID): PRR1-10.2196/63564 %M 39869891 %R 10.2196/63564 %U https://www.researchprotocols.org/2025/1/e63564 %U https://doi.org/10.2196/63564 %U http://www.ncbi.nlm.nih.gov/pubmed/39869891 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 8 %N %P e60479 %T Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial %A Zvulunov,Alex %A Lenevich,Stepan %A Migacheva,Natalia %K atopic dermatitis %K skin %K disease management %K children %K pediatric %K feasibility %K mHealth %K mobile health %K app %K eczema %K Atopic App %K dermatology %D 2025 %7 22.1.2025 %9 %J JMIR Dermatol %G English %X Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ≥8 days showed a more significant decrease in severity scores compared to those who used it for ≤7 days, or did not use it at all. Participants who used the app for ≥8 days had a median SCORAD of 6.25 (95% CI 4.6‐14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95% CI 13.9‐24.0; IQR 13.9-24; P=.03) and those using it ≤7 days (13, 95% CI 9.35‐27; IQR 7.2-27; P=.04). Their median POEM of 2 (95% CI 1.0‐4.5; IQR 1-5.3) was also significantly lower than those using the app ≤7 days (9, 95% CI 2‐12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95% CI 1‐9; IQR 1-9; P=.14). Additionally, using the Atopic App for ≥8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 %R 10.2196/60479 %U https://derma.jmir.org/2025/1/e60479 %U https://doi.org/10.2196/60479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58265 %T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies %A Rizzi,Silvia %A Pavesi,Maria Chiara %A Moser,Alessia %A Paolazzi,Francesca %A Marchesoni,Michele %A Poggianella,Stefania %A Gadotti,Erik %A Forti,Stefano %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K well-being %K maternal health %K digital health %K intervention %K design %K preliminary testing %K technology-based %K interview %K multidisciplinary approach %K mother %K women %K WhatsApp %K email %K midwife %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. %M 39625414 %R 10.2196/58265 %U https://formative.jmir.org/2025/1/e58265 %U https://doi.org/10.2196/58265 %U http://www.ncbi.nlm.nih.gov/pubmed/39625414 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65247 %T Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study %A Krishnamurti,Tamar %A Moon,Rachel %A Richichi,Rudolph %A Berger,Rachel %K SIDS %K infant death %K sleep %K sudden infant death %K US %K United States %K infant %K infancy %K baby %K prenatal %K safe sleep %K breastfeeding %K infant care %K pregnancy %K app %K randomized controlled study %K TodaysBaby %K mobile health %K mHealth %K smartphone %D 2025 %7 14.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app’s learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program—3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID—a leading cause of infant death after 1 month of age—appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. %R 10.2196/65247 %U https://pediatrics.jmir.org/2025/1/e65247 %U https://doi.org/10.2196/65247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53460 %T Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study %A Ramkumar,Vidya %A Joshi B,Deepashree %A Prabhakar,Anil %A Hall,James W %A Vaidyanath,Ramya %+ Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Sri Ramachandra Nagar, Porur, Chennai, 600116, India, 91 9894170609, deepasrijoshi25@sriramachandra.edu.in %K audiometry %K mHealth %K devices %K wireless %K tablet-based screening %K childhood hearing loss %K early hearing detection and intervention %K tablets %K children %K neonates %K hearing loss %K infants %K development %K validation %K mobile phones %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry–screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task–screening for children 1 to 3 years old; and (3) speech recognition task–screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. %M 39805111 %R 10.2196/53460 %U https://formative.jmir.org/2025/1/e53460 %U https://doi.org/10.2196/53460 %U http://www.ncbi.nlm.nih.gov/pubmed/39805111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64191 %T A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study %A Fan,Heidi Sze Lok %A Leung,Emily Tsz Yan %A Lau,Ka Wing %A Wong,Janet Yuen Ha %A Choi,Edmond Pui Hang %A Lam,Christine %A Tarrant,Marie %A Ngan,Hextan Yuen Sheung %A Ip,Patrick %A Lin,Chia Chin %A Lok,Kris Yuet Wan %K Baby-Friendly Community Initiative %K Baby-Friendly Hospital Initiative %K breastfeeding %K community %K stakeholders %K mobile app %K friendly communities %K baby-friendly %K well-being %K mother %K infant %K application %K mHealth %K qualitative %K user-friendly %K self-management %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called “bfGPS” (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged—bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant’s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app’s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. %R 10.2196/64191 %U https://formative.jmir.org/2025/1/e64191 %U https://doi.org/10.2196/64191 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e53748 %T Cultural Adaptation of an Aboriginal and Torres Strait Islanders Maternal and Child mHealth Intervention: Protocol for a Co-Design and Adaptation Research Study %A Ishaque,Sana %A Ela,Ola %A Rissel,Chris %A Canuto,Karla %A Hall,Kerry %A Bidargaddi,Niranjan %A Briley,Annette %A Roberts,Claire T %A Perkes,Sarah Jane %A Dowling,Anna %A Bonevski,Billie %+ College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, 5042, Australia, 61 882013911, isha0018@flinders.edu.au %K Aboriginal %K co-design %K mHealth %K maternal %K child health %K digital health %K children %K women %K female %K cultural adaptation %K Torres Strait %K research study %K Indigenous %K digital health intervention %K diversity %K South Australia %K pregnant %K health professional %K adaption %K focus group %K pretesting %K usability %K app %K health disparities %K information %K technology %K mobile phone %D 2025 %7 10.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective: This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods: Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander–specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app’s cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results: With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions: A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/53748 %M 39793001 %R 10.2196/53748 %U https://www.researchprotocols.org/2025/1/e53748 %U https://doi.org/10.2196/53748 %U http://www.ncbi.nlm.nih.gov/pubmed/39793001 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62795 %T Developing an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Preteen Girls of Low Socioeconomic Position: Multiphase Co-Design Study %A Brennan,Carol %A ODonoghue,Grainne %A Keogh,Alison %A Rhodes,Ryan E %A Matthews,James %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, DO4C7X2, Ireland, 353 1 716 3449, carol.brennan1@ucdconnect.ie %K physical activity %K preteen girls %K socioeconomic position %K maternal support %K mHealth %K intervention %K co-design %K pediatric %K daughter %K design %K development %K behavior change technique %K Behaviour Change Wheel %K sedentary %K inactivity %D 2025 %7 6.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls’ physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people’s physical activity. However, the effects of these interventions on girls’ physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort. Objective: This study aimed to use co-design methods to develop an evidence- and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls. Methods: The intervention prototype was developed in accordance with the United Kingdom Medical Research Council framework, the Behaviour Change Wheel, the Theoretical Domains Framework, and the Behaviour Change Techniques Ontology. The Behaviour Change Intervention Ontology was also used to annotate the intervention characteristics. The co-design process incorporated three phases: (1) behavioral analysis, (2) the selection of intervention components, and (3) refinement of the intervention prototype. Throughout these phases, workshops were conducted with preteen girls (n=10), mothers of preteen girls (n=9), and primary school teachers (n=6), with additional input from an academic advisory panel. Results: This 3-phase co-design process resulted in the development of a theory-informed intervention that targeted two behaviors: (1) mothers’ engagement in a range of supportive behaviors for their daughters’ physical activity and (2) daughters’ physical activity behavior. Formative research identified 11 theoretical domains to be targeted as part of the intervention (eg, knowledge, skills, and beliefs about capabilities). These were to be targeted by 6 intervention functions (eg, education, persuasion, and modeling) and 27 behavior change techniques (eg, goal setting and self-monitoring). The co-design process resulted in a mobile app being chosen as the mode of delivery for the intervention. Conclusions: This paper offers a comprehensive description and analysis of using co-design methods to develop a mother-daughter mobile health intervention prototype that is ready for feasibility and acceptability testing. The Behaviour Change Wheel, Theoretical Domains Framework, and Behaviour Change Techniques Ontology provided a systematic and transparent theoretical foundation for developing the prototype by enabling the identification of potential pathways for behavior change. Annotating the Behaviour Change Intervention Ontology entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication, and implementation of interventions. %M 39761561 %R 10.2196/62795 %U https://pediatrics.jmir.org/2025/1/e62795 %U https://doi.org/10.2196/62795 %U http://www.ncbi.nlm.nih.gov/pubmed/39761561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58693 %T Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources %A Boulton,Kelsie Ann %A Hilton,Makana %A Sutton,Emilia %A Guastella,Adam John %+ Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 0293510984, kelsie.boulton@sydney.edu.au %K digital tools %K neurodevelopmental conditions %K mental health %K digital health %K implementation %K digital interventions %K child neurodevelopment %K digital technology %K mobile phone %D 2025 %7 1.1.2025 %9 Review %J J Med Internet Res %G English %X Background: An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families. Objective: This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions. Methods: We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale. Results: The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=–4.35, P<.001; digital resources; t67=–4.95, P<.001). Conclusions: The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped. %M 39742455 %R 10.2196/58693 %U https://www.jmir.org/2025/1/e58693 %U https://doi.org/10.2196/58693 %U http://www.ncbi.nlm.nih.gov/pubmed/39742455 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51566 %T Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial %A Huang,Yi-Yan %A Wang,Rong %A Huang,Wei-Peng %A Wu,Tian %A Wang,Shi-Yun %A R. Redding,Sharon %A Ouyang,Yan-Qiong %+ School of Nursing, Wuhan University, 115 Donghu Rd, Wuchang District, Wuhan, 430072, China, 86 27 68759710, ouyangyq@whu.edu.cn %K breastfeeding %K co-parenting %K randomized controlled %K child %K efficacy %K depressive symptoms %D 2024 %7 17.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers’ support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant’s BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90% vs 65%, P=.02) and T2 (43.6% vs 22.5%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge (β=.07, 95% CI 0.006-0.13; P=.03) and maternal parenting sense of competence (β=5.49, 95% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 (β=.25, 95% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 (β=5.35, 95% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 (β=.25, 95% CI 0.15-0.35, P<.001), and there was a rise in infants’ BMI at 42 days post partum (β=.33, 95% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant’s BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 %M 39689308 %R 10.2196/51566 %U https://www.jmir.org/2024/1/e51566 %U https://doi.org/10.2196/51566 %U http://www.ncbi.nlm.nih.gov/pubmed/39689308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63454 %T Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial %A Dol,Justine %A Mselle,Lilian Teddy %A Campbell-Yeo,Marsha %A Mbekenga,Columba %A Kohi,Thecla %A McMillan,Douglas %A Dennis,Cindy-Lee %A Tomblin Murphy,Gail %A Aston,Megan %+ IWK Health, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024707706, Justine.dol@dal.ca %K mobile health %K maternal health %K randomized controlled trial %K parenting self-efficacy %K self-efficacy %K maternal %K RCT %K mother %K text message %K coaching %K postnatal %K newborn %K child %K low-income country %K middle-income country %K Africa %K newborn care education %K nurse midwife %K Tanzania %D 2024 %7 5.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective: We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods: ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results: Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions: This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration: ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID): DERR1-10.2196/63454 %M 39636672 %R 10.2196/63454 %U https://www.researchprotocols.org/2024/1/e63454 %U https://doi.org/10.2196/63454 %U http://www.ncbi.nlm.nih.gov/pubmed/39636672 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60610 %T Opportunities for Telemedicine to Improve Parents’ Well-Being During the Neonatal Care Journey: Scoping Review %A Wagenaar,Josephine %A Mah,Crystal %A Bodell,Fredrik %A Reiss,Irwin %A Kleinsmann,Maaike %A Obermann-Borst,Sylvia %A Taal,H Rob %K telemedicine %K telehealth %K neonatal care %K parental well-being %K family-centered care %K pediatrics %K neonates %K newborns %K parents %K neonatal intensive care unit %K NICU %D 2024 %7 2.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Neonatal intensive care unit admissions of newborns are emotional and stressful for parents, influencing their mental and physical well-being and resulting in high rates of psychological morbidities. Significant research has been undertaken to understand and quantify the burden of a newborn’s medical journey on parents’ well-being. Simultaneously, an increase has been observed in the development and implementation of telemedicine interventions, defined as the remote delivery of health care. Telemedicine is used as an overarching term for different technological interventions grouped as real-time audio-visual communication, remote patient monitoring, and asynchronous communication. Various telemedicine interventions have been proposed and developed but scarcely with the primary goal of improving parental well-being during their newborn’s medical journey. Objective: This study aims to identify telemedicine interventions with the potential to improve parents’ well-being and to present the methods used to measure their experience. Methods: A scoping review was conducted, including empirical studies evaluating telemedicine in neonatal care that either measured parental well-being or included parents in the evaluation. Abstract and title screening, full-text screening, and data extraction were performed by three researchers. Two researchers were needed to reach decisions on both the inclusion and extraction of articles. Results: The review included 50 out of 737 screened articles. Telemedicine interventions focused mainly on daily visits at the neonatal intensive care unit and discharge preparedness for parents. Surveys were the primary tool used for outcome measurement (36/50, 72%). Aspects of parents’ well-being were evaluated in 62% (31/50) of studies. Telemedicine interventions developed to provide education and support showed a potential to improve self-efficacy and discharge preparedness and decrease anxiety and stress when they included a real-time telemedicine component. Conclusions: This scoping review identified specific telemedicine interventions, such as real-time audio-visual communication and eHealth apps, that have the potential to improve parental well-being by enhancing self-efficacy and discharge preparedness, and reducing anxiety and stress. However, more insights are needed to understand how these interventions affect well-being. Parents should be included in future research in both the development and evaluation stages. It is important to not only measure parents’ perceptions but also focus on the impact of a telemedicine intervention on their well-being. %R 10.2196/60610 %U https://pediatrics.jmir.org/2024/1/e60610 %U https://doi.org/10.2196/60610 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59564 %T Exploring the Use of a Length AI Algorithm to Estimate Children’s Length from Smartphone Images in a Real-World Setting: Algorithm Development and Usability Study %A Chua,Mei Chien %A Hadimaja,Matthew %A Wong,Jill %A Mukherjee,Sankha Subhra %A Foussat,Agathe %A Chan,Daniel %A Nandal,Umesh %A Yap,Fabian %+ Endocrinology Service, Division of Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Endocrinology Service,, Division of Medicine, Level 3, Clinical Staff Office, Singapore, 229889, Singapore, 65 6394 1127, fabian.yap.k.p@singhealth.com.sg %K computer vision %K length estimation %K artificial intelligence %K smartphone images %K children %K AI %K algorithm %K imaging %K height %K length %K measure %K pediatric %K infant %K neonatal %K newborn %K smartphone %K mHealth %K mobile health %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Length measurement in young children younger than 18 months is important for monitoring growth and development. Accurate length measurement requires proper equipment, standardized methods, and trained personnel. In addition, length measurement requires young children’s cooperation, making it particularly challenging during infancy and toddlerhood. Objective: This study aimed to develop a length artificial intelligence (LAI) algorithm to aid users in determining recumbent length conveniently from smartphone images and explore its performance and suitability for personal and clinical use. Methods: This proof-of-concept study in healthy children (aged 0-18 months) was performed at KK Women’s and Children’s Hospital, Singapore, from November 2021 to March 2022. Smartphone images were taken by parents and investigators. Standardized length-board measurements were taken by trained investigators. Performance was evaluated by comparing the tool’s image-based length estimations with length-board measurements (bias [mean error, mean difference between measured and predicted length]; absolute error [magnitude of error]). Prediction performance was evaluated on an individual-image basis and participant-averaged basis. User experience was collected through questionnaires. Results: A total of 215 participants (median age 4.4, IQR 1.9-9.7 months) were included. The tool produced a length prediction for 99.4% (2211/2224) of photos analyzed. The mean absolute error was 2.47 cm for individual image predictions and 1.77 cm for participant-averaged predictions. Investigators and parents reported no difficulties in capturing the required photos for most participants (182/215, 84.7% participants and 144/200, 72% participants, respectively). Conclusions: The LAI algorithm is an accessible and novel way of estimating children’s length from smartphone images without the need for specialized equipment or trained personnel. The LAI algorithm’s current performance and ease of use suggest its potential for use by parents or caregivers with an accuracy approaching what is typically achieved in general clinics or community health settings. The results show that the algorithm is acceptable for use in a personal setting, serving as a proof of concept for use in clinical settings. Trial Registration: ClinicalTrials.gov NCT05079776; https://clinicaltrials.gov/ct2/show/NCT05079776 %M 39576977 %R 10.2196/59564 %U https://pediatrics.jmir.org/2024/1/e59564 %U https://doi.org/10.2196/59564 %U http://www.ncbi.nlm.nih.gov/pubmed/39576977 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53236 %T Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis %A Brocklehurst,Sarah P %A Morse,Alyssa R %A Cruwys,Tegan %A Batterham,Philip J %A Leach,Liana %A Robertson,Alysia M %A Sahib,Aseel %A Burke,Colette T %A Nguyen,Jessica %A Calear,Alison L %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, Canberra, 2601, Australia, 61 2 6125 8406, alison.calear@anu.edu.au %K postpartum %K depression %K anxiety %K birth %K adoptive %K parents %K mobile phone %D 2024 %7 19.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media. Objective: This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions. Methods: A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses. Results: Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=–0.28, 95% CI –0.41 to –0.15; P<.001) and follow-up (Cohen d=–0.27, 95% CI –0.52 to –0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=–0.29, 95% CI –0.48 to –0.10; P=.002), with a medium effect at follow-up (Cohen d=–0.47, 95% CI –0.88 to –0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI –0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies. Conclusions: Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties. Trial Registration: PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525 %M 39561361 %R 10.2196/53236 %U https://www.jmir.org/2024/1/e53236 %U https://doi.org/10.2196/53236 %U http://www.ncbi.nlm.nih.gov/pubmed/39561361 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58608 %T A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration %A Essop,Hafsa %A Kekana,Ramadimetja Mable %A Brosens,Jacques %A Smuts,Hanlie %+ Department of Radiography, University of Pretoria, 30 Bophelo Road, Gezina, Pretoria, 0008, South Africa, 27 0715897939, hafsa.essop@up.ac.za %K mobile app %K design science research %K usefulness %K pregnant radiographers %K fetal dosimetry %K occupational health and safety %K mobile phone %K maternal and child health %K PregiDose %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users’ perceptions of the app’s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users’ perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app’s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app’s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and “pregnancy brain,” were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. %M 39546780 %R 10.2196/58608 %U https://formative.jmir.org/2024/1/e58608 %U https://doi.org/10.2196/58608 %U http://www.ncbi.nlm.nih.gov/pubmed/39546780 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56807 %T Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study %A Rivera Rivera,Jessica Nathalie %A AuBuchon,Katarina E %A Smith,Marjanna %A Starling,Claire %A Ganacias,Karen G %A Danielson,Aimee %A Patchen,Loral %A Rethy,Janine A %A Blumenthal,H Joseph %A Thomas,Angela D %A Arem,Hannah %+ Healthcare Delivery Research Network, MedStar Health Research Institute, 3007 Tilden Street NW, Suite 6N, Washington, DC, 20008, United States, 1 4436921138, jessica.n.riverarivera@medstar.net %K postpartum care %K newborn care %K health education %K chatbot %K mHealth %K mobile health %K feedback %K health equity %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The 42 days after delivery (“fourth trimester”) are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical “fourth trimester,” we developed 2 ruled-based chatbots—one for birthing individuals and one for newborn caregivers—that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot’s impact on health outcomes and reduce disparities. %M 39541147 %R 10.2196/56807 %U https://pediatrics.jmir.org/2024/1/e56807 %U https://doi.org/10.2196/56807 %U http://www.ncbi.nlm.nih.gov/pubmed/39541147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58624 %T Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia %A Reynolds,Christopher W %A Lee,HaEun %A Sieka,Joseph %A Perosky,Joseph %A Lori,Jody R %+ University of Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, United States, 1 302 377 9925, chwre@med.umich.edu %K mHealth %K mobile triage %K referral pathways %K Liberia %K LMIC %K low- income country %K obstetric triage %K third delay %K mobile health %K mobile application %K digital health %K digital intervention %K smartphone %K middle-income country %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61%), nurses (20/62, 32%), physicians assistants (3/62, 5%), and physicians (1/62, 2%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92%), increasing health worker attentiveness (39/62, 63%), and contributing to improved patient care (34/62, 55%). MORES was perceived as sustainable and scalable (62/62, 100%), particularly if technological barriers (21/62, 34%) and staff training (19/62, 31%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89%), feedback mechanisms for hospitals and RHFs (48/62, 77%), interprofessional teamwork (21/62, 34%), longitudinal follow-up care (20/62, 32%), creating a record of care delays (17/62, 27%), and electronic health record infrastructure (13/62, 21%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. %M 39536307 %R 10.2196/58624 %U https://mhealth.jmir.org/2024/1/e58624 %U https://doi.org/10.2196/58624 %U http://www.ncbi.nlm.nih.gov/pubmed/39536307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48664 %T Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study %A Gulzar,Saleema %A Rahim,Shirin %A Dossa,Khadija %A Saeed,Sana %A Agha,Insiyah %A Khoja,Shariq %A Karmaliani,Rozina %+ School of Nursing and Midwifery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3332356678, saleema.gulzar@aku.edu %K teleconsultation %K digital health %K school health %K child health %K information technology %K eConsultation %K telehealth %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Pakistan’s remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS’s cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. %M 39531262 %R 10.2196/48664 %U https://formative.jmir.org/2024/1/e48664 %U https://doi.org/10.2196/48664 %U http://www.ncbi.nlm.nih.gov/pubmed/39531262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59155 %T Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research %A Kissler,Katherine %A Phillippi,Julia C %A Erickson,Elise %A Holmes,Leah %A Tilden,Ellen %+ College of Nursing, Anschutz Medical Campus, University of Colorado, 13120 E 19th Ave., Mailstop C288, Aurora, CO, 80045, United States, 1 3037244769, katherine.kissler@cuanschutz.edu %K patient-reported outcomes %K survey methods %K smartphone %K labor onset %K prodromal symptoms %K prospective studies %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool’s usability across more diverse populations and disease states. %M 39515816 %R 10.2196/59155 %U https://formative.jmir.org/2024/1/e59155 %U https://doi.org/10.2196/59155 %U http://www.ncbi.nlm.nih.gov/pubmed/39515816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53299 %T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study %A Perme,Natalie %A Reid,Endia %A Eluagu,Macdonald Chinwenwa %A Thompson,John %A Hebert,Courtney %A Gabbe,Steven %A Swoboda,Christine Marie %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu %K health resources %K pregnancy %K patient engagement %K mHealth %K maternal %K mobile health %K app %K focus group %K landscape analysis %K birth %K preterm %K premature %K mortality %K death %K pediatric %K infant %K neonatal %K design %K development %K obstetric %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. %M 39514852 %R 10.2196/53299 %U https://formative.jmir.org/2024/1/e53299 %U https://doi.org/10.2196/53299 %U http://www.ncbi.nlm.nih.gov/pubmed/39514852 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51527 %T Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study %A Vey,Trinity %A Kinnicutt,Eleonora %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3P5, Canada, 1 6135332000, 16tv7@queensu.ca %K mHealth %K short message service %K behavior change communication %K pregnancy %K long-lasting insecticidal nets %K malaria %K protozoan infections %K parasitic diseases %K vector borne diseases %K insecticide %K intervention %K malaria prevention %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. Objective: This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Methods: Following the e-voucher’s expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. Results: While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Conclusions: Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 39499551 %R 10.2196/51527 %U https://www.jmir.org/2024/1/e51527 %U https://doi.org/10.2196/51527 %U http://www.ncbi.nlm.nih.gov/pubmed/39499551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53657 %T Caregiver and Youth Characteristics That Influence Trust in Digital Health Platforms in Pediatric Care: Mixed Methods Study %A Chow,Eric %A Virani,Alice %A Pinkney,Susan %A Abdulhussein,Fatema S %A van Rooij,Tibor %A Görges,Matthias %A Wasserman,Wyeth %A Bone,Jeffrey %A Longstaff,Holly %A Amed,Shazhan %+ Department of Pediatrics, BC Children’s Hospital, 4480 Oak Street, Room K4-206, Vancouver, BC, V6H 3V4, Canada, 1 604 875 2117, SAmed@cw.bc.ca %K pediatrics %K patient trust %K security %K data privacy %K data sharing %K caregivers %K patient engagement %K co-design %K personal health information %K secondary use of data %D 2024 %7 28.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Combining patient-generated health data and digital health platforms may improve patient experience and population health, mitigate rising health care costs, reduce clinician burnout, and enable health equity. However, lack of trust may be a notable barrier to the data-sharing required by such platforms. Understanding sociodemographic, health, and personal characteristics will enable developers and implementers of such technologies to consider these in their technical design requirements. Objective: This study aims to understand relationships between sociodemographic characteristics of caregivers of children or adolescents and trust in and willingness to use digital platforms to store and share personal health information for clinical care and research. Methods: This study used a mixed methods approach, including surveys of caregivers of youth aged <18 years living in Canada or the United States and youth aged 16 to 17 years living in Canada, as well as web-based bulletin board discussions to further explore topics of trust in data sharing. Sociodemographic and survey data were tabulated and explored using proportional odds ordinal regression models. Comments from web-based group discussions were analyzed thematically using a coding approach to identify issues important to the participants. Results: Survey data from 1128 caregivers (female participants: n=549, 48.7%; 36-50 years old: n=660, 58.5%; Canadian: n=603, 53.5%; urban population: n=494, 43.8%) were collected, of which 685 (60.7%) completed all questions. Data from 173 youth (female participants: n=73, 42.2%; urban population: n=94, 54.3%) were collected, of which 129 (74.6%) completed all questions, and data were available for analysis. Furthermore, among 40 participants, 23 (58%) caregivers contributed to the web-based discussion boards. Related to trust, living in a rural area (vs urban; odds ratio [OR] 0.66, 95% CI 0.46-0.95) resulted in lower concern for data privacy and security, while having an undergraduate (OR 1.82, 95% CI 1.30-2.55) or graduate degree (vs secondary or trade school; OR 2.50, 95% CI 1.68-3.73) resulted in higher levels of concern. Living with a chronic disease (OR 1.81, 95% CI 1.35-2.44) increased levels of concern regarding data privacy and security. Interestingly, those with chronic disease were more willing to use digital platforms for clinical care and share personal health information for not-for-profit research. Caregivers were most concerned about data breaches involving data from their children but also highlighted that digital platforms would allow for better coordination of care for their children. Conclusions: Our research confirms the willingness of caregivers and youth to use digital platforms for both clinical care delivery and research and suggests that the value of a digital platform may outweigh the risks of its use. Engagement of end users in co-designing such platforms has the potential to enhance digital trust. However, digital trust varies across sociodemographic groups; therefore, diverse end user engagement is necessary when designing digital applications. %M 39467279 %R 10.2196/53657 %U https://www.jmir.org/2024/1/e53657 %U https://doi.org/10.2196/53657 %U http://www.ncbi.nlm.nih.gov/pubmed/39467279 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56247 %T Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study %A Brinson,Alison K %A Jahnke,Hannah R %A Henrich,Natalie %A Moss,Christa %A Shah,Neel %K digital health %K education %K gestational conditions %K Maven Clinic %K mental health management %K neonatal %K NICU admissions %K neonatal intensive care unit %K mobile phone %D 2024 %7 16.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates. Objective: The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU. Methods: Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy. Results: For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01). Conclusions: Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission. %R 10.2196/56247 %U https://pediatrics.jmir.org/2024/1/e56247 %U https://doi.org/10.2196/56247 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58101 %T mHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis %A Skeens,Micah A %A Jackson,Daniel I %A Sutherland-Foggio,Malcolm S %A Sezgin,Emre %K mHealth %K mobile health %K mobile application %K mobile apps %K digital health %K digital technology %K digital intervention %K smartphones %K cancer %K oncology %K pediatric cancer %K paediatric cancer %K pediatric oncology %K paediatric oncology %K systematic analysis %K systematic analyses %K review %K mobile phone %D 2024 %7 1.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The substantial increase in smartphone ownership has led to a rise in mobile health (mHealth) app use. Developing tailored features through mHealth apps creates a pathway to address the health care needs of pediatric patients with cancer and their families who have complex care needs. However, few apps are designed specifically to integrate with pediatric cancer care. Objective: This study reports a systematic search and analysis of mHealth apps available on the Apple App (iOS) and Google Play (Android) stores designed for pediatric cancer through a list of features that serve (1) patients, (2) caregivers, or (3) both audiences. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed apps for pediatric patients with cancer and caregivers available as of January 30, 2024. We searched the Apple App and Google Play stores with a list of keyword combinations focusing on pediatric cancer care. The inclusion criteria were (1) specifically apps targeted toward pediatric patients with cancer, their families, or both; (2) available in either app store; and (3) available in English. Apps were assessed using the Mobile Application Rating Scale (MARS). The MARS is a quality assessment for mHealth apps, including components of engagement, functionality, aesthetics, and informational quality (5-point Likert scale items—1: low and 5: high quality). Results: In total, 22 apps were identified and 17 of those apps were available on both platforms. The most popular features (n=12) were resource sharing, symptom tracking, reminders, care team connections, journaling, community support, medication tracking, data visualizations, and appointment tracking. Features and interfaces were designed for caregivers (n=9) more frequently than the patients (n=7) while a subset of apps created options for both users (n=6). A total of 16 apps received positive reviews (mean 4.4, SD 0.59; Min=3.1, Max=5.0). A small subset (n=3) achieved over 5000 downloads; however, the majority (n=15) had fewer than 500. More than half (n=12) of the apps were not available in English. Apps requested access to a range of device functionalities to operate (mean 2.72, SD 3.13; Min=0, Max=10). Out of 22, a total of 17 apps were publicly accessible. The mean MARS scores for the apps ranged from 1.71 (SD 0.75) to 4.33 (SD 0.82). Overall, apps scored high on functionality (mean 3.72, SD 0.54) but low on engagement (mean 3.02, SD 0.93). Conclusions: Our review highlights the promising yet underdeveloped potential of mHealth apps in pediatric oncology care, underscoring the need for more inclusive, comprehensive, and integrative digital health solutions. Future developments should actively involve key stakeholders from the pediatric oncology community, including patients, families, and health care professionals, to ensure the apps meet specific needs while addressing linguistic and cultural barriers. %R 10.2196/58101 %U https://pediatrics.jmir.org/2024/1/e58101 %U https://doi.org/10.2196/58101 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59269 %T Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools %A Ng,Wei Ying %A Lau,Ni Yin %A Lee,V Vien %A Vijayakumar,Smrithi %A Leong,Qiao Ying %A Ooi,Shu Qin Delicia %A Su,Lin Lin %A Lee,Yung Seng %A Chan,Shiao-Yng %A Blasiak,Agata %A Ho,Dean %+ The N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 66017766, biedh@nus.edu.sg %K maternal and child health %K conception %K pregnancy %K perinatal care %K postpartum %K maternal care %K obstetric care %K user engagement %K Unified Theory of Acceptance and Use of Technology %K femtech %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shape women’s DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. Methods: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women’s maternal experiences with health care and DH and focuses on the factors that affected women’s DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Five main themes and 10 subthemes were identified that affected women’s adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. Conclusions: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. Trial Registration: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900 %M 39352732 %R 10.2196/59269 %U https://humanfactors.jmir.org/2024/1/e59269 %U https://doi.org/10.2196/59269 %U http://www.ncbi.nlm.nih.gov/pubmed/39352732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53560 %T A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study %A Sosanya,Mercy Eloho %A Samuel,Folake Olukemi %A Bashir,Sadia %A Omoera,Victoria Osariemen %A Freeland-Graves,Jeanne H %+ Department of Nutritional Sciences, University of Texas at Austin, 200 W 24th Street, Austin, TX, 78712-1247, United States, 1 512 967 2026, mercysosanya@utexas.edu %K mobile health %K mHealth %K mobile gaming app %K validation %K infant and young child feeding %K teenage mother %K Nigeria %K mobile phone %D 2024 %7 26.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country’s capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. %M 39326044 %R 10.2196/53560 %U https://www.jmir.org/2024/1/e53560 %U https://doi.org/10.2196/53560 %U http://www.ncbi.nlm.nih.gov/pubmed/39326044 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59191 %T Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study %A Delaney,Tessa %A Jackson,Jacklyn K %A Brown,Alison L %A Lecathelinais,Christophe %A Wolfenden,Luke %A Hudson,Nayerra %A Young,Sarah %A Groombridge,Daniel %A Pinfold,Jessica %A Craven,Paul David %A Redman,Sinead %A Wiggers,John %A Kingsland,Melanie %A Hayes,Margaret %A Sutherland,Rachel %+ Hunter New England Local Health District, Lookout Road, New Lambton, 2306, Australia, 61 249246499, Rachel.Sutherland@health.nsw.gov.au %K maternal %K postnatal %K postpartum %K acceptability %K technology %K digital health %K first 2000 days %K child health %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K pediatric %K pediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K nurse %K nurses %K nursing %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child’s birth. The majority of women (n=282-315, 82%-92%) “strongly agreed or agreed” that receiving information from CFHN via technology would be acceptable, and most (n=308) women “strongly agreed or agreed” with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. %M 39316424 %R 10.2196/59191 %U https://pediatrics.jmir.org/2024/1/e59191 %U https://doi.org/10.2196/59191 %U http://www.ncbi.nlm.nih.gov/pubmed/39316424 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55819 %T Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review %A Kachimanga,Chiyembekezo %A Zaniku,Haules Robbins %A Divala,Titus Henry %A Ket,Johannes C.F %A Mukherjee,Joia S %A Palazuelos,Daniel %A Kulinkina,Alexandra V %A Abejirinde,Ibukun-Oluwa Omolade %A Akker,Thomas van den %+ Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 887247777, c.kachimanga@vu.nl %K maternal health %K antenatal care %K postnatal care %K facility-based births %K sub-Saharan Africa %K mobile health %K mHealth %K review %K narrative synthesis %K mobile phone %D 2024 %7 24.9.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA). Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach. Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes. Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 %M 39316427 %R 10.2196/55819 %U https://mhealth.jmir.org/2024/1/e55819 %U https://doi.org/10.2196/55819 %U http://www.ncbi.nlm.nih.gov/pubmed/39316427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56804 %T Public Maternal Health Dashboards in the United States: Descriptive Assessment %A Callaghan-Koru,Jennifer A %A Newman Chargois,Paige %A Tiwari,Tanvangi %A Brown,Clare C %A Greenfield,William %A Koru,Güneş %+ Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, 2708 S. 48th St., Springdale, AR, 72762, United States, 1 479 713 8102, jck@uams.edu %K dashboard %K maternal health %K data visualization %K data communication %K perinatal health %D 2024 %7 17.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Data dashboards have become more widely used for the public communication of health-related data, including in maternal health. Objective: We aimed to evaluate the content and features of existing publicly available maternal health dashboards in the United States. Methods: Through systematic searches, we identified 80 publicly available, interactive dashboards presenting US maternal health data. We abstracted and descriptively analyzed the technical features and content of identified dashboards across four areas: (1) scope and origins, (2) technical capabilities, (3) data sources and indicators, and (4) disaggregation capabilities. Where present, we abstracted and qualitatively analyzed dashboard text describing the purpose and intended audience. Results: Most reviewed dashboards reported state-level data (58/80, 72%) and were hosted on a state health department website (48/80, 60%). Most dashboards reported data from only 1 (33/80, 41%) or 2 (23/80, 29%) data sources. Key indicators, such as the maternal mortality rate (10/80, 12%) and severe maternal morbidity rate (12/80, 15%), were absent from most dashboards. Included dashboards used a range of data visualizations, and most allowed some disaggregation by time (65/80, 81%), geography (65/80, 81%), and race or ethnicity (55/80, 69%). Among dashboards that identified their audience (30/80, 38%), legislators or policy makers and public health agencies or organizations were the most common audiences. Conclusions: While maternal health dashboards have proliferated, their designs and features are not standard. This assessment of maternal health dashboards in the United States found substantial variation among dashboards, including inconsistent data sources, health indicators, and disaggregation capabilities. Opportunities to strengthen dashboards include integrating a greater number of data sources, increasing disaggregation capabilities, and considering end-user needs in dashboard design. %M 39288409 %R 10.2196/56804 %U https://www.jmir.org/2024/1/e56804 %U https://doi.org/10.2196/56804 %U http://www.ncbi.nlm.nih.gov/pubmed/39288409 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47848 %T Industry 4.0 Technologies in Maternal Health Care: Bibliometric Analysis and Research Agenda %A Sibanda,Khulekani %A Ndayizigamiye,Patrick %A Twinomurinzi,Hossana %+ Department of Applied Information Systems, University of Johannesburg, Bunting Road Campus, Auckland Park, Johannesburg, PO Box 524, South Africa, 27 712544684, anewseason07@gmail.com %K Industry 4.0 %K Fourth Industrial Revolution %K bibliometrics %K maternal health care %K antenatal care %K postnatal care %K lean operations %K maternal %K pregnancy monitoring %K pregnancy %K maternal care %K monitoring %K thematic analysis %K data mining %K machine learning %K IoT %K Internet of Things %K artificial intelligence %K deep learning %K digital health %K wearable %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Industry 4.0 (I4.0) technologies have improved operations in health care facilities by optimizing processes, leading to efficient systems and tools to assist health care personnel and patients. Objective: This study investigates the current implementation and impact of I4.0 technologies within maternal health care, explicitly focusing on transforming care processes, treatment methods, and automated pregnancy monitoring. Additionally, it conducts a thematic landscape mapping, offering a nuanced understanding of this emerging field. Building on this analysis, a future research agenda is proposed, highlighting critical areas for future investigations. Methods: A bibliometric analysis of publications retrieved from the Scopus database was conducted to examine how the research into I4.0 technologies in maternal health care evolved from 1985 to 2022. A search strategy was used to screen the eligible publications using the abstract and full-text reading. The most productive and influential journals; authors’, institutions’, and countries’ influence on maternal health care; and current trends and thematic evolution were computed using the Bibliometrix R package (R Core Team). Results: A total of 1003 unique papers in English were retrieved using the search string, and 136 papers were retained after the inclusion and exclusion criteria were implemented, covering 37 years from 1985 to 2022. The annual growth rate of publications was 9.53%, with 88.9% (n=121) of the publications observed in 2016-2022. In the thematic analysis, 4 clusters were identified—artificial neural networks, data mining, machine learning, and the Internet of Things. Artificial intelligence, deep learning, risk prediction, digital health, telemedicine, wearable devices, mobile health care, and cloud computing remained the dominant research themes in 2016-2022. Conclusions: This bibliometric analysis reviews the state of the art in the evolution and structure of I4.0 technologies in maternal health care and how they may be used to optimize the operational processes. A conceptual framework with 4 performance factors—risk prediction, hospital care, health record management, and self-care—is suggested for process improvement. a research agenda is also proposed for governance, adoption, infrastructure, privacy, and security. %M 39116433 %R 10.2196/47848 %U https://pediatrics.jmir.org/2024/1/e47848 %U https://doi.org/10.2196/47848 %U http://www.ncbi.nlm.nih.gov/pubmed/39116433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58580 %T Protective Assets Reinforced With Integrated Care and Technology (PARITY): Protocol for a Randomized Controlled Trial %A Mollard,Elizabeth %A Cooper Owens,Deirdre %A Bach,Christina %A Gaines,Cydney %A Maloney,Shannon %A Moore,Tiffany %A Wichman,Christopher %A Shah,Neel %A Balas,Michele %+ College of Nursing, University of Nebraska Medical Center, 4111 Dewey Ave, Omaha, NE, 68198, United States, 1 402 472 3665, elizabeth.mollard@unmc.edu %K maternal health %K health disparities %K doula %K African American %K mobile phone %D 2024 %7 8.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. Trial Registration: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615 International Registered Report Identifier (IRRID): DERR1-10.2196/58580 %M 39116423 %R 10.2196/58580 %U https://www.researchprotocols.org/2024/1/e58580 %U https://doi.org/10.2196/58580 %U http://www.ncbi.nlm.nih.gov/pubmed/39116423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53508 %T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study %A Bilal,Ayesha-Mae %A Pagoni,Konstantina %A Iliadis,Stavros I %A Papadopoulos,Fotios C %A Skalkidou,Alkistis %A Öster,Caisa %+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se %K digital phenotyping %K smartphone app %K mHealth %K mobile health %K qualitative study %K user experience %K usability %K perinatal depression %K depression %K app %K user %K users %K qualitative %K perinatal %K mobile app %K clinical research %K acceptability %K behavioral data %K depressive symptoms %K interview %K pregnant %K postpartum %K women %K thematic analysis %K well-being %K monitor %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. %M 39115893 %R 10.2196/53508 %U https://formative.jmir.org/2024/1/e53508 %U https://doi.org/10.2196/53508 %U http://www.ncbi.nlm.nih.gov/pubmed/39115893 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 5 %N %P e48213 %T Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study %A Haq,Zaeem Ul %A Naeem,Ayesha %A Zaeem,Durayya %A Sohail,Mohina %A Pervaiz,Noor ul Ain %K primary health care %K mother and child health %K community health worker %K slums %K digital applications %K health communication. %D 2024 %7 31.7.2024 %9 %J JMIRx Med %G English %X Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers’ self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. %R 10.2196/48213 %U https://xmed.jmir.org/2024/1/e48213 %U https://doi.org/10.2196/48213 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51537 %T Current Use and Discrepancies in the Adoption of Health-Related Internet of Things and Apps Among Working Women in Japan: Large-Scale, Internet-Based, Cross-Sectional Survey %A Sasayama,Kiriko %A Nishimura,Etsuko %A Yamaji,Noyuri %A Ota,Erika %A Tachimori,Hisateru %A Igarashi,Ataru %A Arata,Naoko %A Yoneoka,Daisuke %A Saito,Eiko %+ Sustainable Society Design Center, Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5, Kashiwanoha, Kashiwa-shi, Chiba, Kashiwa, 277-8561, Japan, 81 471 36 4581, esaito@edu.k.u-tokyo.ac.jp %K women's health %K IoT %K mHealth %K mobile health %K app %K apps %K application %K applications %K decision tree %K internet survey %K women %K health %K adoption %K Internet of Things %K survey %K surveys %K management %K working women %K worker %K workers %K employee %K employees %K occupational health %K job %K jobs %K working %K employed %K usage %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Demographic changes and a low birth rate have led to a workforce shortage in Japan. To address this issue, the government has promoted engagement of female employment. However, increased female employment can impact women's health. Using Internet of Things (IoT) and apps to manage women's health has gained attention, but few studies have focused on working women. Objective: This study aimed to clarify the current situation of working women and their use of IoT or apps to manage their health. Methods: A large-scale, nationwide internet survey was conducted among 10,000 female participants aged from 20 years to 64 years in Japan. Participants were recruited from a marketing research company’s active survey panel of 5.24 million members. The survey included questions about health status, sociodemographic factors, psychological characteristics, and the use of IoT or apps for health management. We compared perceived health status and reasons for current IoT use using t tests and assessed participant characteristics that predicted IoT use using the C5.0 decision tree algorithm. Ethical approval was granted by St. Luke's International University. Results: Among participants, 14.6% (1455/10,000) currently used IoT or apps, 7% (695/10,000) used them previously, and 78.5% (7850/10,000) had never used them. Current users (42.7 years old) were older than past users (39.7 years old). Discrepancies were observed between participants’ perceived health problems and the purpose for using IoT or apps, with 21.3% (2130/10,000) of all women reporting they experienced menstrual symptoms or disorders but only 3.5% (347/10,000) used IoT or apps to manage the same symptom. On the other hand, current users were more likely to use IoT or apps to manage nutrition-related problems such as underweight or obesity (405/1455, 27.8%). Device use was highest among current users, with 87.3% (1270/1455) using smartphones, 19.7% (287/1455) using smartwatches, and 13.3% (194/1455) using PCs. Decision tree analysis identified 6 clusters, the largest consisting of 81.6% (5323/6523) of non-IoT users who did not exercise regularly, while pregnant women were more likely to use IoT or apps. Conclusions: Our findings highlight the idea that woman with particular health problems (ie, menstrual symptoms or disorders and premenstrual syndrome) have lower use of IoT or apps, suggesting an unmet need for IoT and apps in specific areas. %M 39083338 %R 10.2196/51537 %U https://publichealth.jmir.org/2024/1/e51537 %U https://doi.org/10.2196/51537 %U http://www.ncbi.nlm.nih.gov/pubmed/39083338 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49205 %T Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis %A Knauss,Samuel %A Andriamiadana,Gracia %A Leitheiser,Roxane %A Rampanjato,Zavaniarivo %A Bärnighausen,Till %A Emmrich,Julius Valentin %+ Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Charitéplatz 1, Berlin, 10117, Germany, 49 17623819512, samuel.knauss@charite.de %K digital health %K behavioral surveillance %K digital health wallet %K mobile money %K COVID-19 %K health financing %K public health %K sub-Saharan Africa %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. Objective: This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. Methods: We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. Results: We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth. Conclusions: The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women’s expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols. %M 39078698 %R 10.2196/49205 %U https://publichealth.jmir.org/2024/1/e49205 %U https://doi.org/10.2196/49205 %U http://www.ncbi.nlm.nih.gov/pubmed/39078698 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52395 %T Effectiveness of a Mobile Phone Messaging–Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial %A Bulcha,Gebeyehu %A Abdissa,Hordofa Gutema %A Noll,Josef %A Sori,Demisew Amenu %A Koricha,Zewdie Birhanu %+ Department of Health, Behavior, and Society, Faculty of Public Health, Institutes of Health, Jimma University, Aba Jifar Palas, 1000, Jimma, 16202, Ethiopia, 251 0911801923, gebeyehubulcha@gmail.com %K message framing %K mHealth %K digital health %K SMS %K maternal health %K newborn health %K cluster randomized controlled trials %K RCT %K Ethiopia %K mobile phone %K effectiveness %K SMS-based interventions %K text messaging %K maternal %K newborn care practice %K randomized %K controlled trial %K controlled trials %K mobile phone messaging %K phone-based intervention %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging–based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging–based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone–based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone–based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 %M 39042451 %R 10.2196/52395 %U https://www.researchprotocols.org/2024/1/e52395 %U https://doi.org/10.2196/52395 %U http://www.ncbi.nlm.nih.gov/pubmed/39042451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55000 %T Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study %A Casella Jean-Baptiste,Meredith %A Vital Julmiste,Thamar Monide %A Ball,Ellen %+ Hôpital Universitaire de Mirebalais, Sante Fanm, Rue Chatulee, Mirebalais, HT 5210, Haiti, 509 4892 3626, mjeanbaptiste@pih.org %K maternal health %K health informatics %K quality improvement %K Plan-Do-Study-Act %K PDSA %K maternal %K neonatal %K data collection %K prenatal %K outpatient %K electronic data %K nursing %K nursing staff %K nursing leadership %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. %M 38875702 %R 10.2196/55000 %U https://formative.jmir.org/2024/1/e55000 %U https://doi.org/10.2196/55000 %U http://www.ncbi.nlm.nih.gov/pubmed/38875702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50087 %T YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study %A van Dijk,Merle R %A van der Marel,Anne-Fleur %A van Rheenen-Flach,Leonie E %A Ganzevoort,Wessel %A Moll,Etelka %A Scheele,Fedde %A Velzel,Joost %+ Department of Obstetrics and Gynecology, Onze Lieve Vrouwen Gasthuis, Oosterpark 9, Amsterdam, 1061AC, Netherlands, 31 0205999111, m.r.vandijk@olvg.nl %K YouTube %K ECV %K external cephalic version %K breech %K education %K video %K cesarean %K health education %K childbirth %K patient information %K cross-sectional study %K cesarean delivery %K implementation %K usefulness %K medical information %K pregnancy %K pregnant women %K engagement %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. %M 38843520 %R 10.2196/50087 %U https://formative.jmir.org/2024/1/e50087 %U https://doi.org/10.2196/50087 %U http://www.ncbi.nlm.nih.gov/pubmed/38843520 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e54983 %T Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers %A Ilhan,Elif I %A Jola,Lucia N %A van der Zalm,Marieke M %A Bernstein,Mike %A Goussard,Pierre %A Redfern,Andrew %A Hesseling,Anneke C %A Hoddinott,Graeme %A McCollum,Eric D %A King,Carina %K pediatrics %K human-centered design %K participatory design %K pulse oximeter %K South Africa %K smartphone %K mobile phone %D 2024 %7 30.5.2024 %9 %J JMIR Hum Factors %G English %X Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user–centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design. %R 10.2196/54983 %U https://humanfactors.jmir.org/2024/1/e54983 %U https://doi.org/10.2196/54983 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51601 %T Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study %A Tilahun,Kefyalew Naniye %A Adem,Jibril Bashir %A Atinafu,Wabi Temesgen %A Walle,Agmasie Damtew %A Mengestie,Nebyu Demeke %A Birhanu,Abraham Yeneneh %+ College of Medicine and Health Sciences, Ambo University, Addis Ababa, Ambo, Ethiopia, 251 922298660, kefyalewnaniye64@gmail.com %K mobile-based partograph %K mHealth %K mobile health %K cross-sectional %K questionnaire %K questionnaires %K survey %K surveys %K modified TAM %K technology acceptance model %K intention to use %K obstetric health care providers %K Ethiopia %K intent %K intention %K TAM %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K partograph %K digital health %K health technology %K birth %K women's health %K obstetrics %K obstetric %K obstetric health care %K labor monitoring %D 2024 %7 10.5.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=–.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. %M 38728079 %R 10.2196/51601 %U https://ojphi.jmir.org/2024/1/e51601 %U https://doi.org/10.2196/51601 %U http://www.ncbi.nlm.nih.gov/pubmed/38728079 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e53186 %T Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study %A Ren,Sicong %A McDonald,Catherine C %A Corwin,Daniel J %A Wiebe,Douglas J %A Master,Christina L %A Arbogast,Kristy B %K concussion %K mHealth %K response rate %K adolescents %K reporting behavior %K remote monitoring %K engagement %K monitoring %K adolescent %K teen %K youth %K remote patient monitoring %K mobile health %K injury %K neurobiological %K neurobiological development %K quality of life %K academic %K academic performance %K mHealth engagement %K tertiary care %D 2024 %7 6.5.2024 %9 %J JMIR Pediatr Parent %G English %X Background: A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective: This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods: Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school’s athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results: A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57% female). The median response rate across all days of app use in the evening was 37.0% (IQR 27.2%-46.4%), which was significantly higher than the morning (21.2%, IQR 15.6%-30.5%) or afternoon (26.4%, IQR 21.1%-31.5%; P<.001). The median daily response was significantly different by sex (female: 53.8%, IQR 46.2%-64.2% vs male: 42.0%, IQR 28.6%-51.1%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1%, IQR 47.4%-62.2% vs starting to use the app ≤7 days since injury: 38.0%, IQR 26.0%-53.3%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4%, IQR 44.5%-70.5% vs participants without concussion history: 42.3%, IQR 36.8%-53.5%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6%, IQR 36.1%-50.4% vs non–sports- or recreation-related injury: 30.6%, IQR 20.0%-42.9%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9%, IQR 35.2%-53.8% vs PCSI scores less than or equal to the median score: 31.9%, IQR 24.6%-40.6%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions: Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement. %R 10.2196/53186 %U https://pediatrics.jmir.org/2024/1/e53186 %U https://doi.org/10.2196/53186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55491 %T A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial %A Cooper,Hal %A Nadzri,Farah Zeehan Mohd %A Vyas,Seema %A Juhari,Rumaya %A Ismail,Nellie %A Arshat,Zarinah %A Rajandiran,Durgesh %A Markle,Laurie %A Calderon,Francisco %A Vallance,Inge %A Melendez-Torres,G J %A Facciolà,Chiara %A Senesathith,Vanisa %A Gardner,Frances %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 270325, hallam.cooper@spi.ox.ac.uk %K parenting intervention %K chatbot-led public health intervention %K engagement %K implementation science %K feasibility %K evidence-based program %D 2024 %7 26.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United Nations’ Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. Objective: This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. Methods: This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers’ use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Results: Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. Conclusions: This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. Trial Registration: OSF Registries; https://osf.io/f32ky International Registered Report Identifier (IRRID): DERR1-10.2196/55491 %M 38669679 %R 10.2196/55491 %U https://www.researchprotocols.org/2024/1/e55491 %U https://doi.org/10.2196/55491 %U http://www.ncbi.nlm.nih.gov/pubmed/38669679 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e48478 %T Evaluation of Parents’ Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study %A Sakamoto,Masahiko %A Ishikawa,Hirono %A Suzuki,Asuka %K health literacy %K European Health Literacy Survey Questionnaire %K HLS-EU-Q47 %K child %K preschool %K parent education %K health care knowledge %K apps %K digital media %K emergency room visit %K mobile phone %D 2024 %7 11.4.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents’ health literacy. Objective: This study aims to evaluate whether parents’ use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children. Methods: Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits. Results: In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non–app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non–app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non–app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non–app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables. Conclusions: This study showed a significant association between parents’ use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children’s health care. Future studies are needed to evaluate the association between app use and emergency room visits. %R 10.2196/48478 %U https://pediatrics.jmir.org/2024/1/e48478 %U https://doi.org/10.2196/48478 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54788 %T Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review %A Kim,Sun-Hee %A Park,Jin-Hwa %A Jung,Sun-Young %A De Gagne,Jennie C %+ College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, Duryugongwon-ro 17-gil 33, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4977, syjung@cu.ac.kr %K anxiety %K body weight %K depression %K gestational diabetes mellitus %K high-risk behavior %K internet-based interventions %K neonatal outcomes %K pregnancy %K premature birth %K pregnancy outcomes %K stress %K systematic review %D 2024 %7 2.4.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. Objective: This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. Methods: A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. Results: This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Conclusions: Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions’ effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. Trial Registration: PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847 %M 38564247 %R 10.2196/54788 %U https://pediatrics.jmir.org/2024/1/e54788 %U https://doi.org/10.2196/54788 %U http://www.ncbi.nlm.nih.gov/pubmed/38564247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49133 %T Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study %A O'Kane,Kiarah M K %A Otamendi,Thalia %A Silverberg,Noah D %A Choi,Esther %A Sicard,Veronik %A Zemek,Roger %A Healey,Katherine %A Brown,Olivier %A Butterfield,Lauren %A Smith,Andra %A Goldfield,Gary %A Kardish,Rachel %A Saab,Bechara J %A Ledoux,Andrée-Anne %A Cairncross,Molly %+ Department of Psychology, Simon Fraser University, Robert C. Brown Hall 7321, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 778 782 7458, molly_cairncross@sfu.ca %K adolescent %K concussion %K digital therapeutics %K eHealth %K mHealth %K mindfulness %K mobile health %K social presence %K working alliance %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence—the extent to which digital encounters feel like they are occurring in person—may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents’ development of therapeutic alliance and social presence with the intervention. Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by “developing a genuine connection” with their mindfulness guides and “sensing real people.” Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides’ “personal backgrounds and voices,” such that participants felt more connected to the guides by knowing information about them and through the guides’ calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants’ average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents’ development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment. %M 38517472 %R 10.2196/49133 %U https://formative.jmir.org/2024/1/e49133 %U https://doi.org/10.2196/49133 %U http://www.ncbi.nlm.nih.gov/pubmed/38517472 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54163 %T Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study %A Sánchez-Fernández,Sergio %A Lasa,Eva María %A Terrados,Soledad %A Sola-Martínez,Francisco Javier %A Martínez-Molina,Sara %A López de Calle,Marta %A Cabrera-Freitag,Paula %A Goikoetxea,María José %+ Allergy and Clinical Immunology Department, Clínica Universidad de Navarra, Pío XII, 36, Pamplona, 31008, Spain, 34 948255400, mjgoiko@unav.es %K adverse reactions %K egg allergy %K food oral immunotherapy %K mHealth %K milk allergy %K monitoring %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective: This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods: Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient’s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results: Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions: The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT. %M 38477961 %R 10.2196/54163 %U https://pediatrics.jmir.org/2024/1/e54163 %U https://doi.org/10.2196/54163 %U http://www.ncbi.nlm.nih.gov/pubmed/38477961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55930 %T Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Adam,Maya %A Nguyễn,Vān Kính %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345840 %R 10.2196/55930 %U https://www.jmir.org/2024/1/e55930 %U https://doi.org/10.2196/55930 %U http://www.ncbi.nlm.nih.gov/pubmed/38345840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53861 %T Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Lin,Yongjian %+ Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 22, Shuangyou Road, Qingxiu District, Nanning, 530021, China, 86 13878870525, linyongjian@stu.gxmu.edu.cn %K letter %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345847 %R 10.2196/53861 %U https://www.jmir.org/2024/1/e53861 %U https://doi.org/10.2196/53861 %U http://www.ncbi.nlm.nih.gov/pubmed/38345847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49561 %T “I Just Wanted a Dentist in My Phone”—Designing Evidence-Based mHealth Prototype to Improve Preschool Children’s Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children’s Teeth %A Al-yaseen,Waraf %A Raggio,Daniela Procida %A Araujo,Mariana %A Innes,Nicola %+ School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom, 44 07413162068, Al-yaseenw1@cardiff.ac.uk %K oral health promotion %K mobile health %K mHealth %K children %K oral health %K behavior change %K coproduction %K mobile phone %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals’ health maintenance. However, little is known about caring for their child’s teeth and what their preferences would be regarding the content or design of an oral health app. Objective: This study aims to co-design the prototype of an app named App for Children’s Teeth with parents, providing a source of information for them about caring for their children’s teeth and promoting positive dental habits. Methods: This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ≤6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children’s oral health, and (3) collect feedback about the app’s acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis. Results: The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children’s Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child’s age, and “In a Nutshell” bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas. Conclusions: The coproduction design approach highlighted parents’ need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child’s age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives. Trial Registration: Open Science Framework; https://osf.io/uj9az %M 38289667 %R 10.2196/49561 %U https://formative.jmir.org/2024/1/e49561 %U https://doi.org/10.2196/49561 %U http://www.ncbi.nlm.nih.gov/pubmed/38289667 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e46973 %T Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review %A Phillips,J Craig %A Alfano,Alliete R %A Barfield,Latisha C %A Cain,Lisa %A Sadjadi,Masoud %A Morales,Eduardo %A Phillips-Beck,Wanda %A Galarza,M Grisel %A Torres,Maritza %A Zindani,Sadaf %A Rayani,Ahmad %A Edwards,Khalee %A Jones,Sande Gracia %A Hannan,Jean %+ School of Nursing, University of Ottawa, 308-29 Main St, Ottawa, ON, K1S 1B1, Canada, 1 613 562 5800 ext 8612, craig.phillips@uottawa.ca %K maternal and child health %K smartphone %K mobile health %K mHealth %K eHealth %K app development %K app evaluation %K app effectiveness %K maternal and infant app %K pregnancy, postpartum %K mothers %K mobile phone %K artificial intelligence %K AI %D 2024 %7 26.1.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. Objective: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. Methods: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences–associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. Results: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. Conclusions: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers’ needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps. %M 38055330 %R 10.2196/46973 %U https://pediatrics.jmir.org/2024/1/e46973 %U https://doi.org/10.2196/46973 %U http://www.ncbi.nlm.nih.gov/pubmed/38055330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54274 %T Development and Implementation of Digital Diagnostic Algorithms for Neonatal Units in Zimbabwe and Malawi: Development and Usability Study %A Gannon,Hannah %A Larsson,Leyla %A Chimhuya,Simbarashe %A Mangiza,Marcia %A Wilson,Emma %A Kesler,Erin %A Chimhini,Gwendoline %A Fitzgerald,Felicity %A Zailani,Gloria %A Crehan,Caroline %A Khan,Nushrat %A Hull-Bailey,Tim %A Sassoon,Yali %A Baradza,Morris %A Heys,Michelle %A Chiume,Msandeni %+ Population, Policy and Practice, Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, United Kingdom, 44 (0) 20 7905 ext 2600, h.gannon@ucl.ac.uk %K mobile health %K mHealth %K neonatology %K digital health %K mobile apps %K newborn %K Malawi, Zimbabwe %K usability %K clinical decision support %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. Objective: This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. Methods: Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital’s health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). Results: Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. Conclusions: This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings. %M 38277198 %R 10.2196/54274 %U https://formative.jmir.org/2024/1/e54274 %U https://doi.org/10.2196/54274 %U http://www.ncbi.nlm.nih.gov/pubmed/38277198 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51792 %T Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review %A Noronha,Judith Angelitta %A Lewis,Mitchelle S %A Phagdol,Tenzin %A Nayak,Baby S %A D,Anupama %A Shetty,Jyothi %A N,Ravishankar %A Nair,Sreekumaran %+ Department of Fundamentals of Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, India, 91 7259693480, lewis.mitchelle@manipal.edu %K digital health %K gestational hypertension %K hypertension %K hypertensive %K knowledge synthesis %K maternal health outcomes %K maternal %K mHealth %K mobile health application %K mobile health %K neonatal health outcomes %K neonatal %K neonates %K preeclampsia %K pregnancy %K pregnant %K review methodology %K review methods %K SMS %K systematic %K telemedicine %K text messaging %K sustainable development goal %D 2023 %7 28.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. Objective: This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? Methods: This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. Results: As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. Conclusions: The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/51792 %M 38015596 %R 10.2196/51792 %U https://www.researchprotocols.org/2023/1/e51792 %U https://doi.org/10.2196/51792 %U http://www.ncbi.nlm.nih.gov/pubmed/38015596 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e47552 %T Implementation of a Web Camera System in an Australian Neonatal Intensive Care Unit: Pre- and Postevaluation of the Parent and Staff Experience %A Legge,Alexandra A %A Middleton,Jennifer L %A Reid,Shelley %A Gordon,Adrienne %K web camera %K telehealth %K telemedicine %K neonate %K neonatology %K NICU %K virtual visitation %K implementation %K Australia %K prematurity %K illness %K newborns %K parent-infant separation %K stress %K parental %K engagement %K neonatal intensive care unit %D 2023 %7 22.11.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Admission to a neonatal intensive care unit (NICU) for prematurity or illness is necessary for approximately 20% of newborns in Australia, resulting in parent-infant separation. Web cameras in the NICU provide a virtual link for parents to remain remotely connected to their infant during admission. Web camera use is increasing; however, there is limited evidence on the impact of web cameras on parents, infants, and neonatal staff. Objective: There were two objectives: (1) to determine the attitudes of parents and staff toward web cameras in the NICU and (2) to compare parental depression, anxiety, and stress levels using validated scales before and after web camera implementation in the NICU. Methods: A pre- and postevaluation survey was administered before and after implementation of the NICVIEW camera system in a tertiary NICU in Sydney, Australia. The NICVIEW camera system provides secure real-time viewing of infants and can be accessed from any device with an internet connection. Surveys were administered to parents of inpatients and staff, and included open- and closed-ended questions and Likert scales. Survey questions aimed to determine parent and staff attitudes and use of web cameras before and after implementation. In addition, pre- and postimplementation parental levels of depression, anxiety, and stress, as measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21) and Parental Stressor Scale: Neonatal Intensive Care Unit, were recorded. Results: In total, 94 parents and 109 staff members completed the pre- and postimplementation surveys. Post implementation, 43 of 44 (98%) parents supported web cameras, and 40 of 42 (95%) parents stated that they used web cameras. The most common reasons for support from parents included web cameras making parents feel more at ease, facilitating parent-infant bonding, increasing parental confidence in staff, and allowing others to see infants. There was no significant difference between the parental groups for the depression, anxiety, or stress scales measured by DASS-21. Staff support for web cameras increased significantly from 34 of 42 (81%) participants before to 64 of 67 (96%) participants after implementation (P=.01). Following implementation, there was a resolution in staff concerns about web cameras having an adverse impact on staff roles and privacy and security concerns. Conclusions: Web camera use in a tertiary Australian NICU was strongly supported by parents and staff and may reduce parental stress, facilitate parent-infant bonding, and encourage positive parent-staff engagement. Web cameras are a feasible method of providing continuity of care for families and should be considered as a standard of care in similarly resourced settings. %R 10.2196/47552 %U https://pediatrics.jmir.org/2023/1/e47552 %U https://doi.org/10.2196/47552 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e48934 %T Understanding the Tensions of “Good Motherhood” Through Women’s Digital Technology Use: Descriptive Qualitative Study %A Facca,Danica %A Hall,Jodi %A Hiebert,Bradley %A Donelle,Lorie %+ College of Nursing, University of South Carolina, 1601 Greene Street, Colombia, SC, 29208, United States, 1 803 777 6528, ldonelle@mailbox.sc.edu %K motherhood %K parenting %K digital health %K apps %K social media %K mother %K parent %K technology use %K use %K computer use %K interview %K interviews %K perspective %K perspectives %K mothers %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of “good motherhood.” Given the ways in which digital technologies can both support and hinder women’s perceptions of their parenting abilities, understanding expectant and new mothers’ experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers’ use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants’ experiences of using digital technologies in the transition to parenting period were captured within the overarching theme “balancing the tensions of digital technology use in the transition to parenting” and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered “in-the-moment” access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. %M 37878372 %R 10.2196/48934 %U https://pediatrics.jmir.org/2023/1/e48934 %U https://doi.org/10.2196/48934 %U http://www.ncbi.nlm.nih.gov/pubmed/37878372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47266 %T Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial %A Adam,Maya %A Kwinda,Zwannda %A Dronavalli,Mithilesh %A Leonard,Elizabeth %A Nguyễn,Vān Kính %A Tshivhase,Vusani %A Bärnighausen,Till %A Pillay,Yogan %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2023 %7 13.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging. Objective: We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa. Methods: We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction. Results: We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] –0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series. Conclusions: While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations. Trial Registration: Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny %M 37831505 %R 10.2196/47266 %U https://www.jmir.org/2023/1/e47266 %U https://doi.org/10.2196/47266 %U http://www.ncbi.nlm.nih.gov/pubmed/37831505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43654 %T A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial %A Sewpaul,Ronel %A Resnicow,Ken %A Crutzen,Rik %A Dukhi,Natisha %A Ellahebokus,Afzal %A Reddy,Priscilla %+ Public Health, Societies and Belonging, Human Sciences Research Council, 134 Pretorius Street, Pretoria, 0002, South Africa, 27 214667912, rsewpaul@hsrc.ac.za %K antenatal care %K adolescent girls and young women %K AGYW %K adolescent pregnancy %K mobile health %K mHealth %K tailoring %K motivational interviewing %K South Africa %K mobile phone %D 2023 %7 13.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention’s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants’ clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention’s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 %M 37703092 %R 10.2196/43654 %U https://www.researchprotocols.org/2023/1/e43654 %U https://doi.org/10.2196/43654 %U http://www.ncbi.nlm.nih.gov/pubmed/37703092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44267 %T Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children’s Socioemotional and Cognitive Development in Afghanistan: Co-Design Study %A LaMonica,Haley M %A Crouse,Jacob J %A Song,Yun J C %A Alam,Mafruha %A Wilson,Chloe E %A Hindmarsh,Gabrielle %A Yoon,Adam %A Boulton,Kelsie A %A Ekambareshwar,Mahalakshmi %A Loblay,Victoria %A Troy,Jakelin %A Torwali,Mujahid %A Guastella,Adam J %A Banati,Richard B %A Hickie,Ian B %+ Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au %K child development %K digital technology %K global health %K co-design %K participatory research %K stakeholder participation %K mobile app %K smartphone %K mobile phone %K Afghanistan %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. Objective: This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. Methods: The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed; detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. Results: The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents; however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children’s screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. Conclusions: Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children’s lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children’s developmental potential despite the security concerns and situational stressors. %M 37610805 %R 10.2196/44267 %U https://formative.jmir.org/2023/1/e44267 %U https://doi.org/10.2196/44267 %U http://www.ncbi.nlm.nih.gov/pubmed/37610805 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43837 %T Novel At-Home Mother’s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment %A Haramati,Sharon %A Firsow,Anastasia %A Navarro,Daniela Abigail %A Shechter,Ravid %+ MyMilk Laboratories Ltd, Glil Yam, Kibbutz, Glil Yam, 4690500, Israel, 972 526166705, shechter.ravid@gmail.com %K breastfeeding %K feasibility %K human milk %K biomarker %K remote sensing technology %K mobile health %K retrospective %K secretory activation %K lactogenesis %K milk supply %K milk %K sensing technology %K monitoring tool %K lactation %K exclusive breastfeeding %K breastfeed %K maternal health %K maternal and infant health %K infant health %K maternal and child health %K prolactin %K lactation consultant %K lactation support provider %K mother %K milk maturation %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth–dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system’s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth–dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. %M 37464893 %R 10.2196/43837 %U https://pediatrics.jmir.org/2023/1/e43837 %U https://doi.org/10.2196/43837 %U http://www.ncbi.nlm.nih.gov/pubmed/37464893 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43673 %T Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Health Sciences Building, Level 2, Sturt Road, Bedford Park, South Australia, 5042, Australia, 61 8 72218410, billie.bonevski@flinders.edu.au %K mobile health %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women’s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin’ Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin’ Up Healthy Jarjums—a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages—for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin’ Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin’ Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin’ Up Healthy Jarjums program at improving health outcomes. %M 37234043 %R 10.2196/43673 %U https://pediatrics.jmir.org/2023/1/e43673 %U https://doi.org/10.2196/43673 %U http://www.ncbi.nlm.nih.gov/pubmed/37234043 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40561 %T Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging–Based Information Campaign: Mixed Methods Study %A Haricharan,Hanne Jensen %A Hacking,Damian %A Lau,Yan Kwan %A Heap,Marion %+ School of Public Health, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 829656103, hanne.haricharan@uct.ac.za %K SMS text messages %K cell phones %K mobile health %K mHealth %K health information %K health literacy %K healthy behavior %K maternal health %K antenatal care %K Deaf %K South Africa %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging–based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants’ knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging–based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women’s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people’s health knowledge. However, attention should be paid to Deaf participants’ specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe %M 37213174 %R 10.2196/40561 %U https://pediatrics.jmir.org/2023/1/e40561 %U https://doi.org/10.2196/40561 %U http://www.ncbi.nlm.nih.gov/pubmed/37213174 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e37359 %T The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study %A Mwenda,Valerian %A Makena,Ireen %A Ogweno,Vincent %A Obonyo,James %A Were,Vincent %+ Department of Non-communicable Diseases, Ministry of Health, PO Box 30016, Nairobi, 00100, Kenya, 254 723992573, valmwenda@gmail.com %K text messages %K adolescent pregnancy %K milestones %K mHealth %K psychosocial support %K Kenya %K nurturing care %D 2023 %7 1.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers’ knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers’ knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse %M 37126373 %R 10.2196/37359 %U https://pediatrics.jmir.org/2023/1/e37359 %U https://doi.org/10.2196/37359 %U http://www.ncbi.nlm.nih.gov/pubmed/37126373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44720 %T Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project %A McBride,Bronwyn %A O'Neil,John %A Nguyen,Phuong Chi %A Linh,Dang Thuy %A Trinh,Hue Thi %A Vu,Nguyen C %A Nguyen,Liem T %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada, 1 6044417162, bronwyn_mcbride@sfu.ca %K mobile health %K digital health %K Vietnam %K maternal health %K maternal, newborn, and child health %K MNCH, health equity, ethnic minority %K maternal and child health %K child health %K ethnography %K coronavirus %K COVID-19 %K perinatal %K antenatal %K woman %K mother %K pregnancy %K newborn %K infant %K baby %K ethnic %K ethnicity %K visible minority %K culture %D 2023 %7 24.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM—a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam—was implemented from 2013-2016 with promising results. Despite mMOM’s findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19–related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women’s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam’s Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 %M 37058576 %R 10.2196/44720 %U https://www.researchprotocols.org/2023/1/e44720 %U https://doi.org/10.2196/44720 %U http://www.ncbi.nlm.nih.gov/pubmed/37058576 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40463 %T Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study %A Aune,Anders %A Vartdal,Gunnar %A Jimenez Diaz,Gabriela %A Gierman,Lobke Marijn %A Bergseng,Håkon %A Darj,Elisabeth %+ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7030, Norway, 47 95034601, a.aune@ntnu.no %K neonatal jaundice %K neonatal hyperbilirubinemia %K newborns %K mobile app %K design %K validation %K regulatory processes %K mobile health %K mHealth %K mobile phone %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. %M 36853753 %R 10.2196/40463 %U https://pediatrics.jmir.org/2023/1/e40463 %U https://doi.org/10.2196/40463 %U http://www.ncbi.nlm.nih.gov/pubmed/36853753 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41508 %T Effectiveness of Remote Fetal Monitoring on Maternal-Fetal Outcomes: Systematic Review and Meta-Analysis %A Li,Suya %A Yang,Qing %A Niu,Shuya %A Liu,Yu %+ Nursing Department, Tongji Hospital, Tongji Medical College, HuaZhong University of Science and Technology, No. 1095 Jiefang Rd, Wuhan, 430030, China, 86 13995579713, hust512@sohu.com %K remote fetal monitoring %K maternal outcomes %K fetal outcomes %K review %D 2023 %7 22.2.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: To solve the disadvantages of traditional fetal monitoring such as time-consuming, cumbersome steps and low coverage, it is paramount to develop remote fetal monitoring. Remote fetal monitoring expands time and space, which is expected to popularize fetal monitoring in remote areas with the low availability of health services. Pregnant women can transmit fetal monitoring data from remote monitoring terminals to the central monitoring station so that doctors can interpret it remotely and detect fetal hypoxia in time. Fetal monitoring involving remote technology has also been carried out, but with some conflicting results. Objective: The review aimed to (1) examine the efficacy of remote fetal monitoring in improving maternal-fetal outcomes and (2) identify research gaps in the field to make recommendations for future research. Methods: We did a systematic literature search with PubMed, Cochrane Library, Web of Science, Embase, MEDLINE, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov, and Open Grey in March 2022. Randomized controlled trials or quasi-experimental trials of remote fetal monitoring were identified. Two reviewers independently searched articles, extracted data, and assessed each study. Primary outcomes (maternal-fetal outcomes) and secondary outcomes (health care usage) were presented as relative risks or mean difference. The review was registered on PROSPERO as CRD42020165038. Results: Of the 9337 retrieved literature, 9 studies were included in the systematic review and meta-analysis (n=1128). Compared with a control group, remote fetal monitoring reduced the risk of neonatal asphyxia (risk ratio 0.66, 95% CI 0.45-0.97; P=.04), with a low heterogeneity of 24%. Other maternal-fetal outcomes did not differ significantly between remote fetal monitoring and routine fetal monitoring, such as cesarean section (P=.21; I2=0%), induced labor (P=.50; I2=0%), instrumental vaginal birth (P=.45; I2=0%), spontaneous delivery (P=.85; I2=0%), gestational weeks at delivery (P=.35; I2=0%), premature delivery (P=.47; I2=0%), and low birth weight (P=.71; I2=0%). Only 2 studies performed a cost analysis, stating that remote fetal monitoring can contribute to reductions in health care costs when compared with conventional care. In addition, remote fetal monitoring might affect the number of visits and duration in the hospital, but it was not possible to draw definite conclusions about the effects due to the limited number of studies. Conclusions: Remote fetal monitoring seems to reduce the incidence of neonatal asphyxia and health care costs compared with routine fetal monitoring. To strengthen the claims on the efficacy of remote fetal monitoring, further well-designed studies are necessary, especially in high-risk pregnant women, such as pregnant women with diabetes, pregnant women with hypertension, and so forth. %M 36811944 %R 10.2196/41508 %U https://mhealth.jmir.org/2023/1/e41508 %U https://doi.org/10.2196/41508 %U http://www.ncbi.nlm.nih.gov/pubmed/36811944 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e38921 %T Designing an App for Parents and Caregivers to Promote Cognitive and Socioemotional Development and Well-being Among Children Aged 0 to 5 Years in Diverse Cultural Settings: Scientific Framework %A Crouse,Jacob J %A LaMonica,Haley M %A Song,Yun Ju Christine %A Boulton,Kelsie A %A Rohleder,Cathrin %A DeMayo,Marilena M %A Wilson,Chloe E %A Loblay,Victoria %A Hindmarsh,Gabrielle %A Stratigos,Tina %A Krausz,Michael %A Foo,Nathanael %A Teo,Melissa %A Hunter,Andrew %A Guastella,Adam J %A Banati,Richard B %A Troy,Jakelin %A Hickie,Ian B %+ Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94-100 Mallett St, Camperdown, 2050, Australia, 61 291144000, jacob.crouse@sydney.edu.au %K early childhood development %K digital technology %K health information technology %K mHealth %K smartphone %K neuroscience %K pediatrics %K mobile app %D 2023 %7 13.2.2023 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Recent years have seen remarkable progress in our scientific understanding of early childhood social, emotional, and cognitive development, as well as our capacity to widely disseminate health information by using digital technologies. Together, these scientific and technological advances offer exciting opportunities to deliver high-quality information about early childhood development (ECD) to parents and families globally, which may ultimately lead to greater knowledge and confidence among parents and better outcomes among children (particularly in lower- and middle-income countries). With these potential benefits in mind, we set out to design, develop, implement, and evaluate a new parenting app—Thrive by Five—that will be available in 30 countries. The app will provide caregivers and families with evidence-based and culturally appropriate information about ECD, accompanied by sets of collective actions that go beyond mere tips for parenting practices. Herein, we describe this ongoing global project and discuss the components of our scientific framework for developing and prototyping the app’s content. Specifically, we describe (1) 5 domains that are used to organize the content and goals of the app’s information and associated practices; (2) 5 neurobiological systems that are relevant to ECD and can be behaviorally targeted to potentially influence social, emotional, and cognitive development; (3) our anthropological and cultural framework for learning about local contexts and appreciating decolonization perspectives; and (4) our approach to tailoring the app’s content to local contexts, which involves collaboration with in-country partner organizations and local and international subject matter experts in ECD, education, medicine, psychology, and anthropology, among others. Finally, we provide examples of the content that was incorporated in Thrive by Five when it launched globally. %M 36780220 %R 10.2196/38921 %U https://pediatrics.jmir.org/2023/1/e38921 %U https://doi.org/10.2196/38921 %U http://www.ncbi.nlm.nih.gov/pubmed/36780220 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40934 %T Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review %A Eppes,Elisabet V %A Augustyn,Marycatherine %A Gross,Susan M %A Vernon,Paris %A Caulfield,Laura E %A Paige,David M %+ Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 484 467 3121, elisabet.eppes@gmail.com %K text messaging %K social media %K mobile app %K low-income %K engagement %K health promotion %K community %K nutrition and physical activity %K pregnancy %K breastfeeding %K maternal and child health %K mobile phone %D 2023 %7 3.2.2023 %9 Review %J J Med Internet Res %G English %X Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. Objective: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. Results: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. Conclusions: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants’ engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services. %M 36735286 %R 10.2196/40934 %U https://www.jmir.org/2023/1/e40934 %U https://doi.org/10.2196/40934 %U http://www.ncbi.nlm.nih.gov/pubmed/36735286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38378 %T The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial %A Koeryaman,Mira Trisyani %A Pallikadavath,Saseendran %A Ryder,Isobel Helen %A Kandala,Ngianga %+ Maternity Nursing Department, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21, Fakultas Keperawatan, Jatinangor, 45363, Indonesia, 62 22 7795596, mira.koeryaman@port.ac.uk %K web-based application %K nutrition %K pregnant women %K pregnancy %K mobile app %K diet %K dietary intake %K application %K Indonesia %K randomized controlled trial %K tool %K consumption %K maternal %K weight %K weight gain %K intervention %K control group %K treatment %K vitamins %K minerals %K healthy diet %K calorie %K food %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods:  First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=–1.39; P=.002), 102.43 g of carbohydrates (95% CI –125.2 to –79.60; d=–1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI –13.71 to –8.20; d=–1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions:  Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 %M 36716078 %R 10.2196/38378 %U https://formative.jmir.org/2023/1/e38378 %U https://doi.org/10.2196/38378 %U http://www.ncbi.nlm.nih.gov/pubmed/36716078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37865 %T Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach %A Dauber,Sarah %A Hammond,Cori %A Hogue,Aaron %A Henderson,Craig %A Nugent,Jessica %A Ford,Veronica %A Brown,Jill %A Scott,Lenore %A Ondersma,Steven %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 212 841 5270, sdauber@toendaddiction.org %K pregnant women %K postpartum women %K home visiting %K substance use %K computerized intervention %K mobile health %K mobile phone %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e–SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective: This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e–SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e–SBI-HV prototype and describe the e–SBI-HV prototype. Methods: Adaptation of the original e-SBI into the e–SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e–SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results: The e–SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor–client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e–SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. Conclusions: This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e–SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e–SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e–SBI-HV. %M 36346648 %R 10.2196/37865 %U https://formative.jmir.org/2022/11/e37865 %U https://doi.org/10.2196/37865 %U http://www.ncbi.nlm.nih.gov/pubmed/36346648 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41356 %T Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study %A Mittone,Diletta F %A Bailey,Caitlin P %A Eddy,Ebony L %A Napolitano,Melissa A %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, DC, 20052, United States, 1 202 994 3695, avyas@gwu.edu %K telehealth %K COVID-19 %K maternal-child health %K Perinatal %K pediatrics %K telemedicine %K pregnancy %K women's health %K patient outcome %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since March 2020, the need to reduce patients’ exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. %M 36125862 %R 10.2196/41356 %U https://pediatrics.jmir.org/2022/4/e41356 %U https://doi.org/10.2196/41356 %U http://www.ncbi.nlm.nih.gov/pubmed/36125862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37866 %T Information Resources Among Flemish Pregnant Women: Cross-sectional Study %A Lanssens,Dorien %A Thijs,Inge M %A Dreesen,Pauline %A Van Hecke,Ann %A Coorevits,Pascal %A Gaethofs,Gitte %A Derycke,Joyce %A Tency,Inge %+ Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, University of Hasselt, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K pregnancy app %K mobile app %K questionnaire %K pregnancy %K pregnant %K mHealth %K mobile health %K cross-sectional %K user need %K user expectation %K survey %K maternal %K maternity %K user experience %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36222794 %R 10.2196/37866 %U https://formative.jmir.org/2022/10/e37866 %U https://doi.org/10.2196/37866 %U http://www.ncbi.nlm.nih.gov/pubmed/36222794 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e38368 %T Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study %A Choudhury,Avishek %A Choudhury,Murari %+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1306 Evansdale Drive, PO Box 6107, Morgantown, WV, 26506-6107, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu %K maternal health %K mHealth %K digital divide %K disparity %K socioeconomic %K India %K health %K awareness %K mobile %K intervention %K adherence %K health behaviors %K tribal %K community %K education %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India’s socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app—Mobile for Mothers (MfM)—as a supporting tool to improve (1) maternal health awareness and (2) maternal health–related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 %M 36129749 %R 10.2196/38368 %U https://mhealth.jmir.org/2022/9/e38368 %U https://doi.org/10.2196/38368 %U http://www.ncbi.nlm.nih.gov/pubmed/36129749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34423 %T Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study %A Ruiz-Burga,Elisa %A Bruijning-Verhagen,Patricia %A Palmer,Paulette %A Sandcroft,Annalisa %A Fernandes,Georgina %A de Hoog,Marieke %A Bryan,Lenroy %A Pierre,Russell %A Bailey,Heather %A Giaquinto,Carlo %A Thorne,Claire %A Christie,Celia D C %A , %+ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford St,, London, WC1N 1EH, United Kingdom, 44 02079052396, e.burga@ucl.ac.uk %K mHealth %K digital health %K arbovirus %K pregnancy %K adherence %K compliance %K low- and middle-income countries %K LMIC %K maternal health %K pregnancy complications %K prenatal care %K pregnancy outcomes %K mobile phone %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. %M 35896029 %R 10.2196/34423 %U https://formative.jmir.org/2022/7/e34423 %U https://doi.org/10.2196/34423 %U http://www.ncbi.nlm.nih.gov/pubmed/35896029 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e32330 %T The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings %A Kirkwood,Elizabeth K %A Clymer,Caitlin %A Imbulana,Kheminda %A Mozumder,Sumaya %A Dibley,Michael J %A Alam,Neeloy Ashraful %+ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 328 Edward Ford, Camperdown, 2006, Australia, 61 0410517874, elizabeth.kirkwood@sydney.edu.au %K mobile health %K mHealth %K gender relations %K systematic review %K low- and middle-income countries %K mobile phone %D 2022 %7 21.7.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective: This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods: We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results: Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions: These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions. %M 35862143 %R 10.2196/32330 %U https://humanfactors.jmir.org/2022/3/e32330 %U https://doi.org/10.2196/32330 %U http://www.ncbi.nlm.nih.gov/pubmed/35862143 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38365 %T An Intervention to Increase Outdoor Play in Early Childhood Education Centers (PROmoting Early Childhood Outside): Protocol for a Pilot Wait-list Control Cluster Randomized Trial %A Ramsden,Rachel %A Han,Christina S %A Mount,Dawn %A Loebach,Janet %A Cox,Adina %A Herrington,Susan %A Bundy,Anita %A Fyfe-Johnson,Amber %A Sandseter,Ellen Beate Hansen %A Stone,Michelle %A Tremblay,Mark S %A Brussoni,Mariana %+ Department of Pediatrics, University of British Columbia, F511, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K early childhood education and care %K preschool %K randomized controlled trial %K RCT %K intervention studies %K outdoor play %K built environment %K pedagogy %K behavior mapping %D 2022 %7 12.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children’s lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. Objective: The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children’s outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. Methods: A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs’ outdoor play space; and children’s psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. Results: Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. Conclusions: The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. Trial Registration: ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380 International Registered Report Identifier (IRRID): DERR1-10.2196/38365 %M 35819829 %R 10.2196/38365 %U https://www.researchprotocols.org/2022/7/e38365 %U https://doi.org/10.2196/38365 %U http://www.ncbi.nlm.nih.gov/pubmed/35819829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33541 %T Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 451994827, sarah.perkes@newcastle.edu.au %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. %M 35802404 %R 10.2196/33541 %U https://formative.jmir.org/2022/7/e33541 %U https://doi.org/10.2196/33541 %U http://www.ncbi.nlm.nih.gov/pubmed/35802404 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e36226 %T Impact of a Mobile Application for Tracking Nausea and Vomiting During Pregnancy (NVP) on NVP Symptoms, Quality of Life, and Decisional Conflict Regarding NVP Treatments: MinSafeStart Randomized Controlled Trial %A Ngo,Elin %A Truong,Maria Bich-Thuy %A Wright,David %A Nordeng,Hedvig %+ PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Postbox 1068 Blindern, Oslo, 0316, Norway, 47 93849866, e.t.p.ngo@farmasi.uio.no %K eHealth %K mHealth %K decision support tool %K nausea and vomiting %K pregnancy %K RCT %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnant women are active users of mobile apps for health purposes. These apps may improve self-management of health-related conditions. Up to 70% of pregnant women experience nausea and vomiting (NVP). Even mild NVP can significantly reduce quality of life (QoL), and it can become an economic burden for both the woman and society. NVP often occurs before the first maternal care visit; therefore, apps can potentially play an important role in empowering pregnant women to recognize, manage, and seek appropriate treatment for NVP, when required. Objective: This study investigated whether the MinSafeStart (MSS) mobile app could impact NVP-related symptoms, QoL, and decisional conflict regarding NVP treatment. Methods: This randomized controlled trial enrolled 268 pregnant women with NVP in Norway from 2019 to 2020. The intervention group had access to the MSS app, which could be used to track NVP symptoms and access tailored advice. NVP severity was rated with the Pregnancy Unique Quantification of Emesis (PUQE) score. The control group followed standard maternal care. We collected data on maternal baseline characteristics, NVP severity, QoL, and decisional conflict using 2 sets of online questionnaires. One set of questionnaires was completed at enrollment, and the other was completed after 2 weeks. We performed linear regression analyses to explore whether the use of the MSS app was associated with NVP severity, QoL, or decisional conflict. Results: Among the 268 women enrolled in the study, 192 (86.5%) completed the baseline questionnaires and were randomized to either the intervention (n=89) or control group (n=103). In the intervention group, 88 women downloaded the app, and 468 logs were recorded. In both groups, women were enrolled at a median of 8 gestational weeks. At baseline, the average PUQE scores were 4.9 and 4.7; the average QoL scores were 146 and 149; and the average DCS scores were 40 and 43 in the intervention and control groups, respectively. The app had no impact on NVP severity (aβ 0.6, 95% Cl −0.1 to 1.2), QoL (aβ −5.3, 95% Cl −12.5 to 1.9), or decisional conflict regarding NVP treatment (aβ −1.1, 95% Cl −6.2 to 4.2), compared with standard care. Conclusions: Tracking NVP symptoms with the MSS app was not associated with improvements in NVP symptoms, QoL, or decisional conflict after 2 weeks, compared with standard care. Future studies should include a process evaluation to improve our understanding of how pregnant women use the app and how to optimize its utility within maternity care. Specifically, studies should focus on how digital tools might facilitate counseling and communication between pregnant women and health care providers regarding NVP management during pregnancy. Trial Registration: ClinicalTrails.gov (NCT04719286): https://www.clinicaltrials.gov/ct2/show/NCT04719286 %M 35787487 %R 10.2196/36226 %U https://mhealth.jmir.org/2022/7/e36226 %U https://doi.org/10.2196/36226 %U http://www.ncbi.nlm.nih.gov/pubmed/35787487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33929 %T A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial %A Thomas,Tainayah %A Xu,Fei %A Sridhar,Sneha %A Sedgwick,Tali %A Nkemere,Linda %A Badon,Sylvia E %A Quesenberry,Charles %A Ferrara,Assiamira %A Mandel,Sarah %A Brown,Susan D %A Hedderson,Monique %+ Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, United States, 1 3107211208, tainayah@stanford.edu %K mobile health %K gestational weight gain %K obesity %K physical activity %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective: This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods: We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results: Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions: The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration: ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283 %M 35731565 %R 10.2196/33929 %U https://formative.jmir.org/2022/6/e33929 %U https://doi.org/10.2196/33929 %U http://www.ncbi.nlm.nih.gov/pubmed/35731565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34852 %T Access to and Use of Mobile Phone by Postpartum, Married Women in Punjab, India: Secondary Analysis of mHealth Intervention Pilot Data %A Pendse,Ruchita S %A El Ayadi,Alison M %A Sharma,Preetika %A Ahuja,Alka %A Hosapatna Basavarajappa,Darshan %A Duggal,Mona %A Kankaria,Ankita %A Singh,Pushpendra %A Kumar,Vijay %A Bagga,Rashmi %A Diamond-Smith,Nadia G %+ Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4154762300, nadia.diamond-smith@ucsf.edu %K pregnancy %K mothers %K postpartum period %K postnatal care %K mobile phone use %K mHealth %K mobile health %K digital health %K telemedicine %K health education %K sex factors %K gender %K India %K South Asia %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective: We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods: A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results: The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. Conclusions: These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. %M 35551059 %R 10.2196/34852 %U https://formative.jmir.org/2022/5/e34852 %U https://doi.org/10.2196/34852 %U http://www.ncbi.nlm.nih.gov/pubmed/35551059 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31831 %T Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals’ Guide to Locating and Assessing Anxiety Apps %A Evans,Kerry %A Donelan,Jasper %A Rennick-Egglestone,Stefan %A Cox,Serena %A Kuipers,Yvonne %+ School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2HA, United Kingdom, 44 115 95 15559, kerry.evans1@nottingham.ac.uk %K anxiety %K pregnancy %K antenatal %K mobile applications %K digital interventions %K mHealth %K mobile app %K psychological well-being %K maternity %K evaluation %K quality assessment %D 2022 %7 23.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women’s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps. Objective: This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women. Methods: A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps. Results: Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers’ scores and app user rating scores, with higher user rating scores associated with lower reviewer scores. Conclusions: App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria. %M 35319482 %R 10.2196/31831 %U https://www.jmir.org/2022/3/e31831 %U https://doi.org/10.2196/31831 %U http://www.ncbi.nlm.nih.gov/pubmed/35319482 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29189 %T COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis %A Ruiz-Roman,Rebeca %A Martinez-Perez,Clara %A Gil Prados,Inés %A Cristóbal,Ignacio %A Sánchez-Tena,Miguel Ángel %+ Department of Gynecology and Obstetrics, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain, 34 913303000, rebecaruizroman@gmail.com %K pandemic %K COVID-19 %K SARS-CoV-2 %K pregnancy %K perinatal %K citation %K bibliometric %K network analysis %K women %K maternal health %K fetal health %K research %K literature %K transmission %K delivery %K impact %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 spread quickly around the world shortly after the first outbreaks of the new coronavirus disease at the end of December 2019, affecting all populations, including pregnant women. Objective: The aim of this study was to analyze the relationship between different publications on COVID-19 in pregnancy and their authors through citation networks, as well as to identify the research areas and to determine the publication that has been the most highly cited. Methods: The search for publications was carried out through the Web of Science database using terms such as “pregnancy,” “SARS-CoV-2,” “pregnant,” and “COVID-19” for the period between January and December 2020. Citation Network Explorer software was used for publication analysis and VOSviewer software was used to construct the figures. This approach enabled an in-depth network analysis to visualize the connections between the related elements and explain their network structure. Results: A total of 1330 publications and 5531 citation networks were identified in the search, with July being the month with the largest number of publications, and the United States, China, and England as the countries with the greatest number of publications. The most cited publication was “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records” by Chen and colleagues, which was published in March 2020. Six groups identified as being close in the citation network reflect multidisciplinary research, including clinical characteristics and outcomes in pregnancy, vertical transmission, delivery mode, and psychological impacts of the pandemic on pregnant women. Conclusions: Thousands of articles on COVID-19 have been published in several journals since the disease first emerged. Identifying relevant publications and obtaining a global view of the main papers published on COVID-19 and pregnancy can lead to a better understanding of the topic. With the accumulation of scientific knowledge, we now know that the clinical features of COVID-19 during pregnancy are generally similar to those of infected nonpregnant women. There is a small increase in frequency of preterm birth and cesarean birth, related to severe maternal illness. Vaccination for all pregnant women is recommended. Several agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy. These results could form the basis for further research. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyze other relevant indicators in this field. %M 35044301 %R 10.2196/29189 %U https://pediatrics.jmir.org/2022/1/e29189 %U https://doi.org/10.2196/29189 %U http://www.ncbi.nlm.nih.gov/pubmed/35044301 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32428 %T Understanding the Needs of a Mobile Phone–Based Telemonitoring Program for Pregnant Women at High Risk for Pre-Eclampsia: Interpretive Qualitative Description Study %A Feroz,Anam Shahil %A De Vera,Kristina %A D Bragagnolo,Nadia %A Saleem,Sarah %A Bhutta,Zulfiqar %A Seto,Emily %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 6478676702, anam.shahil@mail.utoronto.ca %K telemonitoring %K pre-eclampsia %K qualitative study %K Pakistan %K pregnant women at high risk %K low- to middle-income country %K pregnant %K pregnancy %K women %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan. Objective: This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone–based TM program. Methods: An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone–based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique. Results: The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one’s health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding the adoption of a TM program, including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives. Conclusions: Our findings highlight the perceived feasibility of a mobile phone–based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs. %M 35200152 %R 10.2196/32428 %U https://formative.jmir.org/2022/2/e32428 %U https://doi.org/10.2196/32428 %U http://www.ncbi.nlm.nih.gov/pubmed/35200152 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32815 %T Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study %A Blair,Rachel A %A Horn,Christine E %A Dias,Jennifer M %A McDonnell,Marie E %A Seely,Ellen W %+ Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, United States, 1 6177329479, rblair4@bwh.harvard.edu %K gestational diabetes mellitus %K SMS text messaging %K mobile phone %K mobile health %K pregnancy %K blood glucose self-monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. %M 35191851 %R 10.2196/32815 %U https://humanfactors.jmir.org/2022/1/e32815 %U https://doi.org/10.2196/32815 %U http://www.ncbi.nlm.nih.gov/pubmed/35191851 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28886 %T Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial %A Gonzalez-Plaza,Elena %A Bellart,Jordi %A Arranz,Ángela %A Luján-Barroso,Leila %A Crespo Mirasol,Esther %A Seguranyes,Gloria %+ Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Sabino de Arana, 1, Barcelona, 08028, Spain, 34 932275400 ext 7294, eplaza@clinic.cat %K obesity %K maternal %K pregnancy %K mHealth %K mobile apps %K telemedicine %K telenursing %K physical activity %K gestational weight gain %K lifestyle %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire–Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI −0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks–minutes per week vs 1386 metabolic equivalents of tasks–minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 %M 35166684 %R 10.2196/28886 %U https://mhealth.jmir.org/2022/2/e28886 %U https://doi.org/10.2196/28886 %U http://www.ncbi.nlm.nih.gov/pubmed/35166684 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32545 %T Patients’ and Providers’ Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study %A Aquino,Maria %A Griffith,Janessa %A Vattaparambil,Tessy %A Munce,Sarah %A Hladunewich,Michelle %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, maria.aquino@mail.utoronto.ca %K high-risk pregnancy %K blood pressure %K preeclampsia %K telemonitoring %K home monitoring %K mHealth %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective: The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods: This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results: In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions: The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE. %M 35129445 %R 10.2196/32545 %U https://humanfactors.jmir.org/2022/1/e32545 %U https://doi.org/10.2196/32545 %U http://www.ncbi.nlm.nih.gov/pubmed/35129445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e22093 %T The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review %A Sowon,Karen %A Maliwichi,Priscilla %A Chigona,Wallace %+ University of Cape Town, Department of Information Systems, University of Cape Town, Cape Town, 7700, South Africa, 27 651932568, swnkar004@myuct.ac.za %K human-technology interaction %K maternal health %K mHealth %K mobile phone %K utilization %K Kenya %D 2022 %7 27.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective: This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods: Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results: A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions: In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness. %M 35084356 %R 10.2196/22093 %U https://mhealth.jmir.org/2022/1/e22093 %U https://doi.org/10.2196/22093 %U http://www.ncbi.nlm.nih.gov/pubmed/35084356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29644 %T Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study %A Zhang,Puhong %A Chen,Huan %A Shang,Jie %A Ge,Jun %A Zhang,Huichen %A Xu,Mingjun %A Bian,Cui %A Zhao,Yang %A Chen,Minyuan %A Hirst,Jane Elizabeth %+ The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building, No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, China, 86 13691270366, zpuhong@georgeinstitute.org.cn %K maternal and child health %K mHealth %K mobile apps %K retrospective study %K pregnancy outcomes %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal and child health (MCH)–related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks’ gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women’s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. %M 35076402 %R 10.2196/29644 %U https://formative.jmir.org/2022/1/e29644 %U https://doi.org/10.2196/29644 %U http://www.ncbi.nlm.nih.gov/pubmed/35076402 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31607 %T Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie J %A Alfrey,Kristie-Lee %A Waters,Kim %A Cannon,Summer %A Mielke,Gregore I %A Keating,Shelley E %A Mena,Gabriela P %A Mottola,Michelle F %A Evenson,Kelly R %A Davenport,Margie H %A Barlow,S Ariel %A Budzynski-Seymour,Emily %A Comardelle,Natalie %A Dickey,Madison %A Harrison,Cheryce L %A Kebbe,Maryam %A Moholdt,Trine %A Moran,Lisa J %A Nagpal,Taniya S %A Schoeppe,Stephanie %A Alley,Stephanie %A Brown,Wendy J %A Williams,Susan %A Vincze,Lisa %+ Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Building 7/LG.12, North Rockhampton Campus, Rockhampton, 4701, Australia, 61 749306912, m.j.hayman@cqu.edu.au %K apps %K exercise %K mobile health %K mHealth %K mobile phone %K physical activity %K pregnancy %K exercise prescription %K evidence-based guidelines %K app development %K systematic review %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 35044318 %R 10.2196/31607 %U https://mhealth.jmir.org/2022/1/e31607 %U https://doi.org/10.2196/31607 %U http://www.ncbi.nlm.nih.gov/pubmed/35044318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26356 %T Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial %A Wynn,Chelsea S %A Catallozzi,Marina %A Kolff,Chelsea A %A Holleran,Stephen %A Meyer,Dodi %A Ramakrishnan,Rajasekhar %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, VC 417, New York, NY, 10032, United States, 1 212 342 5732, mss2112@cumc.columbia.edu %K text messaging %K mobile reminders %K human papillomavirus %K adolescent %K text reminders %K vaccine completion %K vaccine decision-making %K vaccine education %K transtheoretical model %K mobile phone %K smartphone %K mHealth %K mobile health %K minority health %D 2021 %7 27.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 %M 34958306 %R 10.2196/26356 %U https://mhealth.jmir.org/2021/12/e26356 %U https://doi.org/10.2196/26356 %U http://www.ncbi.nlm.nih.gov/pubmed/34958306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e17185 %T Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Seeley,John R %A Holt,Christopher J %A Holt,Charlene %A Ericksen,Jennifer %A Tyler,Milagra S %A Gau,Jeff M %A Gemmill,Alan W %+ Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Heidelberg Heights, 3081, Australia, 61 3 9496 4496, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K postnatal anxiety %K postpartum anxiety %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K online intervention %K treatment %K mobile phone %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. Results: Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true %M 34889742 %R 10.2196/17185 %U https://www.jmir.org/2021/12/e17185 %U https://doi.org/10.2196/17185 %U http://www.ncbi.nlm.nih.gov/pubmed/34889742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29214 %T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study %A Atukunda,Esther Cathyln %A Matthews,Lynn T %A Musiimenta,Angella %A Mugyenyi,Godfrey Rwambuka %A Mugisha,Samuel %A Ware,Norma C %A Obua,Celestino %A Siedner,Mark J %+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug %K mHealth app %K app development %K messaging %K health education %K health promotion %K mobile phone %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. %M 34842541 %R 10.2196/29214 %U https://formative.jmir.org/2021/11/e29214 %U https://doi.org/10.2196/29214 %U http://www.ncbi.nlm.nih.gov/pubmed/34842541 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27995 %T Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores %A Muñoz-Mancisidor,Aranzazu %A Martin-Payo,Ruben %A Gonzalez-Mendez,Xana %A Fernández-Álvarez,María Del Mar %+ Universidad de Oviedo, Calle Julián Clavería s/n, Campus del Cristo, Oviedo, 33006, Spain, 34 985 103 147, martinruben@uniovi.es %K pregnancy %K mobile apps %K behavior %K technology assessment, biomedical %K telemedicine %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective: The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods: A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results: A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002). Conclusions: The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals. %M 34787587 %R 10.2196/27995 %U https://mhealth.jmir.org/2021/11/e27995 %U https://doi.org/10.2196/27995 %U http://www.ncbi.nlm.nih.gov/pubmed/34787587 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31611 %T The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial %A Nuruddin,Rozina %A Vadsaria,Khadija %A Mohammed,Nuruddin %A Sayani,Saleem %+ Department of Community Health Sciences, Medical College, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 21 3486 ext 4833, rozina.nuruddin@aku.edu %K coaching %K compliance %K diet %K maternal health %K mobile health %K offspring health %K physical activity %K pregnancy %K supplement use %K usability %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 %M 34783675 %R 10.2196/31611 %U https://www.researchprotocols.org/2021/11/e31611 %U https://doi.org/10.2196/31611 %U http://www.ncbi.nlm.nih.gov/pubmed/34783675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25667 %T Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features %A Frid,Gabriela %A Bogaert,Kelly %A Chen,Katherine T %+ Icahn School of Medicine at Mount Sinai, 1 Gustace L. Levy Pl, New York, NY, 10029, United States, 1 3478664514, gabriela.frid@icahn.mssm.edu %K app %K app store %K mHealth %K mobile health %K prenatal %K pregnancy %K women's health %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women’s health–related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women’s satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term “pregnancy app.” After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps. %M 34524100 %R 10.2196/25667 %U https://www.jmir.org/2021/10/e25667 %U https://doi.org/10.2196/25667 %U http://www.ncbi.nlm.nih.gov/pubmed/34524100 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30404 %T Characteristics and Quality of Mobile Apps Containing Prenatal Genetic Testing Information: Systematic App Store Search and Assessment %A Wu,Ko-Lin %A Alegria,Rebeca %A Gonzalez,Jazzlyn %A Hu,Harrison %A Wang,Haocen %A Page,Robin %A Robbins-Furman,Patricia %A Ma,Ping %A Tseng,Tung-Sung %A Chen,Lei-Shih %+ Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77840, United States, 1 979 862 2912, lacechen@tamu.edu %K mobile applications %K prenatal genetic testing %K pregnancy %K review %K evaluation %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward. %M 34647898 %R 10.2196/30404 %U https://mhealth.jmir.org/2021/10/e30404 %U https://doi.org/10.2196/30404 %U http://www.ncbi.nlm.nih.gov/pubmed/34647898 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e22653 %T Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review %A Maliwichi,Priscilla %A Chigona,Wallace %A Sowon,Karen %+ Department of Information Systems, Faculty of Commerce, University of Cape Town, Private Bag X1, Rondebosch, Cape Town, 7701, South Africa, 27 21 650 2261, pmaliwichi@must.ac.mw %K mHealth %K appropriation %K mobile phones %K model of technology appropriation %K maternal health %K community of purpose %K hermeneutic literature review %D 2021 %7 6.10.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective: This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods: This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results: This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions: The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions. %M 34612835 %R 10.2196/22653 %U https://mhealth.jmir.org/2021/10/e22653 %U https://doi.org/10.2196/22653 %U http://www.ncbi.nlm.nih.gov/pubmed/34612835 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27769 %T Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study %A Noddin,Katie %A Bradley,Dani %A Wolfberg,Adam %+ Ovia Health, 308 Congress St, Boston, MA, 02210, United States, 1 3392032545, katie@oviahealth.com %K digital health %K COVID-19 %K maternal health %K obstetrics %K COVID %K pandemic %K pregnant women %K birth %K hospital %K delivery %K women's health %K Cesarean sections %D 2021 %7 4.10.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. %M 34509975 %R 10.2196/27769 %U https://pediatrics.jmir.org/2021/4/e27769 %U https://doi.org/10.2196/27769 %U http://www.ncbi.nlm.nih.gov/pubmed/34509975 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e30240 %T Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study %A Levey,Elizabeth J %A Onyeaka,Henry %A Bartles,Sophia M %A Sanchez Calderon,Elena %A Sanchez,Sixto E %A Prom,Maria C %A Fesseha,Eden M %A Gelaye,Bizu %+ Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 726 2000, elevey@mgh.harvard.edu %K access to care %K adolescent motherhood %K LMICs %K mobile phone %K perinatal mental health %K telehealth %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. %M 34533473 %R 10.2196/30240 %U https://pediatrics.jmir.org/2021/3/e30240 %U https://doi.org/10.2196/30240 %U http://www.ncbi.nlm.nih.gov/pubmed/34533473 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27403 %T Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis %A Biviji,Rizwana %A Williams,Karmen S %A Vest,Joshua R %A Dixon,Brian E %A Cullen,Theresa %A Harle,Christopher A %+ Science of Healthcare Delivery, College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ, 85004, United States, 1 602 496 3300, Rizwana.Biviji@asu.edu %K mHealth %K mobile applications %K maternal and infant health %K smartphones %K mobile phone %D 2021 %7 1.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives. Objective: This study aims to assess users’ self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores—Apple App Store and Google Play Store. Methods: We conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach. Results: The three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team. Conclusions: Users generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment. %M 34468323 %R 10.2196/27403 %U https://www.jmir.org/2021/9/e27403 %U https://doi.org/10.2196/27403 %U http://www.ncbi.nlm.nih.gov/pubmed/34468323 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e21471 %T Development of a Mobile App to Improve Numeracy Skills of Children With Autism Spectrum Disorder: Participatory Design and Usability Study %A Ntalindwa,Theoneste %A Nduwingoma,Mathias %A Karangwa,Evariste %A Rashid Soron,Tanjir %A Uworwabayeho,Alphonse %A Uwineza,Annette %+ Telepsychiatry Research and Innovation Network Ltd, Rupayon Trade Center, Dhaka, 1215, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K autism spectrum disorder %K mobile app %K learning %K information and communication technologies %K education %K numeracy %K mathematics %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users. Objective: This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app. Methods: A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method. Results: During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future. Conclusions: The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda. %M 34463629 %R 10.2196/21471 %U https://pediatrics.jmir.org/2021/3/e21471 %U https://doi.org/10.2196/21471 %U http://www.ncbi.nlm.nih.gov/pubmed/34463629 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31072 %T Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting %A Baggett,Kathleen M %A Davis,Betsy %A Sheeber,Lisa %A Miller,Katy %A Leve,Craig %A Mosley,Elizabeth A %A Landry,Susan H %A Feil,Edward G %+ Georgia State University, 14 Marietta St NW, Atlanta, GA, 30303, United States, 1 404 413 1571, kbaggett@gsu.edu %K maternal depression %K parenting %K infant social-emotional and social-communication development %K mobile intervention %K remote coaching %K trial protocol %K mobile phone %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 %M 34406122 %R 10.2196/31072 %U https://www.researchprotocols.org/2021/8/e31072 %U https://doi.org/10.2196/31072 %U http://www.ncbi.nlm.nih.gov/pubmed/34406122 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e25425 %T Mobile Apps as Audience-Centered Health Communication Platforms %A Mackert,Michael %A Mandell,Dorothy %A Donovan,Erin %A Walker,Lorraine %A Henson-García,Mike %A Bouchacourt,Lindsay %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 348 8490, mackert@utexas.edu %K health communication %K mHealth %K mobile apps %K mobile health %K prenatal health %K pregnancy %K audience-centered %D 2021 %7 17.8.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms—particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father’s Playbook, a mobile app designed to encourage men to be more involved during their partner’s pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father’s Playbook as a vehicle for their messages. %M 34402797 %R 10.2196/25425 %U https://mhealth.jmir.org/2021/8/e25425 %U https://doi.org/10.2196/25425 %U http://www.ncbi.nlm.nih.gov/pubmed/34402797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29151 %T Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores %A Brunelli,Laura %A De Vita,Chiara %A Cenedese,Fabrizio %A Cinello,Michela %A Paris,Marta %A Samogizio,Francesca %A Starec,Anja %A Bava,Michele %A Dal Cin,Margherita %A Zanchiello,Sara %A Stampalija,Tamara %+ Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria, 65, Trieste, 34137, Italy, 39 0432554768, laura.brunelli@phd.units.it %K pregnancy %K postnatal care %K app %K mHealth %K mobile health %K newborn %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children’s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health–related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. %M 34383668 %R 10.2196/29151 %U https://www.jmir.org/2021/8/e29151 %U https://doi.org/10.2196/29151 %U http://www.ncbi.nlm.nih.gov/pubmed/34383668 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30450 %T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach %A Weber,Summer J %A Shearer,Elyse %A Mulvaney,Shelagh A %A Schmidt,Douglas %A Thompson,Chris %A Jones,Jessica %A Ahmad,Haseeb %A Coe,Martina %A Hull,Pamela C %+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu %K WIC %K mobile technology %K maternal-child health %K childhood obesity %K nutrition %K government programs %K mobile app %K user-centered design %K low income %K women %K infant %K child %K formative %K development %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. %M 34328432 %R 10.2196/30450 %U https://formative.jmir.org/2021/7/e30450 %U https://doi.org/10.2196/30450 %U http://www.ncbi.nlm.nih.gov/pubmed/34328432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e27581 %T A Mobile App for Self-Triage for Pediatric Emergency Patients in Japan: 4 Year Descriptive Epidemiological Study %A Katayama,Yusuke %A Kiyohara,Kosuke %A Hirose,Tomoya %A Matsuyama,Tasuku %A Ishida,Kenichiro %A Nakao,Shunichiro %A Tachino,Jotaro %A Ojima,Masahiro %A Noda,Tomohiro %A Kiguchi,Takeyuki %A Hayashida,Sumito %A Kitamura,Tetsuhisa %A Mizobata,Yasumitsu %A Shimazu,Takeshi %+ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 5650871, Japan, 81 16 6879 5707, orion13@hp-emerg.med.osaka-u.ac.jp %K emergency medicine %K self-triage %K mobile app %K children %K telemedicine %K app %K mobile health %K mHealth %K epidemiology %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: When children suffer sudden illness or injury, many parents wonder whether they should go to the hospital immediately or call an ambulance. In 2015, we developed a mobile app that allows parents or guardians to determine the urgency of their child’s condition or call an ambulance and that indicates available hospitals and clinics when their child is suddenly sick or injured by simple selection of the child’s chief complaints and symptoms. However, the effectiveness of medical apps used by the general public has not been well evaluated. Objective: The purpose of this study was to clarify the use profile of this mobile app based on data usage in the app. Methods: This study was a descriptive epidemiological study with a 4-year study period running from January 2016 to December 2019. We included cases in which the app was used either by the children themselves or by their parents and other guardians. Cases in which the app was downloaded but never actually used were excluded from this study. Continuous variables are presented as median and IQR, and categorical variables are presented as actual number and percentages. Results: The app was used during the study period for 59,375 children whose median age was 1 year (IQR 0-3 years). The app was used for 33,874 (57.05%) infants, 16,228 (27.33%) toddlers, 8102 (13.65%) elementary school students, and 1117 (1.88%) junior high school students, with 54 (0.09%) having an unknown status. Furthermore, 31,519 (53.08%) were male and 27,329 (46.03%) were female, with sex being unknown for 527 (0.89%) children. “Sickness” was chosen for 49,101 (78.51%) patients, and “injury, poisoning, foreign, substances and others” was chosen for 13,441 (21.49%). For “sickness,” “fever” was the most commonly selected option (22,773, 36.41%), followed by “cough” (4054, 6.48%), and “nausea/vomiting” (3528, 5.64%), whereas for “injury, poisoning, foreign substances and others,” “head and neck injury” was the most commonly selected option (3887, 6.22%), followed by “face and extremities injury” (1493, 2.39%) and “injury and foreign substances in eyes” (1255, 2.01%). Conclusions: This study clarified the profile of use of a self-triage app for pediatric emergency patients in Japan. %M 34255709 %R 10.2196/27581 %U https://pediatrics.jmir.org/2021/2/e27581 %U https://doi.org/10.2196/27581 %U http://www.ncbi.nlm.nih.gov/pubmed/34255709 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27603 %T Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia %A Mekonnen,Zeleke Abebaw %A Gelaye,Kassahun Alemu %A Were,Martin %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, University of Gondar, Chechela Street, Gondar, 196, Ethiopia, 251 913747092, zelekeabebaw7@gmail.com %K mHealth %K eHealth %K mobile phone %K text message %K short message service %K reminder %K immunization %K vaccination %K Ethiopia %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 %M 34128813 %R 10.2196/27603 %U https://mhealth.jmir.org/2021/6/e27603 %U https://doi.org/10.2196/27603 %U http://www.ncbi.nlm.nih.gov/pubmed/34128813 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e17189 %T Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial %A Greene,Ellen M %A O'Brien,Eileen C %A Kennelly,Maria A %A O'Brien,Orna A %A Lindsay,Karen L %A McAuliffe,Fionnuala M %+ UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Dublin 2, Ireland, 353 637 3216, fionnuala.mcauliffe@ucd.ie %K pregnancy %K mHealth %K nutrition %K lifestyle %K acceptability %K app %K mobile phone %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 %M 33978597 %R 10.2196/17189 %U https://mhealth.jmir.org/2021/5/e17189 %U https://doi.org/10.2196/17189 %U http://www.ncbi.nlm.nih.gov/pubmed/33978597 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27382 %T Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study %A Burduli,Ekaterina %A Jones,Hendrée E %A Brooks,Olivia %A Barbosa-Leiker,Celestina %A Johnson,Ron Kim %A Roll,John %A McPherson,Sterling Marshall %+ College of Nursing, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202, United States, 1 509 324 7368, eburduli@wsu.edu %K neonatal abstinence syndrome %K opioid use disorder %K mHealth %K maternal child outcomes %D 2021 %7 15.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. Objective: In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. Methods: Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes—maternal drug relapse and OAT continuation—and secondary outcomes—maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Results: This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. Conclusions: The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. Trial Registration: ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558 International Registered Report Identifier (IRRID): DERR1-10.2196/27382 %M 33856360 %R 10.2196/27382 %U https://www.researchprotocols.org/2021/4/e27382 %U https://doi.org/10.2196/27382 %U http://www.ncbi.nlm.nih.gov/pubmed/33856360 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24579 %T Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial %A Scott,Jane Anne %A Burns,Sharyn K %A Hauck,Yvonne L %A Giglia,Roslyn C %A Jorgensen,Anita M %A White,Becky Kate %A Martin,Annegret %A Robinson,Suzanne %A Dhaliwal,Satvinder S %A Binns,Colin W %A Maycock,Bruce R %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, Australia, 61 040 413 0489, jane.scott@curtin.edu.au %K breastfeeding %K fathers %K peer support %K mHealth, smartphone app %K infants %K social support %K feeding %K smartphone %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 %M 33843604 %R 10.2196/24579 %U https://pediatrics.jmir.org/2021/2/e24579 %U https://doi.org/10.2196/24579 %U http://www.ncbi.nlm.nih.gov/pubmed/33843604 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23649 %T Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie %A Alfrey,Kristie-Lee %A Cannon,Summer %A Alley,Stephanie %A Rebar,Amanda L %A Williams,Susan %A Short,Camille E %A Altazan,Abby %A Comardelle,Natalie %A Currie,Sinead %A Denton,Caitlin %A Harrison,Cheryce L %A Lamerton,Tayla %A Mena,Gabriela P %A Moran,Lisa %A Mottola,Michelle %A Nagpal,Taniya S %A Vincze,Lisa %A Schoeppe,Stephanie %+ School of Health, Medical and Applied Sciences, CQUniversity, Bruce Highway, Rockhampton, 4701, Australia, 61 49306912 ext 56912, m.j.hayman@cqu.edu.au %K pregnancy %K exercise %K physical activity %K mobile health (mHealth) %K applications %K MARS %K behavior change techniques %K mobile phone %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. %M 33825693 %R 10.2196/23649 %U https://mhealth.jmir.org/2021/4/e23649 %U https://doi.org/10.2196/23649 %U http://www.ncbi.nlm.nih.gov/pubmed/33825693 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26159 %T Participants’ Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial %A Sandborg,Johanna %A Henriksson,Pontus %A Larsen,Erica %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Söderström,Emmie %A Maddison,Ralph %A Löf,Marie %+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se %K pregnancy %K gestational weight gain %K mHealth %K telemedicine %K digital health %K mobile health %K eHealth %K smartphone intervention %K mobile application %K smartphone application %K engagement %K physical activity %K exercise %K nutrition %K diet %K qualitative %K thematic analysis %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health–delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users’ experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants’ engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, “One could suit many: a multifunctional tool to strengthen women’s health during pregnancy,” and the 2 subthemes, “Factors within and beyond the app influence app engagement” and “Trust, knowledge, and awareness: aspects that can motivate healthy habits,” illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 %M 33666554 %R 10.2196/26159 %U https://mhealth.jmir.org/2021/3/e26159 %U https://doi.org/10.2196/26159 %U http://www.ncbi.nlm.nih.gov/pubmed/33666554 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e23154 %T Combining Wearable Devices and Mobile Surveys to Study Child and Youth Development in Malawi: Implementation Study of a Multimodal Approach %A Leal Neto,Onicio %A Haenni,Simon %A Phuka,John %A Ozella,Laura %A Paolotti,Daniela %A Cattuto,Ciro %A Robles,Daniel %A Lichand,Guilherme %+ Department of Economics, University of Zurich, Schönberggasse 1, Zurich, 8001, Switzerland, 41 44 634 55 80, onicio@gmail.com %K child development %K wearables %K participatory surveillance %K proximity sensors %K mobile surveying %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimodal approaches have been shown to be a promising way to collect data on child development at high frequency, combining different data inputs (from phone surveys to signals from noninvasive biomarkers) to understand children’s health and development outcomes more integrally from multiple perspectives. Objective: The aim of this work was to describe an implementation study using a multimodal approach combining noninvasive biomarkers, social contact patterns, mobile surveying, and face-to-face interviews in order to validate technologies that help us better understand child development in poor countries at a high frequency. Methods: We carried out a mixed study based on a transversal descriptive analysis and a longitudinal prospective analysis in Malawi. In each village, children were sampled to participate in weekly sessions in which data signals were collected through wearable devices (electrocardiography [ECG] hand pads and electroencephalography [EEG] headbands). Additionally, wearable proximity sensors to elicit the social network were deployed among children and their caregivers. Mobile surveys using interactive voice response calls were also used as an additional layer of data collection. An end-line face-to-face survey was conducted at the end of the study. Results: During the implementation, 82 EEG/ECG data entry points were collected across four villages. The sampled children for EEG/ECG were 0 to 5 years old. EEG/ECG data were collected once a week. In every session, children wore the EEG headband for 5 minutes and the ECG hand pad for 3 minutes. In total, 3531 calls were sent over 5 weeks, with 2291 participants picking up the calls and 984 of those answering the consent question. In total, 585 people completed the surveys over the course of 5 weeks. Conclusions: This study achieved its objective of demonstrating the feasibility of generating data through the unprecedented use of a multimodal approach for tracking child development in Malawi, which is one of the poorest countries in the world. Above and beyond its multiple dimensions, the dynamics of child development are complex. It is the case not only that no data stream in isolation can accurately characterize it, but also that even if combined, infrequent data might miss critical inflection points and interactions between different conditions and behaviors. In turn, combining different modes at a sufficiently high frequency allows researchers to make progress by considering contact patterns, reported symptoms and behaviors, and critical biomarkers all at once. This application showcases that even in developing countries facing multiple constraints, complementary technologies can leverage and accelerate the digitalization of health, bringing benefits to populations that lack new tools for understanding child well-being and development. %M 33536159 %R 10.2196/23154 %U https://publichealth.jmir.org/2021/3/e23154 %U https://doi.org/10.2196/23154 %U http://www.ncbi.nlm.nih.gov/pubmed/33536159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18240 %T Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study %A Militello,Lisa %A Sezgin,Emre %A Huang,Yungui %A Lin,Simon %+ Martha S Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, 1585 Neil Ave, 145 Newton Hall, Columbus, OH, 43210, United States, 1 3128135007, militello.14@osu.edu %K perinatal care %K infant mortality %K health education %K mobile health %K feasibility studies %K family %K mobile phone %K webcasts as topic %K user-computer interface %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children’s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention–Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants’ perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. %M 33646136 %R 10.2196/18240 %U https://formative.jmir.org/2021/3/e18240 %U https://doi.org/10.2196/18240 %U http://www.ncbi.nlm.nih.gov/pubmed/33646136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19073 %T Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma %A Bonciani,Manila %A De Rosis,Sabina %A Vainieri,Milena %+ Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, 56127, Italy, 39 3462405234, m.bonciani@santannapisa.it %K mHealth %K maternal care pathway %K impact evaluation %K quasiexperimental study %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy). Objective: The protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway. Methods: A pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results: Following study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway. Conclusions: The study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application. International Registered Report Identifier (IRRID): DERR1-10.2196/19073 %M 33464218 %R 10.2196/19073 %U http://www.researchprotocols.org/2021/1/e19073/ %U https://doi.org/10.2196/19073 %U http://www.ncbi.nlm.nih.gov/pubmed/33464218 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e22102 %T An Interactive Smartphone App, Nenne Navi, for Improving Children’s Sleep: Pilot Usability Study %A Yoshizaki,Arika %A Mohri,Ikuko %A Yamamoto,Tomoka %A Shirota,Ai %A Okada,Shiho %A Murata,Emi %A Hoshino,Kyoko %A Kato-Nishimura,Kumi %A Matsuzawa,Shigeyuki %A Kato,Takafumi %A Taniike,Masako %+ United Graduate School of Child Development, Osaka University, 2-2-D5 Yamadaoka, Suita, Osaka, 567-0876, Japan, 81 6 6879 3863, ikuko@kokoro.med.osaka-u.ac.jp %K infant sleep %K app %K mHealth %K behavioral intervention %K sleep health, PDCA cycle %D 2020 %7 1.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Healthy sleep is important not only for physical health but also for brain development in children. Several reports have revealed that Japanese adults and children have later bedtimes and shorter sleep durations compared with those in other countries, possibly because of Japanese culture and lifestyles. Therefore, an intervention tool that is suitable to the Japanese sociocultural environment is urgently needed to improve children’s sleep problems in their early years. Objective: To provide appropriate sleep health literacy to caregivers and change their parenting behavior, we developed a smartphone app that allows reciprocal interaction between caregivers and pediatric sleep experts. This paper describes a preliminary study to examine the app’s basic design and functions and to establish its acceptability and usability in a small sample. Methods: A total of 10 caregivers and 10 infants (aged 18-28 months; 4/10, 40% boys) living in Japan participated in the study. At the start of the trial, the e-learning content regarding sleep health literacy was delivered via a smartphone. Thereafter, caregivers manually inputted recorded data about their own and their infant’s sleep habits for 8 consecutive days per month for 2 months. After pediatric sleep experts retrieved this information from the Osaka University server, they specified the problems and provided multiple sleep habit improvement suggestions to caregivers. Caregivers then selected one of the feasible pieces of advice to practice and reported their child’s sleep-related behaviors via the app. Actigraphy was used to monitor children’s sleep behaviors objectively. The concordance between the information provided by caregivers and the actigraphy data was assessed. The acceptability and usability of the app were evaluated using self-report questionnaires completed by caregivers; qualitative feedback was obtained via semistructured interviews after the intervention. Results: There was no significant difference between the information provided by the caregivers and the actigraphy data for bedtimes and wake-up times (P=.13 to P=.97). However, there was a difference between the actigraphy data and the caregivers’ reports of nighttime sleep duration and nighttime awakenings (P<.001 each), similar to prior findings. User feedback showed that 6 and 5 of the 10 caregivers rated the app easy to understand and easy to continue to use, respectively. Additionally, 6 of the 10 caregivers rated the app’s operativity as satisfactory. Although this was a short-term trial, children’s sleep habits, caregivers’ sleep health consciousness, and parenting behaviors improved to some extent. Conclusions: The present findings suggest that the app can easily be used and is acceptable by Japanese caregivers. Given the user feedback, the app has the potential to improve children’s sleep habits by sending individualized advice that fits families’ backgrounds and home lives. Further studies are needed to confirm the efficacy of the app and facilitate social implementation. %M 33122163 %R 10.2196/22102 %U http://pediatrics.jmir.org/2020/2/e22102/ %U https://doi.org/10.2196/22102 %U http://www.ncbi.nlm.nih.gov/pubmed/33122163 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18614 %T Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial %A Garnweidner-Holme,Lisa %A Henriksen,Lena %A Torheim,Liv Elin %A Lukasse,Mirjam %+ OsloMet - Oslo Metropolitan University of Applied Sciences, St Olavs Plass; PO Box 4, Oslo, 0310, Norway, 47 48091956, lgarnwei@oslomet.no %K gestational diabetes mellitus %K diet %K mHealth %K mobile phone %K randomized controlled trial %D 2020 %7 4.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM. Objective: We analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM. Methods: Women with a 2-hour oral glucose tolerance test level of ≥9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet. Results: A total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02). Conclusions: Our findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women’s diet. Trial Registration: ClinicalTrials.gov NCT02588729; https://clinicaltrials.gov/ct2/show/NCT02588729 %M 33146620 %R 10.2196/18614 %U http://mhealth.jmir.org/2020/11/e18614/ %U https://doi.org/10.2196/18614 %U http://www.ncbi.nlm.nih.gov/pubmed/33146620 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19953 %T Effect of a Text Messaging–Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial %A Su,Yanfang %A Heitner,Jesse %A Yuan,Changzheng %A Si,Yafei %A Wang,Dan %A Zhou,Zhiying %A Zhou,Zhongliang %+ School of Public Policy and Administration, Xi’an Jiaotong University, 28# Xianning West Road, Xi'an, China, 86 18291498261, zzliang1981@xjtu.edu.cn %K cesarean section %K short message service %K SMS text messaging %K quasirandomized controlled trial %K mobile health %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China’s cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China’s 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi’an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother’s birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few “basic” messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman’s gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women’s likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 %M 33141099 %R 10.2196/19953 %U https://mhealth.jmir.org/2020/11/e19953 %U https://doi.org/10.2196/19953 %U http://www.ncbi.nlm.nih.gov/pubmed/33141099 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18966 %T Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands %A van den Heuvel,Josephus F M %A Ayubi,Samira %A Franx,Arie %A Bekker,Mireille N %+ Department of Obstetrics, University Medical Center, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, Netherlands, 31 088 75 55555, m.n.bekker-3@umcutrecht.nl %K mobile health %K telemonitoring %K pregnancy complications %K digital health %K telemedicine %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used. Objective: This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands. Methods: This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians. Results: The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues. Conclusions: Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice. %M 33112250 %R 10.2196/18966 %U http://mhealth.jmir.org/2020/10/e18966/ %U https://doi.org/10.2196/18966 %U http://www.ncbi.nlm.nih.gov/pubmed/33112250 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e16485 %T Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit %A Crehan,Caroline %A Kesler,Erin %A Chikomoni,Indira Angela %A Sun,Kristi %A Dube,Queen %A Lakhanpaul,Monica %A Heys,Michelle %+ UCL-Great Ormond Street Hospital Institute of Child Health, University College London, 30 Guilford Street, Holborn, London, WC1N 1EH, United Kingdom, 44 (0)2079052212, m.heys@ucl.ac.uk %K infant, newborn %K mHealth %K data collection %K clinical audit %K digital health %K low income population %K mobile phone %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. Objective: This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. Methods: Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. Results: Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. Conclusions: This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings. %M 33084581 %R 10.2196/16485 %U https://mhealth.jmir.org/2020/10/e16485 %U https://doi.org/10.2196/16485 %U http://www.ncbi.nlm.nih.gov/pubmed/33084581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17066 %T Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial %A Modi,Dhiren %A Saha,Somen %A Vaghela,Prakash %A Dave,Kapilkumar %A Anand,Ankit %A Desai,Shrey %A Shah,Pankaj %+ Indian Institute of Public Health Gandhinagar, NH-147, Palaj Village, opp. New Air Force Station HQ, Gandhinagar, 382042, India, 91 9687207549, ssaha@iiphg.org %K mHealth, cost-effectiveness %K life-years saved %K India, ASHA %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective: In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions: Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27 %M 33052122 %R 10.2196/17066 %U https://mhealth.jmir.org/2020/10/e17066 %U https://doi.org/10.2196/17066 %U http://www.ncbi.nlm.nih.gov/pubmed/33052122 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17895 %T Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study %A Green,Eric P %A Lai,Yihuan %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Jones,Rachel M %A Bhat,Chaya %A Mulinge,Antonia %A Puffer,Eve S %+ Duke Global Health Institute, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K mobile phone %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 %M 33016883 %R 10.2196/17895 %U https://formative.jmir.org/2020/10/e17895 %U https://doi.org/10.2196/17895 %U http://www.ncbi.nlm.nih.gov/pubmed/33016883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18519 %T Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination %A Baggett,Kathleen M %A Davis,Betsy %A Landry,Susan H %A Feil,Edward G %A Whaley,Anna %A Schnitz,Alana %A Leve,Craig %+ Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State Universtiy, 14th Marietta Street NW, Suite 100&200, GA 30303, Atlanta, GA, 30303, United States, 1 4044131571, kbaggett@gsu.edu %K early intervention %K equity %K NICU %K low birthweight %K transition %K mobile internet intervention %K infants %K mothers %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective: This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods: Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results: NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions: The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions. %M 32960178 %R 10.2196/18519 %U http://www.jmir.org/2020/9/e18519/ %U https://doi.org/10.2196/18519 %U http://www.ncbi.nlm.nih.gov/pubmed/32960178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18414 %T Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study %A Zaidi,Shehla %A Kazi,Abdul Momin %A Riaz,Atif %A Ali,Ammarah %A Najmi,Rabia %A Jabeen,Rawshan %A Khudadad,Umerdad %A Sayani,Saleem %+ Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan, 92 3062016825, shehla.zaidi@aku.edu %K mHealth %K community health workers %K usability %K usefulness %K task-technology fit %D 2020 %7 17.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology. %M 32940612 %R 10.2196/18414 %U http://www.jmir.org/2020/9/e18414/ %U https://doi.org/10.2196/18414 %U http://www.ncbi.nlm.nih.gov/pubmed/32940612 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21573 %T An Innovative Artificial Intelligence–Based App for the Diagnosis of Gestational Diabetes Mellitus (GDM-AI): Development Study %A Shen,Jiayi %A Chen,Jiebin %A Zheng,Zequan %A Zheng,Jiabin %A Liu,Zherui %A Song,Jian %A Wong,Sum Yi %A Wang,Xiaoling %A Huang,Mengqi %A Fang,Po-Han %A Jiang,Bangsheng %A Tsang,Winghei %A He,Zonglin %A Liu,Taoran %A Akinwunmi,Babatunde %A Wang,Chi Chiu %A Zhang,Casper J P %A Huang,Jian %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China, 86 14715485116, wkming@connect.hku.hk %K AI %K application %K disease diagnosis %K maternal health care %K artificial intelligence %K app %K women %K rural %K innovation %K diabetes %K gestational diabetes %K diagnosis %D 2020 %7 15.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective: This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods: An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters. For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results: The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions: Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms. %M 32930674 %R 10.2196/21573 %U https://www.jmir.org/2020/9/e21573 %U https://doi.org/10.2196/21573 %U http://www.ncbi.nlm.nih.gov/pubmed/32930674 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20312 %T Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic %A Casilang,Clarisse G %A Stonbraker,Samantha %A Japa,Ingrid %A Halpern,Mina %A Messina,Luz %A Steenhoff,Andrew P %A Lowenthal,Elizabeth D %A Fleisher,Linda %+ Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, United States, 1 267 426 6298, casilangc@email.chop.edu %K global health %K breast feeding %K mHealth %K mobile phone %D 2020 %7 21.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods: Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results: All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding. %M 32821063 %R 10.2196/20312 %U http://pediatrics.jmir.org/2020/2/e20312/ %U https://doi.org/10.2196/20312 %U http://www.ncbi.nlm.nih.gov/pubmed/32821063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16924 %T Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review %A Brigden,Amberly %A Anderson,Emma %A Linney,Catherine %A Morris,Richard %A Parslow,Roxanne %A Serafimova,Teona %A Smith,Lucie %A Briggs,Emily %A Loades,Maria %A Crawley,Esther %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 42 83080, amberly.brigden@bristol.ac.uk %K mobile phone %K mHealth %K mobile health %K eHealth %K electronic health %K digital health %K behavior %K pediatrics %K chronic illness %K systematic review %D 2020 %7 31.7.2020 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. %M 32735227 %R 10.2196/16924 %U http://www.jmir.org/2020/7/e16924/ %U https://doi.org/10.2196/16924 %U http://www.ncbi.nlm.nih.gov/pubmed/32735227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17665 %T The Effect of Women’s Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior in Bangladesh: Retrospective Cross-Sectional Study %A Alam,Mafruha %A Banwell,Cathy %A Lokuge,Kamalini %+ Australian National University, 62 Mills Road, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, ACT, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com %K mHealth %K inequality %K access %K pregnancy %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. Objective: This study aims to evaluate the effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. Methods: In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. Results: In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women’s differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged≥25 years). Secondary education was statistically significantly associated with women’s ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women’s satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. Conclusions: The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households. %M 32706694 %R 10.2196/17665 %U https://mhealth.jmir.org/2020/7/e17665 %U https://doi.org/10.2196/17665 %U http://www.ncbi.nlm.nih.gov/pubmed/32706694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17535 %T Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study %A Lebrun,Victoria %A Dulli,Lisa %A Alami,Sayed Omar %A Sidiqi,Arzoo %A Sultani,Ahmad Shah %A Rastagar,Sayed Haroon %A Halimzai,Iftikhar %A Ahmadzai,Sharif %A Todd,Catherine S %+ Global Health, Population, and Nutrition, FHI 360, 359 Blackwell St #200, Durham, NC, 27701, United States, 1 9195447040 ext 11640, vlebrun@fhi360.org %K Afghanistan %K mobile apps %K pregnant women %K maternal health %K newborn health %K social and behavior change %K mHealth %K voice message %K SMS %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn’s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh. Objective: The aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up. Methods: We conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test. Results: Overall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of participants with correct knowledge significantly increased for all but one MNCH measure at follow up. Conclusions: This assessment indicates that the pilot MAMA program is feasible and acceptable in the Afghan context. Further research should be conducted to determine whether program participation leads to improved MNCH knowledge, health practices, and health service utilization in this fragile setting prior to larger scale up. %M 32706690 %R 10.2196/17535 %U https://mhealth.jmir.org/2020/7/e17535 %U https://doi.org/10.2196/17535 %U http://www.ncbi.nlm.nih.gov/pubmed/32706690 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17779 %T Development of an Intervention to Support the Reproductive Health of Cambodian Women Who Seek Medical Abortion: Research Protocol %A Oreglia,Elisa %A Ly,Sokhey %A Tijamo,Camille %A Ou,Amra %A Free,Caroline %A Smith,Chris %+ School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan, 81 8087105309, christopher.smith@lshtm.ac.uk %K reproductive health %K abortion %K Cambodia %K mHealth %K mobile phone %D 2020 %7 10.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Cambodia, abortion has been legally permitted on request during the first trimester of pregnancy since 1997. However, although there has been an increase in the percentage of women having induced abortion and medical abortion, there has also been a decrease in the percentage of women who say they received help from a health worker with their abortion. These data point toward the demedicalization of abortion, and although medical abortion has been shown to be safe, there are concerns about safety, given the variety of available products and counseling provided. These concerns are particularly relevant for female factory workers, who typically come from rural areas where access to good health care and information about reproductive health care is limited. Objective: This study aims to understand the reproductive health needs of female Cambodian garment factory workers after medical abortion from a multidisciplinary and mixed-methods perspective, focusing on how they seek and share medical abortion- and health-related information; how they use their mobile phones for this and other purposes; what cultural challenges exist around reproductive health; and how they might be magnified or mitigated by mobile phones, linguistic challenges around health care, and mobile phone use. The main purpose of this study is to combine multidisciplinary methods, theories, and expertise to gain new, culturally grounded insights into family planning and medical abortion in Cambodia, but the findings could help inform the development of a relevant intervention to support comprehensive postabortion care. Methods: The methods proposed are interviews and participant observation among factory workers, health providers, and mobile phone providers; a linguistic analysis of relevant data (interview transcripts, web-based sources, and other fieldwork materials); and digital methods to understand what kind of information about medical abortion exists on the web in Cambodia and how it is accessed by the targeted population. Results: The data collection part of the project will end on December 31, 2020. The team conducted 67 semistructured interviews with female factory workers, women who sought a medical abortion, health providers, and mobile phone providers; participant observation with factory workers and health providers; and an analysis of YouTube and Facebook to understand what kind of information is available, who creates it, and how it is used. The team is currently performing data analysis, and the findings are clustered around (1) the use of mobile phones and digital resources for health-related and medical abortion-related information, (2) the experience of medical abortion care, and (3) the development of an intervention through edutainment videos. Conclusions: The project highlights both the widely untapped potential of using digital platforms (especially YouTube and Facebook) to distribute accurate information on medical abortion and the challenges in providing individual information via mobile phones while respecting individuals’ privacy. International Registered Report Identifier (IRRID): DERR1-10.2196/17779 %M 32423893 %R 10.2196/17779 %U https://www.researchprotocols.org/2020/7/e17779 %U https://doi.org/10.2196/17779 %U http://www.ncbi.nlm.nih.gov/pubmed/32423893 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17183 %T Effect of a Health System–Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study %A Cawley,Caroline %A Buckenmeyer,Hannelore %A Jellison,Trina %A Rinaldi,Joseph B %A Vartanian,Keri B %+ Center for Outcomes Research and Education, Providence Portland Medical Center, 5251 NE Glisan Street, Portland, OR, 97213, United States, 1 503 215 2594, Keri.Vartanian@providence.org %K mobile health %K perinatal health %K health behaviors %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective: The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods: This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. %M 32628123 %R 10.2196/17183 %U https://mhealth.jmir.org/2020/7/e17183 %U https://doi.org/10.2196/17183 %U http://www.ncbi.nlm.nih.gov/pubmed/32628123 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e16676 %T Achieving Optimal Gestational Weight Gain, Birth Weight, and Perinatal Outcomes Among Pregnant Women at Risk of Hypertension: Protocol for a Pilot Randomized Controlled Trial %A Hasan,S M Tafsir %A Ahmed,Syed Imran %A Khan,Md Alfazal %A Sarker,Shafiqul Alam %A Ahmed,Tahmeed %+ Nutrition and Clinical Services Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 1712523391, tafsir.hasan@icddrb.org %K hypertensive disorder %K hypertension %K pregnancy %K preeclampsia %K gestational weight gain %K continuous blood pressure monitor %K wearable device %K Health Gauge %K birth weight %K perinatal outcome %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Hypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined. Objective: The objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications. Methods: The study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care. Results: A validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020. Conclusions: The findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy. Trial Registration: ClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595 International Registered Report Identifier (IRRID): DERR1-10.2196/16676 %M 32459639 %R 10.2196/16676 %U http://www.researchprotocols.org/2020/6/e16676/ %U https://doi.org/10.2196/16676 %U http://www.ncbi.nlm.nih.gov/pubmed/32459639 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15890 %T Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study %A Watterson,Jessica L %A Castaneda,Diego %A Catalani,Caricia %+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3602014410, jessica.watterson@gmail.com %K mHealth %K antenatal care %K maternal health %K text messages %D 2020 %7 2.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective: This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods: This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results: The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions: These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization. %M 32484446 %R 10.2196/15890 %U https://mhealth.jmir.org/2020/6/e15890 %U https://doi.org/10.2196/15890 %U http://www.ncbi.nlm.nih.gov/pubmed/32484446 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e14632 %T An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study %A Hsu,Chen-Fang %A Chien,Tsair-Wei %A Chow,Julie Chi %A Yeh,Yu-Tsen %A Chou,Willy %+ Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Chi Mei Medical Groups, No. 901, Chung Hwa Road, Yung Kung District, Tainan, 710, Taiwan, 886 62812811, ufan0101@ms22.hinet.net %K computer adaptive testing %K developmental delay %K multidimensional %K mobile phone %K screening %D 2020 %7 16.4.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date. Objective: We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage. Methods: We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment. Results: MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT. Conclusions: Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult. %M 32297867 %R 10.2196/14632 %U http://pediatrics.jmir.org/2020/1/e14632/ %U https://doi.org/10.2196/14632 %U http://www.ncbi.nlm.nih.gov/pubmed/32297867 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14118 %T A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study %A Martin,Anne %A Caon,Maurizio %A Adorni,Fulvio %A Andreoni,Giuseppe %A Ascolese,Antonio %A Atkinson,Sarah %A Bul,Kim %A Carrion,Carme %A Castell,Conxa %A Ciociola,Valentina %A Condon,Laura %A Espallargues,Mireia %A Hanley,Janet %A Jesuthasan,Nithiya %A Lafortuna,Claudio L %A Lang,Alexandra %A Prinelli,Federica %A Puidomenech Puig,Elisa %A Tabozzi,Sarah A %A McKinstry,Brian %+ UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, 44 141353 ext 7603, Anne.Martin@glasgow.ac.uk %K health behavior %K obesity %K co-design %K mHealth %K mobile app %K mobile phone %K adolescents %K youth %K focus groups %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. %M 32130179 %R 10.2196/14118 %U https://mhealth.jmir.org/2020/3/e14118 %U https://doi.org/10.2196/14118 %U http://www.ncbi.nlm.nih.gov/pubmed/32130179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16426 %T Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study %A Matin,Shababa B %A Wallingford,Allison %A Xu,Shicheng %A Ng,Natalie %A Ho,Anthony %A Vanosdoll,Madison %A Waiswa,Peter %A Labrique,Alain B %A Acharya,Soumyadipta %+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, , Baltimore, MD, , United States, 1 4105167074, acharya@jhu.edu %K newborn %K neonatal health %K community health workers %K maternal behavior %K Uganda %K World Health Organization %K mobile apps %K telemedicine %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective: The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods: A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results: In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. Three days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions: NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health. %M 32130174 %R 10.2196/16426 %U https://mhealth.jmir.org/2020/2/e16426 %U https://doi.org/10.2196/16426 %U http://www.ncbi.nlm.nih.gov/pubmed/32130174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15663 %T Factors Related to User Ratings and User Downloads of Mobile Apps for Maternal and Infant Health: Cross-Sectional Study %A Biviji,Rizwana %A Vest,Joshua R %A Dixon,Brian E %A Cullen,Theresa %A Harle,Christopher A %+ Science of Healthcare Delivery, College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ, 85004, United States, 1 6024963300, Rizwana.Biviji@asu.edu %K mHealth %K mobile apps %K pregnancy %K parturition %K infant care %K smartphones %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps related to maternal and infant health (MIH) are prevalent and frequently used. Some of these apps are extremely popular and have been downloaded over 5 million times. However, the understanding of user behavior and user adoption of these apps based on consumer preferences for different app features and categories is limited. Objective: This study aimed to examine the relationship between MIH app characteristics and users’ perceived satisfaction and intent to use. Methods: The associations between app characteristics, ratings, and downloads were assessed in a sample of MIH apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. Multivariable linear regression was used to assess the relationship between app characteristics and user ratings, and ordinal logistic regression was used to assess the relationship between app characteristics and user downloads. Results: The analyses of user ratings and downloads included 421 and 213 apps, respectively. The average user rating was 3.79 out of 5. Compared with the Apple App Store, the Google Play Store was associated with high user ratings (beta=.33; P=.005). Apps with higher standardized user ratings (beta=.80; P<.001), in-app purchases (beta=1.12; P=.002), and in-app advertisements (beta=.64; P=.02) were more frequently downloaded. Having a health care organization developer as part of the development team was neither associated with user ratings (beta=−.20; P=.06) nor downloads (beta=−.14; P=.63). Conclusions: A majority of MIH apps are developed by non–health care organizations, which could raise concern about the accuracy and trustworthiness of in-app information. These findings could benefit app developers in designing better apps and could help inform marketing and development strategies. Further work is needed to evaluate the clinical accuracy of information provided within the apps. %M 32012107 %R 10.2196/15663 %U http://mhealth.jmir.org/2020/1/e15663/ %U https://doi.org/10.2196/15663 %U http://www.ncbi.nlm.nih.gov/pubmed/32012107 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14219 %T A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps %A Zhao,Jing %A Li,Mu %A Freeman,Becky %+ School of Public Health, Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, Australia, 61 04 0650 2156, jzha5010@uni.sydney.edu.au %K infant formula %K food policy %K health promotion %K marketing %K mobile app %K parenting %K breastfeeding %K advertisement %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing. Objective: This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding. Methods: We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure. Results: The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure. Conclusions: The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors. %M 31782743 %R 10.2196/14219 %U http://mhealth.jmir.org/2019/11/e14219/ %U https://doi.org/10.2196/14219 %U http://www.ncbi.nlm.nih.gov/pubmed/31782743 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13604 %T Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study %A Isler,Jasmin %A Sawadogo,N Hélène %A Harling,Guy %A Bärnighausen,Till %A Adam,Maya %A Kagoné,Moubassira %A Sié,Ali %A Greuel,Merlin %A McMahon,Shannon A %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 06221 565344, mcmahon@uni-heidelberg.de %K mHealth %K Burkina Faso %K mothers %K Community Health Workers %K pregnancy %K diet %K dgital health %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions. %M 31710302 %R 10.2196/13604 %U http://mhealth.jmir.org/2019/11/e13604/ %U https://doi.org/10.2196/13604 %U http://www.ncbi.nlm.nih.gov/pubmed/31710302 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 5 %N 1 %P e15231 %T Look to the Future and SMILE: Feasibility of Interactive Voice Assistant Technology to Support Maternal Infant Health %A Sezgin,Emre %A Militello,Lisa %A Huang,Yungui %A Lin,Simon %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, United States, 6143556814, emre.sezgin@nationwidechildrens.org %K behavioral health %K interactive voice response %K mobile health %K mothers %K pregnancy %K self care %K self-management %D 2019 %7 2.10.2019 %9 Abstract %J iproc %G English %X Background: Both maternal and infant mortality rates serve as indicators of population health and are unacceptably high worldwide. Voice assistant (VA) technologies present a potential new modality to support maternal child health. We developed an interactive VA intervention app (SMILE) to deliver brief, maternal-infant education and management skills (eg, perinatal care, stress management, breast feeding, infant-care) using evidence-based content. Objective: The objective was to understand the feasibility and usability of an interactive VA intervention to support maternal and infant health among a group of pregnant women. Methods: We employed a mixed methods study design. Pregnant women were recruited via email and word of mouth. Participants completed a baseline demographic and technology-use survey and were asked to use the intervention over the course of two weeks. Postintervention, participants were invited to participate in an individual or group interview. Interviews were conducted to elicit feedback regarding thoughts and attitudes towards VA technology to support the health of mothers and infants. Descriptive analysis was used to summarize quantitative data (ie, survey responses, app logs) and thematic analysis was used for qualitative data (ie, transcriptions of voice recordings collected from SMILE, transcriptions of follow-up interviews). Results: Out of 46 respondents, 19 participants were consented, completed baseline surveys and used SMILE. Approximately 63% (n=12) of participants participated in exit interviews. The sample was predominantly 25-34 years old (n=16, 84%), part of a two-parent household (n=19, 100%), white (n=15, 79%), and pregnant with their first child (n=12, 63%). Nine participants (47.4%) reported that they practice stress management, and favorable stress-management activities were mainly comprised of exercise activities, yoga, and outdoor activities without technology involvement. Over half of the participants reported using technology to support pregnancy self-management (n=10, 53%). However, participants preferred mobile apps for education and self-management support during pregnancy and relied on the Internet to access health-related information. More than half of participants reported using default VAs on their phone (n=11, 58%) and on smart speakers (n=10, 53%). Yet, VA technology was mainly reported as being used for basic tasks, such as setting a timer or reminder, checking the weather, turning on/off the lights, or playing music. Postintervention, participants verbalized that VA technology was a potential medium for receiving health information, pregnancy-related information, and could be a strategy to engage other family members in the process. Major concerns revolved around security, privacy, trust, and concerns regarding interacting via voice when in public. Conclusions: Although this research is limited by the small and predominantly white sample size, this research represents one of the first studies to explore perceptions and attitudes towards VA to promote maternal-infant health. As VA technology increases in popularity, adoption and utility to support health and well-being among pregnant women is nascent. While VA technology offers some benefits (eg, reduce literacy barriers, hands-free), familiarity and trust of nonvoice digital health tools (eg, mobile apps, Web-based content) remain important in supporting maternal-child health. Digital health solutions that incorporate multiple platforms (eg, mobile apps, Internet, voice) warrant further exploration to optimize support for maternal child health. %R 10.2196/15231 %U https://www.iproc.org/2019/1/e15231 %U https://doi.org/10.2196/15231 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12879 %T Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs %A Amoakoh,Hannah Brown %A Klipstein-Grobusch,Kerstin %A Grobbee,Diederick E %A Amoakoh-Coleman,Mary %A Oduro-Mensah,Ebenezer %A Sarpong,Charity %A Frimpong,Edith %A Kayode,Gbenga A %A Agyepong,Irene Akua %A Ansah,Evelyn K %+ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, PO Box 85500, Utrecht, 3508 GA, Netherlands, 233 264545762, ansomaame@hotmail.com %K mHealth %K maternal health %K neonatal health %K health care systems %K developing countries %K decision-making %K information retrieval systems %D 2019 %7 24.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. Objective: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). Methods: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. Results: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). Conclusions: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health. %M 31127719 %R 10.2196/12879 %U http://mhealth.jmir.org/2019/5/e12879/ %U https://doi.org/10.2196/12879 %U http://www.ncbi.nlm.nih.gov/pubmed/31127719 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e11456 %T Use of Big Data and Machine Learning Methods in the Monitoring and Evaluation of Digital Health Programs in India: An Exploratory Protocol %A Mohan,Diwakar %A Bashingwa,Jean Juste Harrisson %A Dane,Pierre %A Chamberlain,Sara %A Tiffin,Nicki %A Lefevre,Amnesty %+ Department of International Health, Global Disease Epidemiology & Control Program, Johns Hopkins Bloomberg School Public Health, 615 N Wolfe Street, E5614, Baltimore, MD, 21205, United States, 1 4105024545, dr.dmohan79@gmail.com %K machine learning %K mobile health %K IVR messaging %D 2019 %7 24.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health programs, which encompass the subsectors of health information technology, mobile health, electronic health, telehealth, and telemedicine, have the potential to generate “big data.” Objective: Our aim is to evaluate two digital health programs in India—the maternal mobile messaging service (Kilkari) and the mobile training resource for frontline health workers (Mobile Academy). We illustrate possible applications of machine learning for public health practitioners that can be applied to generate evidence on program effectiveness and improve implementation. Kilkari is an outbound service that delivers weekly gestational age–appropriate audio messages about pregnancy, childbirth, and childcare directly to families on their mobile phones, starting from the second trimester of pregnancy until the child is one year old. Mobile Academy is an Interactive Voice Response audio training course for accredited social health activists (ASHAs) in India. Methods: Study participants include pregnant and postpartum women (Kilkari) as well as frontline health workers (Mobile Academy) across 13 states in India. Data elements are drawn from system-generated databases used in the routine implementation of programs to provide users with health information. We explain the structure and elements of the extracted data and the proposed process for their linkage. We then outline the various steps to be undertaken to evaluate and select final algorithms for identifying gaps in data quality, poor user performance, predictors for call receipt, user listening levels, and linkages between early listening and continued engagement. Results: The project has obtained the necessary approvals for the use of data in accordance with global standards for handling personal data. The results are expected to be published in August/September 2019. Conclusions: Rigorous evaluations of digital health programs are limited, and few have included applications of machine learning. By describing the steps to be undertaken in the application of machine learning approaches to the analysis of routine system-generated data, we aim to demystify the use of machine learning not only in evaluating digital health education programs but in improving their performance. Where articles on analysis offer an explanation of the final model selected, here we aim to emphasize the process, thereby illustrating to program implementors and evaluators with limited exposure to machine learning its relevance and potential use within the context of broader program implementation and evaluation. International Registered Report Identifier (IRRID): DERR1-10.2196/11456 %M 31127716 %R 10.2196/11456 %U https://www.researchprotocols.org/2019/5/e11456/ %U https://doi.org/10.2196/11456 %U http://www.ncbi.nlm.nih.gov/pubmed/31127716 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12364 %T Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory %A Sidhu,Suhail %A Ma,Kaoer %A Sadovnikova,Anna %+ LiquidGoldConcept, Inc, , Ypsilanti, MI,, United States, 1 916 905 3544, anna@liquidgoldconcept.com %K milk production %K milk supply %K human lactation %K breastfeeding %K breastfeeding app %K smartphone app %K Social Cognitive Theory %K breastfeeding self-efficacy %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. %M 31518317 %R 10.2196/12364 %U http://pediatrics.jmir.org/2019/1/e12364/ %U https://doi.org/10.2196/12364 %U http://www.ncbi.nlm.nih.gov/pubmed/31518317 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11842 %T Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study %A Alam,Mafruha %A Banwell,Cathy %A Olsen,Anna %A Lokuge,Kamalini %+ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, Canberra, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com %K mobile-based consultation %K mHealth %K remote diagnosis %K referral %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective: We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods: We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results: Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions: Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded. %M 31008716 %R 10.2196/11842 %U http://mhealth.jmir.org/2019/4/e11842/ %U https://doi.org/10.2196/11842 %U http://www.ncbi.nlm.nih.gov/pubmed/31008716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12223 %T Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study %A Ahn,Sang Hyun %A Zhiang,Jooho %A Kim,Hyery %A Chang,Seyun %A Shin,Jaewon %A Kim,Myeongchan %A Lee,Yura %A Lee,Jae-Ho %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %K patient-generated health data %K vaccination %K postvaccination fever %K digital health care %K mobile app %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ≥39°C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05%) children had taken antipyretic drugs, and 3238 (89.15%) children took antibiotics at body temperatures above 38°C. The number of children taking antipyretics at a body temperature of 38°C was more than four times that of those taking antipyretics at 37.9°C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9°C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. %M 31008712 %R 10.2196/12223 %U http://mhealth.jmir.org/2019/4/e12223/ %U https://doi.org/10.2196/12223 %U http://www.ncbi.nlm.nih.gov/pubmed/31008712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11620 %T Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review %A Richardson,Brianna %A Dol,Justine %A Rutledge,Kallen %A Monaghan,Joelle %A Orovec,Adele %A Howie,Katie %A Boates,Talia %A Smit,Michael %A Campbell-Yeo,Marsha %+ School of Nursing, Dalhousie University, PO Box 15000, Forrest Bldg, 5869 University Avenue, Halifax, NS, B3H4R2, Canada, 1 9024944283, marsha.campbell-yeo@dal.ca %K parenting %K intensive care units, neonatal %K review %K mobile health %K mHealth %K mobile apps %K eHealth %K education, nonprofessional %K infant, premature %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents. Objective: This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility. Methods: We systematically searched the Apple App Store and Google Play using 49 key terms (eg, “preterm infant”) from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app’s content usability; and Trust it or Trash It to measure credibility. Results: The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer’s expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures. Conclusions: This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility. %M 30985282 %R 10.2196/11620 %U http://mhealth.jmir.org/2019/4/e11620/ %U https://doi.org/10.2196/11620 %U http://www.ncbi.nlm.nih.gov/pubmed/30985282 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12366 %T Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal %A Kohrt,Brandon A %A Rai,Sauharda %A Vilakazi,Khanya %A Thapa,Kiran %A Bhardwaj,Anvita %A van Heerden,Alastair %+ Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L Street NW, Suite 600, Washington, DC, 20037, United States, 1 4048951643, bkohrt@gwu.edu %K child development %K confidentiality %K culturally competent care %K developing countries %K global health %K mental health %K mobile phones %K wireless technology %D 2019 %7 16.01.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies. Objective: Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology. Methods: We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality. Results: In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child’s wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child. Conclusions: The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology. %M 31518316 %R 10.2196/12366 %U https://pediatrics.jmir.org/2019/1/e12366/ %U https://doi.org/10.2196/12366 %U http://www.ncbi.nlm.nih.gov/pubmed/31518316 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11468 %T Unveiling the Black Box of Diagnostic and Clinical Decision Support Systems for Antenatal Care: Realist Evaluation %A Abejirinde,Ibukun-Oluwa Omolade %A Zweekhorst,Marjolein %A Bardají,Azucena %A Abugnaba-Abanga,Rudolf %A Apentibadek,Norbert %A De Brouwere,Vincent %A van Roosmalen,Jos %A Marchal,Bruno %+ Athena Institute, Faculty of Science, Vrije Universiteit, WN Building, S-544, De Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 205983143, i.o.abejirinde@vu.nl %K systems analysis %K Ghana %K clinical decision support %K antenatal care %K mHealth %K program evaluation %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital innovations have shown promise for improving maternal health service delivery. However, low- and middle-income countries are still at the adoption-utilization stage. Evidence on mobile health has been described as a black box, with gaps in theoretical explanations that account for the ecosystem of health care and their effect on adoption mechanisms. Bliss4Midwives, a modular integrated diagnostic kit to support antenatal care service delivery, was piloted for 1 year in Northern Ghana. Although both users and beneficiaries valued Bliss4Midwives, results from the pilot showed wide variations in usage behavior and duration of use across project sites. Objective: To strengthen the design and implementation of an improved prototype, the study objectives were two-fold: to identify causal factors underlying the variation in Bliss4Midwives usage behavior and understand how to overcome or leverage these in subsequent implementation cycles. Methods: Using a multiple case study design, a realist evaluation of Bliss4Midwives was conducted. A total of 3 candidate program theories were developed and empirically tested in 6 health facilities grouped into low and moderate usage clusters. Quantitative and qualitative data were collected and analyzed using realist thinking to build configurations that link intervention, context, actors, and mechanisms to program outcomes, by employing inductive and deductive reasoning. Nonparametric t test was used to compare the perceived usefulness and perceived ease of use of Bliss4Midwives between usage clusters. Results: We found no statistically significant differences between the 2 usage clusters. Low to moderate adoption of Bliss4Midwives was better explained by fear, enthusiasm, and high expectations for service delivery, especially in the absence of alternatives. Recognition from pregnant women, peers, supervisors, and the program itself was a crucial mechanism for device utilization. Other supportive mechanisms included ownership, empowerment, motivation, and adaptive responses to the device, such as realignment and negotiation. Champion users displayed high adoption-utilization behavior in contexts of participative or authoritative supervision, yet used the device inconsistently. Intervention-related (technical challenges, device rotation, lack of performance feedback, and refresher training), context-related (staff turnover, competing priorities, and workload), and individual factors (low technological self-efficacy, baseline knowledge, and internal motivation) suppressed utilization mechanisms. Conclusions: This study shed light on optimal conditions necessary for Bliss4Midwives to thrive in a complex social and organizational setting. Beyond usability and viability studies, advocates of innovative technologies for maternal care need to consider how implementation strategies and contextual factors, such as existing collaborations and supervision styles, trigger mechanisms that influence program outcomes. In addition to informing scale-up of the Bliss4Midwives prototype, our results highlight the need for interventions that are guided by research methods that account for complexity. %M 30578177 %R 10.2196/11468 %U http://mhealth.jmir.org/2018/12/e11468/ %U https://doi.org/10.2196/11468 %U http://www.ncbi.nlm.nih.gov/pubmed/30578177 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11447 %T An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation %A Pham,Quynh %A Graham,Gary %A Lalloo,Chitra %A Morita,Plinio P %A Seto,Emily %A Stinson,Jennifer N %A Cafazzo,Joseph A %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, Suite 425, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 (416) 340 4800 ext 4765, q.pham@mail.utoronto.ca %K analytics %K engagement %K log data %K mobile health %K mobile apps %K chronic disease %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. %M 30578179 %R 10.2196/11447 %U http://mhealth.jmir.org/2018/12/e11447/ %U https://doi.org/10.2196/11447 %U http://www.ncbi.nlm.nih.gov/pubmed/30578179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e192 %T Parents’ Perspectives on the Theoretical Domains Framework Elements Needed in a Pediatric Health Behavior App: A Crowdsourced Social Validity Study %A Cushing,Christopher C %A Fedele,David A %A Brannon,Erin E %A Kichline,Tiffany %+ Clinical Child Psychology Program, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Room 2011, Lawrence, KS, 66049, United States, 1 7858640713, christopher.cushing@ku.edu %K mHealth %K adolescent %K children %K parent %K stakeholder %K consumer preference %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial products that are not based in theory or evidence and may not take stakeholder preferences into account. Objective: The aim was to assess parent preference for mobile app features that map onto specific Theoretical Domains Framework (TDF) elements. Methods: This study was a crowdsourced social validity study of 183 parents who were asked to rate their preferences for mobile app features that correspond to elements of the TDF. The TDF organizes a large number of theoretical models and constructs into three components: (1) capability, (2) motivation, and (3) opportunity. Parents of children were recruited through Amazon Mechanical Turk. Results: The majority of participants were Caucasian and mean age was 36.9 (SD 8.0) years. Results revealed broad acceptability of communication, motivation, and opportunity domains. However, the degree to which each domain was valued varied within behavioral category. Parents demonstrated a preference for increasing procedural knowledge for physical activity and diet behaviors over sleep (F2,545=5.18, P=.006). Similarly, parents valued self-monitoring as more important for physical activity than sleep (F2,546=4.04, P=.02). When asked about the value of features to help children develop skills, parents preferred those features for dietary behavior over sleep (F2,546=3.57, P=.03). Parents perceived that goal-setting features would be most useful for physical activity over sleep and diet (F2,545=5.30, P=.005). Incentive features within the app were seen as most useful for physical activity over sleep (F2,546=4.34, P=.01). Conclusions: This study presents a low-cost strategy for involving a large number of stakeholders in the discussion of how health behavior theory should be applied in a mHealth intervention. Our approach is innovative in that it took a scientific framework (ie, TDF) and made it digestible to parents so that they could then provide their opinions about features that might appear in a future app. Our survey items discriminated between various health behaviors allowing stakeholders to communicate the different health behaviors that they would like a TDF feature to change. Moreover, we were able to develop a set of consumer opinions about features that were directly linked to elements of the TDF. %M 30578173 %R 10.2196/mhealth.9808 %U https://mhealth.jmir.org/2018/12/e192/ %U https://doi.org/10.2196/mhealth.9808 %U http://www.ncbi.nlm.nih.gov/pubmed/30578173 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11213 %T The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial %A Xie,Ri-Hua %A Tan,Hongzhuan %A Taljaard,Monica %A Liao,Yan %A Krewski,Daniel %A Du,Qingfeng %A Wen,Shi Wu %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON, ON K1H 8L6, Canada, 1 6137378899 ext 73912, swwen@ohri.ca %K maternal education %K text messaging %K maternal health %K infant health %K cluster trial %D 2018 %7 19.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. Objective: This study aimed to explore the impact of a maternal education program through text messaging. Methods: We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. Results: A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. Conclusions: Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. Trial Registration: ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo) %M 30567693 %R 10.2196/11213 %U http://mhealth.jmir.org/2018/12/e11213/ %U https://doi.org/10.2196/11213 %U http://www.ncbi.nlm.nih.gov/pubmed/30567693 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11080 %T Clinical Adoption of mHealth Technology to Support Pediatric Cystic Fibrosis Care in Sweden: Qualitative Case Study %A Longacre,Meghan %A Grande,Stuart %A Hager,Andreas %A Montan,Meera %A Bergquist,Rikard Palmer %A Martensson,Maria %A Kotzbauer,Greg %+ The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Medical Center Drive, HB 7252, Lebanon, NH, 03756-1000, United States, 1 603 650 1565, meghan.longacre@dartmouth.edu %K cystic fibrosis %K mHealth %K mobile phone %K pediatrics %K qualitative case study %K technology %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mobile health (mHealth) technologies have potential to improve self-management and care co-ordination of pediatric chronic diseases requiring complex care, such as cystic fibrosis (CF). Barriers to implementation include the lack of support and infrastructure to use mHealth in the clinical microsystem. Coproducing mHealth technology with patients, clinicians, and designers may increase the likelihood of successful integration into the clinical setting. Objective: This study explored the development, adoption, and integration of a new, co-produced mHealth platform (Genia) for the management of pediatric CF in Sweden. Methods: A retrospective, qualitative case study approach was used. The case was defined as the process of introducing and using Genia at the Pediatric Cystic Fibrosis Center at Skåne University Hospital in Lund, Sweden. Data sources included interviews, presentations, meeting notes, and other archival documents created between 2014 and 2017. To be included, data sources must have described or reflected upon the Genia adoption process. Iterative content analysis of data source materials was conducted by 2 qualitatively trained researchers to derive themes characterizing the mHealth clinical adoption process. Results: In total, 4 core themes characterized successful clinical integration of Genia in Lund: cultural readiness to use mHealth; use of weekly huddles to foster momentum and rapid iteration; engagement in incremental “Genia Talk” to motivate patient adoption; and co-design approach toward pediatric chronic care. Conclusions: Principles of quality improvement, relational co-ordination, user-centered design, and coproduction can facilitate the integration of mHealth technology into clinical care systems for pediatric CF care. %M 31518297 %R 10.2196/11080 %U http://pediatrics.jmir.org/2018/2/e11080/ %U https://doi.org/10.2196/11080 %U http://www.ncbi.nlm.nih.gov/pubmed/31518297 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e189 %T The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review %A Hughson,Jo-anne Patricia %A Daly,J Oliver %A Woodward-Kron,Robyn %A Hajek,John %A Story,David %+ Research Unit for Multilingualism and Cross-Cultural Communication, University of Melbourne, Babel Building, Parkville, 3010, Australia, 61 425710396, hughson@unimelb.edu.au %K culture %K emigrants and immigrants %K health communication %K information-seeking behavior %K literacy %K maternal health %K mHealth %K mobile phone %K pregnancy %K self-care %K vulnerable populations %D 2018 %7 16.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control. Objective: This review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed. Methods: We chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women’s use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies. Results: We found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women’s use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information. %M 30446483 %R 10.2196/mhealth.9119 %U https://mhealth.jmir.org/2018/11/e189/ %U https://doi.org/10.2196/mhealth.9119 %U http://www.ncbi.nlm.nih.gov/pubmed/30446483 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e9 %T Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study %A Endehabtu,Berhanu %A Weldeab,Adane %A Were,Martin %A Lester,Richard %A Worku,Abebaw %A Tilahun,Binyam %+ eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, PO Box 196, Gondar,, Ethiopia, 251 913875066, binigcms@gmail.com %K mHealth %K mobile phone %K pregnant women %K SMS %K willingness %K Ethiopia %K antenatal care %K maternal health %D 2018 %7 17.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)–based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message–based mHealth intervention. Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message–based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message–based mHealth interventions. %M 31518334 %R 10.2196/pediatrics.9618 %U http://pediatrics.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/pediatrics.9618 %U http://www.ncbi.nlm.nih.gov/pubmed/31518334 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e153 %T Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis %A LeFevre,Amnesty %A Cabrera-Escobar,Maria A %A Mohan,Diwakar %A Eriksen,Jaran %A Rogers,Debbie %A Neo Parsons,Annie %A Barre,Iman %A Jo,Youngji %A Labrique,Alain %A Coleman,Jesse %+ Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm,, Sweden, 46 852480000, denots@gmail.com %K mHealth %K cost effectiveness %K cost utility analysis %K digital health %D 2018 %7 27.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Limited evidence exists on the value for money of mHealth information programs in low resource settings. Objective: This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017. Methods: Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant’s first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses. Results: Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results. %M 30054263 %R 10.2196/mhealth.8185 %U http://mhealth.jmir.org/2018/7/e153/ %U https://doi.org/10.2196/mhealth.8185 %U http://www.ncbi.nlm.nih.gov/pubmed/30054263 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e6 %T Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children: Mixed-Methods Predevelopment Formative Research %A Hollier,John M %A Vaughan,Adetola O %A Liu,Yan %A van Tilburg,Miranda AL %A Shulman,Robert J %A Thompson,Debbe I %+ Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite 1010, Houston, TX, 77030, United States, 1 8328243814, jmhollie@bcm.edu %K functional abdominal pain disorders %K guided imagery therapy %K mixed methods %K mobile applications %K pediatrics %K parents %K Technology Acceptance Model %K imagery (psychotherapy) %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child’s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care. %M 31518303 %R 10.2196/pediatrics.8535 %U http://pediatrics.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/pediatrics.8535 %U http://www.ncbi.nlm.nih.gov/pubmed/31518303 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e144 %T How New and Expecting Fathers Engage With an App-Based Online Forum: Qualitative Analysis %A White,Becky K %A Giglia,Roslyn C %A Scott,Jane A %A Burns,Sharyn K %+ Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 4123, s.burns@curtin.edu.au %K mHealth %K mobile app %K breastfeeding %K fathers %K online communities %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is important for infants, and fathers are influential in supporting their partner in their decision to breastfeed and how long they breastfeed for. Fathers can feel excluded from traditional antenatal education and support opportunities but highly value social support from peers. Online health forums can be a useful source of social support, yet little is known about how fathers would use a conversation forum embedded in a breastfeeding-focused app. Milk Man is a mobile app that aimed to increase paternal support for breastfeeding using a range of strategies, including a conversation forum. Objective: The aim of this study was to examine how fathers used a breastfeeding-focused conversation forum contained within a mobile app throughout the perinatal period. Methods: A qualitative analysis of comments posted by users in the online forum contained within the Milk Man app was conducted. The app contained a library of information for fathers, as well as a conversation forum. Thematic analysis was used to organize and understand the data. The NVivo 11 software package was used to code comments into common nodes, which were then organized into key themes. Results: In all, 208 contributors (35.5% [208/586] of those who had access to the app) posted at least once within the forum. In total, 1497 comments were included for analysis. These comments were coded to 3799 individual nodes and then summarized to 54 tree nodes from which four themes emerged to describe how fathers used the app. Themes included seek and offer support, social connection, informational support provision, and sharing experiences. Posting in the forum was concentrated in the antenatal period and up to approximately 6 weeks postpartum. Conclusions: These data show that fathers are prepared to use a breastfeeding-focused online forum in a variety of ways to facilitate social support. Fathers can be difficult to reach in the perinatal period, yet engaging them and increasing social support is important. This research demonstrates the acceptability of an innovative way of engaging new and expecting fathers. %M 29914862 %R 10.2196/mhealth.9999 %U http://mhealth.jmir.org/2018/6/e144/ %U https://doi.org/10.2196/mhealth.9999 %U http://www.ncbi.nlm.nih.gov/pubmed/29914862 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e140 %T The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets %A Zhang,Puhong %A Dong,Le %A Chen,Huan %A Chai,Yanling %A Liu,Jianbo %+ Department of Women and Child Health, The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Beijing, 100088, China, 86 1082800577 ext 512, zpuhong@georgeinstitute.org.cn %K mHealth %K health services, maternal-child %K mobile apps %K market research %D 2018 %7 08.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health services are thriving in the field of maternal and child health in China due to expansions in the field of electronic health and the introduction of the two-child policy. There are numerous maternal and child health apps in computer stores, but the exact number of apps, number of downloads, and features of these apps is not known. Objective: This study aimed to explore the use of maternal and child health apps in Android and iOS app stores and to describe the key functional features of the most popular apps, with the purpose of providing insight into further research and development of maternal and child health mobile health products. Methods: The researchers conducted a search in the 3 most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant, and 360 Mobile Assistant) and the iTunes App Store in China. All apps regarding family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were included in the initial analysis. Maternal and child health mobile apps with predominant features of product marketing, children’s songs, animation, or games were excluded from the study. The 50 most frequently used apps in each of the Android stores as well as the iTunes store (a total of 78 deduplicated apps) were selected and downloaded for an in-depth analysis. Results: A total of 5276 Android apps and 877 iOS apps developed for maternal and child health care were identified. Of the 78 most frequently used apps, 43 (55%) apps focused on one stage of MCH care, mainly targeting child care (25 apps) and before pregnancy care (11 apps), whereas 35 (45%) of the apps covered 2 or more stages, most of which (32 apps) included both pregnancy and child care services. The app features that were commonly adopted by the popular apps were health education, communication, health status self-monitoring, a diary, reminders, and counseling. Within the app feature of “health status self-monitoring,” the researchers found 47 specific tools supporting activities such as pregnancy preparation, fetal heart monitoring, blood glucose and blood pressure monitoring, and doctor visits. A few apps were equipped with external devices (n=3) or sensors. No app with intelligent decision-support features to support disease management for conditions such as gestational diabetes and pregnancy-induced hypertension was found. A small number of apps (n=5) had a Web connection with hospital information systems to support appointment making, payments, hospital service guidance, or checking of laboratory results. Conclusions: There are thousands of maternal and child health apps in the Chinese market. Child care, pregnancy, and before pregnancy were the mostly covered maternal and child health stages, in that order. Various app features and tools were adopted by maternal and child health apps, but the use of internal or external sensors, intelligent decision support, and tethering with existing hospital information systems was rare and these features need more research and development. %M 29884601 %R 10.2196/mhealth.9302 %U http://mhealth.jmir.org/2018/6/e140/ %U https://doi.org/10.2196/mhealth.9302 %U http://www.ncbi.nlm.nih.gov/pubmed/29884601