TY - JOUR AU - Waring, E. Molly AU - McManus-Shipp, E. Katherine AU - Field, M. Christiana AU - Bhusal, Sandesh AU - Perez, Asley AU - Shapiro, Olivia AU - Gaspard, A. Sophia AU - Dennis, Cindy-Lee PY - 2025/4/30 TI - Exposure to and Engagement With Digital Psychoeducational Content and Community Related to Maternal Mental Health by Perinatal Persons and Mothers: Protocol for a Web-Based Survey With Optional Follow-Up JO - JMIR Res Protoc SP - e64075 VL - 14 KW - social media KW - podcasts KW - blogs KW - perinatal mental health KW - maternal mental health KW - digital health KW - engagement N2 - Background: Leveraging digital platforms may be an effective strategy for connecting perinatal persons and mothers with evidence-based information and support related to maternal mental health and peers. Momwell is a mom-centered model of care that provides psychoeducational content through several digital platforms, including social media, a podcast, and a blog. The aims of this project were to describe how perinatal persons and mothers engage with Momwell?s psychoeducational content and community; describe the perceived benefits of exposure to and engagement with content and community; examine associations between engagement with digital psychoeducational content and maternal mental health, parenting attitudes, and interparental relationships; and examine changes in mental health and parenting attitudes and concurrent engagement with Momwell?s digital psychoeducational content and community over 2 to 3 months. Objective: This paper aims to describe the design of a study of perinatal persons and mothers who are exposed to or engage with Momwell?s psychoeducational content and community and describe sample characteristics. Methods: Adults who engaged with Momwell on any of their digital platforms were recruited to complete a web-based survey in July 2023 to September 2023. Participants completed either a longer or shorter survey. Participants who provided permission to be recontacted were invited to complete a second survey 2 to 3 months later. The surveys included validated psychological measures, study-specific quantitative questions, and open-ended questions that assessed participant demographics, exposure to and engagement with Momwell?s psychoeducational content and community, maternal mental health, parenting relationships, parenting self-efficacy, and additional psychosocial and health measures. We outline planned analyses to achieve the aims of the project. Results: Data collection occurred from July 2023 to September 2023 (N=584). A subset of participants completed the optional second survey in October 2023 to December 2023 (N=246). Participants were >99% mothers (582/584, 99.7%); 45.5% (266/584) perinatal (59/584, 10.1% pregnant; 210/584, 36% post partum); and, on average, aged 32.4 (SD 3.9) years. In total, 59.1% (345/584) were from the United States, 35.6% (208/584) were from Canada, and 5.3% (31/584) were from other countries. The vast majority (552/584, 94.5%) followed Momwell on Instagram, 44.2% (258/584) listened to the Momwell podcast, and 41.1% (240/584) received their newsletter. Most participants had been exposed to Momwell?s psychoeducational content for at least 6 months across the different platforms (range 16/36, 44% on TikTok to 480/552, 87% on Instagram). Conclusions: Data from this study will provide insights into how pregnant persons and mothers use digital psychoeducational content and peer communities to support their mental health throughout the perinatal period and into the early years of motherhood. Leveraging digital platforms to disseminate evidence-based digital psychoeducational content related to maternal mental health and connect peers has the potential to change how we care for perinatal persons and mothers. International Registered Report Identifier (IRRID): DERR1-10.2196/64075 UR - https://www.researchprotocols.org/2025/1/e64075 UR - http://dx.doi.org/10.2196/64075 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64075 ER - TY - JOUR AU - Chua, Xin Joelle Yan AU - Choolani, Mahesh AU - Chee, Ing Cornelia Yin AU - Yi, Huso AU - Lalor, Gabrielle Joan AU - Chong, Seng Yap AU - Shorey, Shefaly PY - 2025/4/17 TI - A Mobile App?Based Intervention (Parentbot?a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e64882 VL - 27 KW - perinatal KW - mobile app KW - app use KW - survey response KW - parents KW - randomized controlled trial KW - artificial intelligence KW - AI N2 - Background: Mobile app?based interventions are viable methods of delivering perinatal care support to parents. A mobile app?based intervention entitled Parentbot?a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants? use and the components that are appreciated by them. Objective: This study aims to examine the (1) relationship between participants? characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants? characteristics and the time taken to respond to the surveys (survey response timing). Methods: This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents? characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants? sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants? sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes. Results: The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents? anxiety (?=?0.48, 95% CI ?0.94 to ?0.009; P=.046), parent-child bonding (?=?0.10, 95% CI ?0.19 to ?0.01; P=.03), social support (?=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (?=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents? age, ethnicity, grouping, and number of children were found to be related to the survey response timing. Conclusions: As the viewing of PDA?s educational materials was linked to improvements in parents? perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents? well-being, future interventions could explore alternative activities to better engage parents. Future mobile app?based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study. UR - https://www.jmir.org/2025/1/e64882 UR - http://dx.doi.org/10.2196/64882 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64882 ER - TY - JOUR AU - Parry, Monica AU - Huang, Tony AU - Clarke, Hance AU - Bjørnnes, Kristin Ann AU - Harvey, Paula AU - Parente, Laura AU - Norris, Colleen AU - Pilote, Louise AU - Price, Jennifer AU - Stinson, N. Jennifer AU - O?Hara, Arland AU - Fernando, Madusha AU - Watt-Watson, Judy AU - Nickerson, Nicole AU - Spiteri DeBonis, Vincenza AU - Hart, Donna AU - Faubert, Christine PY - 2025/4/17 TI - Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study JO - JMIR Hum Factors SP - e57583 VL - 12 KW - digital health KW - chatbot KW - women KW - cardiac pain KW - usability testing KW - self-management KW - artificial intelligence KW - AI N2 - Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092 UR - https://humanfactors.jmir.org/2025/1/e57583 UR - http://dx.doi.org/10.2196/57583 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57583 ER - TY - JOUR AU - Ajayi, Toluwalase AU - Kueper, Jacqueline AU - Ariniello, Lauren AU - Ho, Diana AU - Delgado, Felipe AU - Beal, Matthew AU - Waalen, Jill AU - Baca Motes, Katie AU - Ramos, Edward PY - 2025/4/7 TI - Digital Health Platform for Maternal Health: Design, Recruitment Strategies, and Lessons Learned From the PowerMom Observational Cohort Study JO - JMIR Form Res SP - e70149 VL - 9 KW - maternal health research KW - digital health platforms KW - pregnancy monitoring KW - decentralized clinical trials KW - participant engagement KW - health disparities N2 - Background: Maternal health research faces challenges in participant recruitment, retention, and data collection, particularly among underrepresented populations. Digital health platforms like PowerMom (Scripps Research) offer scalable solutions, enabling decentralized, real-world data collection. Using innovative recruitment and multimodal techniques, PowerMom engages diverse cohorts to gather longitudinal and episodic data during pregnancy and post partum. Objective: This study aimed to evaluate the design, implementation, and outcomes of the PowerMom research platform, with a focus on participant recruitment, engagement, and data collection across diverse populations. Secondary objectives included identifying challenges encountered during implementation and deriving lessons to inform future digital maternal health studies. Methods: Participants were recruited via digital advertisements, pregnancy apps, and the PowerMom Consortium of more than 15 local and national organizations. Data collection included self-reported surveys, wearable devices, and electronic health records. Anomaly detection measures were implemented to address fraudulent enrollment activity. Recruitment trends and descriptive statistics from survey data were analyzed to summarize participant characteristics, assess engagement metrics, and quantify missing data to identify gaps. Results: Overall, 5617 participants were enrolled from 2021 to 2024, with 69.8% (n=3922) providing demographic data. Of these, 48.5% (2723/5617) were younger than 35 years, 14% (788/5617) identified as Hispanic or Latina, and 13.7% (770/5617) identified as Black or African American. Geographic representation spanned all 50 US states, Puerto Rico, and Guam, with 58.3% (3276/5617) residing in areas with moderate access to maternity care and 16.4% (919/5617) in highly disadvantaged neighborhoods based on the Area Deprivation Index. Enrollment rates increased substantially over the study period, from 55 participants in late 2021 to 3310 in 2024, averaging 99.4 enrollments per week in 2024. Participants completed a total of 17,123 surveys, with 71.8% (4033/5617) completing the Intake Survey and 12.4% (697/5617) completing the Postpartum Survey. Wearable device data were shared by 1168 participants, providing more than 378,000 daily biometric measurements, including activity levels, sleep, and heart rate. Additionally, 96 participants connected their electronic health records, contributing 276 data points such as diagnoses, medications, and laboratory results. Among pregnancy-related characteristics, 28.1% (1578/5617) enrolled during the first trimester, while 15.1% (849/5617) reported information about the completion of their pregnancies during the study period. Among the 913 participants who shared delivery information, 56.1% (n=512) had spontaneous vaginal deliveries and 17.9% (n=163) underwent unplanned cesarean sections. Conclusions: The PowerMom platform demonstrates the feasibility of using digital tools to recruit and engage diverse populations in maternal health research. Its ability to integrate multimodal data sources showcases its potential to provide comprehensive maternal-fetal health insights. Challenges with data completeness and survey attrition underscore the need for sustained participant engagement strategies. These findings offer valuable lessons for scaling digital health platforms and addressing disparities in maternal health research. Trial Registration: ClinicalTrials.gov NCT03085875; https://clinicaltrials.gov/study/NCT03085875 UR - https://formative.jmir.org/2025/1/e70149 UR - http://dx.doi.org/10.2196/70149 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70149 ER - TY - JOUR AU - Plouvier, Pauline AU - Marcilly, Romaric AU - Robin, Geoffroy AU - Benamar, Chaymae AU - Robin, Camille AU - Simon, Virginie AU - Piau, Sophie Anne AU - Cambay, Isabelle AU - Schiro, Jessica AU - Decanter, Christine PY - 2025/2/24 TI - Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study JO - JMIR Hum Factors SP - e63570 VL - 12 KW - mobile apps KW - mHealth KW - mobile health KW - assisted reproductive technologies KW - evaluation KW - satisfaction KW - reproduction KW - fertility KW - ovarian stimulation KW - ease of use KW - usability KW - midwives KW - obstetrics KW - gynecology N2 - Background: Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR). Objective: This study aimed to evaluate the patients? and midwives? levels of satisfaction with the connected mobile app. Methods: We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users? opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives. Results: Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app?s ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors. Conclusions: The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team?s workload, the time savings provided by the app constitute a nonnegligible advantage. UR - https://humanfactors.jmir.org/2025/1/e63570 UR - http://dx.doi.org/10.2196/63570 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63570 ER - TY - JOUR AU - Hassdenteufel, Kathrin AU - Müller, Mitho AU - Abele, Harald AU - Brucker, Yvonne Sara AU - Graf, Johanna AU - Zipfel, Stephan AU - Bauer, Armin AU - Jakubowski, Peter AU - Pauluschke-Fröhlich, Jan AU - Wallwiener, Markus AU - Wallwiener, Stephanie PY - 2025/2/24 TI - Improving Maternal Mental Health and Weight Control With a Mindfulness Blended Care Approach: Insights From a Randomized Controlled Trial JO - J Med Internet Res SP - e56230 VL - 27 KW - peripartum mental health KW - digital intervention KW - depression KW - anxiety KW - personal coaching KW - ehealth KW - pregnancy KW - maternal mental health KW - weight gain KW - mindfulness-based intervention KW - coaching KW - randomized controlled clinical trial KW - postpartum KW - treatment KW - electronic KW - effectiveness KW - women N2 - Background: Perinatal maternal mental health problems, such as depression and anxiety, are highly prevalent during pregnancy and post partum. Electronic mindfulness-based interventions (eMBIs) are a promising treatment option, which can be provided in a low-threshold, cost-effective manner. However, research underscores the fact that face-to-face coaching sessions are more effective than solely digital methods. A blended care approach (eMBI with direct face-to-face coaching) could amplify the therapeutic impact on maternal mental health and weight gain during the perinatal period. Objective: We investigated whether combining an eMBI intervention with face-to-face personal support significantly improves maternal mental health, and whether the intervention can influence weight gain in affected women during pregnancy. Methods: A community-based sample of 460 pregnant women with a singleton pregnancy who screened positive for depression was enrolled in a multicenter randomized controlled trial (RCT) including the University Hospitals of Heidelberg and Tübingen as well as more than 200 gynecological practices within the state of Baden-Württemberg in Germany between February 2019 and October 2020. Participating women were randomized 1:1 to the control group (CG) or intervention group (IG) that received access to an 8-week pregnancy-adapted eMBI between the 29th and 36th gestational week. In a subanalysis, we grouped participants in those receiving only the initial face-to-face coaching session at recruitment (no personal coaching) and those with ?2 personal coaching sessions. Primary outcome measures were severity of depressive symptoms using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, the Pregnancy-Related Anxiety Questionnaire, the Freiburg Mindfulness Inventory, and the Patient Health Questionnaire; secondary outcome measure, BMI. Results: In the final sample, 137 CG women and 102 IG women received only one coaching session, whereas 37 CG women and 40 IG women received at least 2 (mean 2.3, SD 0.7) coaching sessions. The analyses were adjusted for significant confounders. The IG?s mindfulness scores increased significantly (F1.873,344.619=4.560, P=.01, ?²=0.024, ?²=0.012) regardless of coaching frequency. Both general anxiety (F12,129=2.361, P=.01, ?²=0.0180, ?²=0.100) and depression symptoms (F4.758, 699.423=3.033, P=.01, ?²=0.020, ?²=0.009) were significantly lower in the group that received ?2 coaching sessions than in the no-personal-coaching group. In the group receiving ?2 coaching sessions, BMI generally was lower in the IG than in the CG (F3.555,444.416=4.732, P=.002, ?²=0.036, ?²=0.013). Conclusions: Adding a minimal amount of PC to the digital eMBI increased mindfulness and decreased birth-related anxiety, symptoms of depression, and anxiety in at-risk pregnant women. Favorable effects on gestational weight gain were found in the respective IGs, the strongest effect being within the PC group. This blended digital health approach amplifies the effectiveness of the digital intervention. Trial Registration: German Clinical Trials Register DRKS00017210; https://www.drks.de/search/de/trial/DRKS00017210 UR - https://www.jmir.org/2025/1/e56230 UR - http://dx.doi.org/10.2196/56230 UR - http://www.ncbi.nlm.nih.gov/pubmed/39992700 ID - info:doi/10.2196/56230 ER - TY - JOUR AU - Fitzgerald, Haley AU - Frank, Madison AU - Kasula, Katelyn AU - Krans, E. Elizabeth AU - Krishnamurti, Tamar PY - 2025/2/13 TI - Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study JO - JMIR Pediatr Parent SP - e60038 VL - 8 KW - substance use disorder KW - substance use screening KW - mHealth KW - mobile health apps KW - pregnancy KW - technology N2 - Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75%) and Medicaid insured (26/28, 93%), with an annual household income of 12). Two main themes were generated from the analysis: (1) Mothers? Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. UR - https://www.jmir.org/2024/1/e53720 UR - http://dx.doi.org/10.2196/53720 UR - http://www.ncbi.nlm.nih.gov/pubmed/39680428 ID - info:doi/10.2196/53720 ER - TY - JOUR AU - Jones, Catherine AU - Cui, Yi AU - Jeminiwa, Ruth AU - Bajracharya, Elina AU - Chang, Katie AU - Ma, Tony PY - 2024/12/12 TI - Personalized and Culturally Tailored Features of Mobile Apps for Gestational Diabetes Mellitus and Their Impact on Patient Self-Management: Scoping Review JO - JMIR Diabetes SP - e58327 VL - 9 KW - gestational diabetes KW - pregnancy KW - cultural tailoring KW - cultural adaptation KW - personalization KW - maternal health KW - mobile health KW - mHealth KW - smartphone KW - mobile app KW - mobile phone KW - self management; social determinants of health N2 - Background: Gestational diabetes mellitus (GDM) is an increasingly common high-risk pregnancy condition requiring intensive daily self-management, placing the burden of care directly on the patient. Understanding personal and cultural differences among patients is critical for delivering optimal support for GDM self-management, particularly in high-risk populations. Although mobile apps for GDM self-management are being used, limited research has been done on the personalized and culturally tailored features of these apps and their impact on patient self-management. Objective: This scoping review aims to explore the extent to which published studies report the integration and effectiveness of personalized and culturally tailored features in GDM mobile apps for patient self-management support. Methods: We examined English-language peer-reviewed articles published between October 2016 and May 2023 from PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, Proquest Research Library, and Google Scholar using search terms related to digital tools, diabetes, pregnancy, and cultural tailoring. We reviewed eligible articles and extracted data using the Arskey and O?Malley methodological framework. Results: Our search yielded a total of 1772 articles after the removal of duplicates and 158 articles for full-text review. A total of 21 articles that researched 15 GDM mobile apps were selected for data extraction. Our results demonstrated the stark contrast between the number of GDM mobile apps with personalized features for the individual user (all 15 mobile apps) and those culturally tailored for a specific population (only 3 of the 15 mobile apps). Our findings showed that GDM mobile apps with personalized and culturally tailored features were perceived to be useful to patients and had the potential to improve patients? adherence to glycemic control and nutrition plans. Conclusions: There is a strong need for increased research and development to foster the implementation of personalized and culturally tailored features in GDM mobile apps for self-management that cater to patients from diverse backgrounds and ethnicities. Personalized and culturally tailored features have the potential to serve the unique needs of patients more efficiently and effectively than generic features alone; however, the impacts of such features still need to be adequately studied. Recommendations for future research include examining the cultural needs of different ethnicities within the increasingly diverse US population in the context of GDM self-management, conducting participatory-based research with these groups, and designing human-centered mobile health solutions for both patients and providers. UR - https://diabetes.jmir.org/2024/1/e58327 UR - http://dx.doi.org/10.2196/58327 ID - info:doi/10.2196/58327 ER - TY - JOUR AU - Rivera Rivera, Nathalie Jessica AU - AuBuchon, E. Katarina AU - Smith, Marjanna AU - Starling, Claire AU - Ganacias, G. Karen AU - Danielson, Aimee AU - Patchen, Loral AU - Rethy, A. Janine AU - Blumenthal, Joseph H. AU - Thomas, D. Angela AU - Arem, Hannah PY - 2024/11/14 TI - Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study JO - JMIR Pediatr Parent SP - e56807 VL - 7 KW - postpartum care KW - newborn care KW - health education KW - chatbot KW - mHealth KW - mobile health KW - feedback KW - health equity N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e56807 UR - http://dx.doi.org/10.2196/56807 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56807 ER - TY - JOUR AU - Ramsey, Maya AU - Oberman, Nina AU - Quesenberry Jr, P. Charles AU - Kurtovich, Elaine AU - Gomez Chavez, Lizeth AU - Chess, Aaloni AU - Brown, Denise Susan AU - Albright, L. Cheryl AU - Bhalala, Mibhali AU - Badon, E. Sylvia AU - Avalos, A. Lyndsay PY - 2024/10/29 TI - A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression?the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e56882 VL - 13 KW - postpartum depression KW - depression KW - eHealth KW - online workout videos KW - exercise videos KW - physical activity KW - wellness KW - health promotion KW - digital interventions N2 - Background: Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. Objective: This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)?an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. Methods: This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. Results: The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ?66% for questionnaires and ?48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. Conclusions: The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. Trial Registration: ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696 International Registered Report Identifier (IRRID): DERR1-10.2196/56882 UR - https://www.researchprotocols.org/2024/1/e56882 UR - http://dx.doi.org/10.2196/56882 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470705 ID - info:doi/10.2196/56882 ER - TY - JOUR AU - Brinson, K. Alison AU - Jahnke, R. Hannah AU - Henrich, Natalie AU - Moss, Christa AU - Shah, Neel PY - 2024/10/16 TI - Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e56247 VL - 7 KW - digital health KW - education KW - gestational conditions KW - Maven Clinic KW - mental health management KW - neonatal KW - NICU admissions KW - neonatal intensive care unit KW - mobile phone N2 - 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: ?=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: ?=.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. UR - https://pediatrics.jmir.org/2024/1/e56247 UR - http://dx.doi.org/10.2196/56247 ID - info:doi/10.2196/56247 ER - TY - JOUR AU - Pokorna, Nikola AU - Palmer, Melanie AU - Pearson, Oliver AU - Beckley-Hoelscher, Nicholas AU - Shearer, James AU - Kostyrka-Allchorne, Katarzyna AU - Robertson, Olly AU - Koch, Marta AU - Slovak, Petr AU - Day, Crispin AU - Byford, Sarah AU - Waite, Polly AU - Creswell, Cathy AU - Sonuga-Barke, S. Edmund J. AU - Goldsmith, Kimberley PY - 2024/10/8 TI - Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e53864 VL - 7 KW - parenting KW - intervention KW - smartphone app KW - randomized controlled trial KW - COVID-19 pandemic KW - moderators KW - conduct problems KW - emotional problems N2 - Background: A smartphone app, Parent Positive, was developed to help parents manage their children?s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children?s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive?s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=?0.41, 95% CI ?0.82 to 0.0004; P=.05) or significant (T3: B=?0.76, 95% CI ?1.22 to ?0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive?s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 UR - https://pediatrics.jmir.org/2024/1/e53864 UR - http://dx.doi.org/10.2196/53864 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378100 ID - info:doi/10.2196/53864 ER - TY - JOUR AU - Magnuson, I. Katherine AU - Li, Kexin AU - Beuley, Grace AU - Ryan-Pettes, R. Stacy PY - 2024/9/24 TI - The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review JO - JMIR Mhealth Uhealth SP - e51273 VL - 12 KW - behavioral parent training KW - mobile health KW - mHealth KW - mobile app KW - adolescent KW - substance use KW - child mental health condition KW - mobile phone N2 - Background: The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. Objective: This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Results: Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Conclusions: Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings. UR - https://mhealth.jmir.org/2024/1/e51273 UR - http://dx.doi.org/10.2196/51273 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316435 ID - info:doi/10.2196/51273 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents? values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family?s experience. Conclusions: Parents? use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Franco, Pamela AU - Olhaberry, Marcia AU - Muzard, Antonia AU - Harismendy, Ángeles AU - Kelders, Saskia PY - 2024/8/19 TI - Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach JO - JMIR Form Res SP - e56319 VL - 8 KW - internet-based intervention KW - postpartum depression KW - user-centered development KW - perinatal mental health KW - user-centered design KW - mobile phone N2 - Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders? openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype?s final version. The resulting intervention, named Mamá, te entiendo (?Mom, I get you?), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. UR - https://formative.jmir.org/2024/1/e56319 UR - http://dx.doi.org/10.2196/56319 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56319 ER - TY - JOUR AU - Sibanda, Khulekani AU - Ndayizigamiye, Patrick AU - Twinomurinzi, Hossana PY - 2024/8/8 TI - Industry 4.0 Technologies in Maternal Health Care: Bibliometric Analysis and Research Agenda JO - JMIR Pediatr Parent SP - e47848 VL - 7 KW - Industry 4.0 KW - Fourth Industrial Revolution KW - bibliometrics KW - maternal health care KW - antenatal care KW - postnatal care KW - lean operations KW - maternal KW - pregnancy monitoring KW - pregnancy KW - maternal care KW - monitoring KW - thematic analysis KW - data mining KW - machine learning KW - IoT KW - Internet of Things KW - artificial intelligence KW - deep learning KW - digital health KW - wearable KW - mobile phone N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e47848 UR - http://dx.doi.org/10.2196/47848 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47848 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Sobolev, Michael AU - Giacco, Domenico PY - 2024/6/28 TI - A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology JO - JMIR Form Res SP - e54892 VL - 8 KW - parenting KW - child behavior KW - mental health KW - app development KW - digital N2 - Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non?English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. UR - https://formative.jmir.org/2024/1/e54892 UR - http://dx.doi.org/10.2196/54892 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54892 ER - TY - JOUR AU - Ameyaw, Kwabena Edward AU - Amoah, Adusei Padmore AU - Ezezika, Obidimma PY - 2024/5/29 TI - Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews JO - J Med Internet Res SP - e49510 VL - 26 KW - mHealth KW - mobile health KW - maternal health KW - telemedicine KW - technology KW - health care KW - newborn KW - systematic review KW - database KW - mHealth impact KW - mHealth effectiveness KW - health care applications N2 - Background: Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. Objective: This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. Methods: We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. Results: A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). Conclusions: The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. Trial Registration: PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77 UR - https://www.jmir.org/2024/1/e49510 UR - http://dx.doi.org/10.2196/49510 UR - http://www.ncbi.nlm.nih.gov/pubmed/38810250 ID - info:doi/10.2196/49510 ER - TY - JOUR AU - Kim, Sun-Hee AU - De Gagne, C. Jennie PY - 2024/5/15 TI - Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e58326 VL - 13 KW - cartoon KW - cartoons KW - webtoon KW - webtoons KW - story KW - stories KW - storytelling KW - preterm KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - perception KW - perceptions KW - web-based KW - satisfaction KW - client satisfaction KW - clinical trial protocol KW - education KW - health belief model KW - web-based intervention KW - premature birth KW - prevention and control KW - prevention KW - premature KW - maternal KW - pregnant KW - pregnancy KW - randomized controlled feasibility trials KW - self-efficacy KW - women KW - randomized KW - controlled trial KW - controlled trials KW - birth KW - mobile phone N2 - Background: Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. Objective: This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention?Pregnancy Story I Didn?t Know in Interactive Webtoon Series (PSIDK-iWebtoons)?designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Methods: Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn?t Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. Results: The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. Conclusions: This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857 International Registered Report Identifier (IRRID): DERR1-10.2196/58326 UR - https://www.researchprotocols.org/2024/1/e58326 UR - http://dx.doi.org/10.2196/58326 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748471 ID - info:doi/10.2196/58326 ER - TY - JOUR AU - Smith, M. Sharissa AU - Bais, Babette AU - Ismaili M'hamdi, Hafez AU - Schermer, HN Maartje AU - Steegers-Theunissen, PM Régine PY - 2024/4/22 TI - Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study JO - JMIR Hum Factors SP - e53614 VL - 11 KW - preconception care KW - mHealth KW - mobile health KW - pregnancy preparation KW - nudge KW - health inequality KW - socioeconomic status KW - lifestyle KW - women KW - pregnancy KW - pregnant women KW - pregnant KW - socioeconomic KW - pilot feasibility study KW - mHealth app KW - mHealth application KW - app KW - application KW - risk factor KW - nutrition KW - stress KW - chronic stress KW - health literacy KW - usability KW - user satisfaction KW - user KW - users N2 - Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion ?living in a deprived neighborhood? was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 UR - https://humanfactors.jmir.org/2024/1/e53614 UR - http://dx.doi.org/10.2196/53614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648092 ID - info:doi/10.2196/53614 ER - TY - JOUR AU - Wada, Aya AU - Nakamura, Yasuka AU - Kawajiri, Maiko AU - Takeishi, Yoko AU - Yoshida, Mikako AU - Yoshizawa, Toyoko PY - 2023/11/14 TI - Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study JO - JMIR Form Res SP - e48637 VL - 7 KW - work KW - pregnancy KW - occupation KW - occupational health KW - mHealth KW - mobile application KW - feasibility KW - usability KW - longitudinal KW - observational study KW - Japan KW - mobile health KW - occupational health and safety KW - ergonomics N2 - Background: Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. Objective: This study aims to verify the feasibility and usability of the Job Adjustment mobile app. Methods: A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. Results: The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). Conclusions: The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. Trial Registration: UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas UR - https://formative.jmir.org/2023/1/e48637 UR - http://dx.doi.org/10.2196/48637 UR - http://www.ncbi.nlm.nih.gov/pubmed/37962945 ID - info:doi/10.2196/48637 ER - TY - JOUR AU - Amore, Dunn Alexis AU - Britt, Abby AU - Arconada Alvarez, J. Santiago AU - Greenleaf, N. Morgan PY - 2023/8/18 TI - A Web-Based Intervention to Address Risk Factors for Maternal Morbidity and Mortality (MAMA LOVE): Development and Evaluation Study JO - JMIR Pediatr Parent SP - e44615 VL - 6 KW - maternal mortality prevention KW - mobile technology KW - pregnancy KW - Black women KW - maternal KW - pregnant KW - mortality KW - web-based KW - utility KW - usability KW - mHealth KW - mobile health KW - algorithm KW - development KW - design KW - software KW - risk assessment KW - patient education N2 - Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation?s worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool?s initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals. UR - https://pediatrics.jmir.org/2023/1/e44615 UR - http://dx.doi.org/10.2196/44615 ID - info:doi/10.2196/44615 ER - TY - JOUR AU - Brammall, R. Bonnie AU - Garad, M. Rhonda AU - Boyle, A. Jacqueline AU - Hayman, J. Melanie AU - de Jersey, J. Susan AU - Teede, J. Helena AU - Hong, V. Quoc AU - Carrandi, Alayna AU - Harrison, L. Cheryce PY - 2022/11/25 TI - Assessing the Content and Quality of Digital Tools for Managing Gestational Weight Gain: Systematic Search and Evaluation JO - J Med Internet Res SP - e37552 VL - 24 IS - 11 KW - digital KW - gestational KW - weight KW - tracking KW - pregnancy N2 - Background: Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. Objective: In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. Methods: Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. Results: Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ?3 items. Conclusions: This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care. UR - https://www.jmir.org/2022/11/e37552 UR - http://dx.doi.org/10.2196/37552 UR - http://www.ncbi.nlm.nih.gov/pubmed/36427237 ID - info:doi/10.2196/37552 ER - TY - JOUR AU - Birati, Yosefa AU - Yefet, Enav AU - Perlitz, Yuri AU - Shehadeh, Naim AU - Spitzer, Sivan PY - 2022/10/14 TI - Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review JO - J Med Internet Res SP - e37844 VL - 24 IS - 10 KW - gestational diabetes mellitus KW - maternal health KW - mobile health KW - mHealth KW - mobile apps KW - mobile phone KW - telemedicine KW - culture KW - health literacy KW - vulnerable populations KW - pregnancy outcome N2 - Background: The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective: This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems? effectiveness in improving glycemic control and maternal and infant outcomes. Methods: We conducted a scoping review using a framework adapted from Arksey and O?Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results: We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ?3 out of 5 in our assessment of digital health literacy. Conclusions: mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women?s self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes. UR - https://www.jmir.org/2022/10/e37844 UR - http://dx.doi.org/10.2196/37844 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240008 ID - info:doi/10.2196/37844 ER - TY - JOUR AU - DeWitt, Akeiylah AU - Kientz, Julie AU - Coker, R. Tumaini AU - Liljenquist, Kendra PY - 2022/10/6 TI - mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review JO - JMIR Pediatr Parent SP - e37718 VL - 5 IS - 4 KW - mobile health technologies KW - early childhood health promotion KW - child development KW - parent support technologies KW - mobile phone N2 - Background: Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. Objective: In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. Methods: We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. Results: Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. Conclusions: To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. Trial Registration: PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2 UR - https://pediatrics.jmir.org/2022/4/e37718 UR - http://dx.doi.org/10.2196/37718 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201391 ID - info:doi/10.2196/37718 ER - TY - JOUR AU - Thomas, Tainayah AU - Xu, Fei AU - Sridhar, Sneha AU - Sedgwick, Tali AU - Nkemere, Linda AU - Badon, E. Sylvia AU - Quesenberry, Charles AU - Ferrara, Assiamira AU - Mandel, Sarah AU - Brown, D. Susan AU - Hedderson, Monique PY - 2022/6/22 TI - A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e33929 VL - 6 IS - 6 KW - mobile health KW - gestational weight gain KW - obesity KW - physical activity KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2022/6/e33929 UR - http://dx.doi.org/10.2196/33929 UR - http://www.ncbi.nlm.nih.gov/pubmed/35731565 ID - info:doi/10.2196/33929 ER - TY - JOUR AU - Oh, Soyeon Sarah AU - Moon, Youn Jong AU - Chon, Doukyoung AU - Mita, Carol AU - Lawrence, A. Jourdyn AU - Park, Eun-Cheol AU - Kawachi, Ichiro PY - 2022/4/11 TI - Effectiveness of Digital Interventions for Preventing Alcohol Consumption in Pregnancy: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e35554 VL - 24 IS - 4 KW - fetal alcohol spectrum disorders KW - fetal alcohol syndrome KW - digital health KW - pregnancy KW - alcohol consumption KW - text message KW - text messaging KW - alcohol KW - digital intervention KW - mother KW - systematic review KW - meta-analysis KW - mobile health KW - mHealth KW - computer-based intervention KW - internet-based intervention N2 - Background: Alcohol consumption in pregnancy has been associated with serious fetal health risks and maternal complications. While previous systematic reviews of digital interventions during pregnancy have targeted smoking cessation and flu vaccine uptake, few studies have sought to evaluate their effectiveness in preventing alcohol consumption during pregnancy. Objective: This systematic review aims to assess (1) whether digital interventions are effective in preventing alcohol consumption during the pregnancy/pregnancy-planning period, and (2) the differential effectiveness of alternative digital intervention platforms (ie, computers, mobiles, and text messaging services). Methods: PubMed, Embase, CINAHL, and Web of Science were searched for studies with digital interventions aiming to prevent alcohol consumption among pregnant women or women planning to become pregnant. A random effects primary meta-analysis was conducted to estimate the combined effect size and extent to which different digital platforms were successful in preventing alcohol consumption in pregnancy. Results: Six studies were identified and included in the final review. The primary meta-analysis produced a sample-weighted odds ratio (OR) of 0.62 (95% CI 0.42-0.91; P=.02) in favor of digital interventions decreasing the risk of alcohol consumption during pregnancy when compared to controls. Computer/internet-based interventions (OR 0.59, 95% CI 0.38-0.93) were an effective platform for preventing alcohol consumption. Too few studies of text messaging (OR 0.29, 95% CI 0.29-2.52) were available to draw a conclusion. Conclusions: Overall, our review highlights the potential for digital interventions to prevent alcohol consumption among pregnant women and women planning to become pregnant. Considering the advantages of digital interventions in promoting healthy behavioral changes, future research is necessary to understand how certain platforms may increase user engagement and intervention effectiveness to prevent women from consuming alcohol during their pregnancies. UR - https://www.jmir.org/2022/4/e35554 UR - http://dx.doi.org/10.2196/35554 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404257 ID - info:doi/10.2196/35554 ER - TY - JOUR AU - Simon, L. Stacey AU - Kaar, L. Jill AU - Talker, Ishaah AU - Reich, Jennifer PY - 2022/3/3 TI - Evidence-Based Behavioral Strategies in Smartphone Apps for Children?s Sleep: Content Analysis JO - JMIR Pediatr Parent SP - e32129 VL - 5 IS - 1 KW - pediatrics KW - technology KW - smartphones KW - health behavior KW - sleep applications KW - children KW - mobile health KW - mHealth KW - smartphone applications KW - health applications KW - sleep disorders KW - sleep problems KW - developer descriptions KW - apps N2 - Background: Empirically supported treatments for pediatric sleep problems exist, but many families turn to other sources for help with their children?s sleep, such as smartphone apps. Sleep apps are easy for families to access, but little evidence exists regarding the validity of the services and information provided in the developer descriptions of the apps. Objective: The goal of this study was to examine the features and claims of developer descriptions of sleep apps for children. Methods: A search of the Apple iTunes store and Google Play was conducted using the terms ?kids sleep,? ?child sleep,? and ?baby sleep.? Data on the type of app, price, user rating, and number of users were collected. Apps were analyzed in comparison with evidence-based behavioral strategies and were thematically coded on the basis of claims provided in developer descriptions. Results: A total of 83 app descriptions were examined, of which only 2 (2.4%) offered sleep improvement strategies. The majority were sound and light apps (78%) and 19% were bedtime games or stories. Only 18 of 83 (21.6%) apps were identified as containing empirically supported behavioral sleep strategies. Despite this, many apps asserted claims that they will help children ?fall asleep instantly,? ?cry less and sleep better,? or improve child development. Conclusions: A large variety of sleep apps exist for use among children, but few include evidence-based behavioral strategies according to the developer descriptions of the apps. Addressing sleep difficulties in children is important to promote physical, cognitive, and emotional development. Collaboration between sleep researchers and technology developers may be beneficial for creating evidence-supported apps to help with children?s sleep in the future. UR - https://pediatrics.jmir.org/2022/1/e32129 UR - http://dx.doi.org/10.2196/32129 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238787 ID - info:doi/10.2196/32129 ER - TY - JOUR AU - Petrenko, McGee Christie Lynn AU - Kautz-Turnbull, Christine Carson AU - Roth, Rose Alicia AU - Parr, Elizabeth Jennifer AU - Tapparello, Cristiano AU - Demir, Utku AU - Olson, Carmichael Heather PY - 2021/12/2 TI - Initial Feasibility of the ?Families Moving Forward Connect? Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach JO - JMIR Form Res SP - e29687 VL - 5 IS - 12 KW - fetal alcohol spectrum disorders KW - fetal alcohol syndrome KW - intervention KW - mobile health KW - mHealth KW - parenting KW - children KW - prenatal alcohol KW - digital health KW - user-centered design KW - mobile phone N2 - Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers? stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. UR - https://formative.jmir.org/2021/12/e29687 UR - http://dx.doi.org/10.2196/29687 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860661 ID - info:doi/10.2196/29687 ER - TY - JOUR AU - Li, Jane AU - Silvera-Tawil, David AU - Varnfield, Marlien AU - Hussain, Sazzad M. AU - Math, Vanitha PY - 2021/12/2 TI - Users? Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study JO - JMIR Form Res SP - e28628 VL - 5 IS - 12 KW - pregnancy care KW - wearable sensors KW - mobile health KW - acceptance KW - mHealth service KW - design KW - mobile phone N2 - Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women?s monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians? and pregnant women?s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. UR - https://formative.jmir.org/2021/12/e28628 UR - http://dx.doi.org/10.2196/28628 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860665 ID - info:doi/10.2196/28628 ER - TY - JOUR AU - Atukunda, Cathyln Esther AU - Matthews, T. Lynn AU - Musiimenta, Angella AU - Mugyenyi, Rwambuka Godfrey AU - Mugisha, Samuel AU - Ware, C. Norma AU - Obua, Celestino AU - Siedner, J. Mark PY - 2021/11/25 TI - mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study JO - JMIR Form Res SP - e29214 VL - 5 IS - 11 KW - mHealth app KW - app development KW - messaging KW - health education KW - health promotion KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/11/e29214 UR - http://dx.doi.org/10.2196/29214 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842541 ID - info:doi/10.2196/29214 ER - TY - JOUR AU - Jimah, Tamara AU - Borg, Holly AU - Kehoe, Priscilla AU - Pimentel, Pamela AU - Turner, Arlene AU - Labbaf, Sina AU - Asgari Mehrabadi, Milad AU - Rahmani, M. Amir AU - Dutt, Nikil AU - Guo, Yuqing PY - 2021/11/17 TI - A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study JO - JMIR Form Res SP - e30991 VL - 5 IS - 11 KW - ecological momentary assessment KW - heart rate KW - mHealth KW - physical activity KW - pregnancy KW - sleep KW - wearable electronic device N2 - Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user?s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app?based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=?0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. UR - https://formative.jmir.org/2021/11/e30991 UR - http://dx.doi.org/10.2196/30991 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787576 ID - info:doi/10.2196/30991 ER - TY - JOUR AU - Chukwu, Emeka AU - Gilroy, Sonia AU - Addaquay, Kojo AU - Jones, Nafisa Nki AU - Karimu, Gbadia Victor AU - Garg, Lalit AU - Dickson, Eva Kim PY - 2021/11/12 TI - Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey JO - JMIR Form Res SP - e23874 VL - 5 IS - 11 KW - young people KW - short message service KW - SMS KW - chatbot KW - text message KW - interactive voice response KW - IVR KW - WhatsApp KW - Facebook KW - family planning KW - contraceptives KW - Sierra Leone N2 - Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media?only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. UR - https://formative.jmir.org/2021/11/e23874 UR - http://dx.doi.org/10.2196/23874 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766908 ID - info:doi/10.2196/23874 ER - TY - JOUR AU - Sushko, Katelyn AU - Wang, Rui Qi AU - Tschirhart Menezes, Holly AU - Fitzpatrick-Lewis, Donna AU - Sherifali, Diana PY - 2021/10/29 TI - Patient-Reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e29727 VL - 10 IS - 10 KW - diabetes KW - pregnancy KW - type 1 diabetes KW - type 2 diabetes KW - gestational diabetes mellitus KW - mobile health KW - mHealth KW - virtual care KW - scoping review N2 - Background: For women with pre-existing and gestational diabetes mellitus, pregnancy involves specialized and intensive medical care to improve maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. Barriers to face-to-face care during the COVID-19 pandemic have signaled the need for high-quality, patient-centered virtual health care modalities, such as mobile health (mHealth). Objective: The objective of the proposed scoping review is to identify the patient-reported benefits and limitations of mHealth technology among women with diabetes in pregnancy. We also aim to determine how the women?s experiences align with the best practice standards for patient-centered communication. Methods: Arksey and O?Malley?s framework for conducting scoping reviews with refinements by Levac et al will be used to guide the conduct of this scoping review. Relevant studies will be identified through comprehensive database searches of MEDLINE, Embase, Emcare, and PsycINFO. Following database searches, studies will be screened for eligibility at the title, abstract, and full-text level by two independent reviewers, with the inclusion of a third reviewer if required to reach consensus. Data charting of included studies will be conducted by one reviewer using a standardized data extraction form and verified independently by a second reviewer. Synthesis of results will be guided by Thomas and Harden?s ?Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.? Results: As of August 2020, we have carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies. Conclusions: With the results of this review, we hope to describe the patient-reported benefits and limitations of mHealth technology for women with diabetes in pregnancy. Furthermore, we aim to determine how women?s experiences align with the best practice standards for patient-centered communication. Ultimately, our review can provide valuable information for guideline developers, policy makers, and clinicians related to mobile technologies to support virtual care delivery for women with diabetes in pregnancy. International Registered Report Identifier (IRRID): PRR1-10.2196/29727 UR - https://www.researchprotocols.org/2021/10/e29727 UR - http://dx.doi.org/10.2196/29727 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714251 ID - info:doi/10.2196/29727 ER - TY - JOUR AU - Frid, Gabriela AU - Bogaert, Kelly AU - Chen, T. Katherine PY - 2021/10/18 TI - Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features JO - J Med Internet Res SP - e25667 VL - 23 IS - 10 KW - app KW - app store KW - mHealth KW - mobile health KW - prenatal KW - pregnancy KW - women's health N2 - 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. UR - https://www.jmir.org/2021/10/e25667 UR - http://dx.doi.org/10.2196/25667 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524100 ID - info:doi/10.2196/25667 ER - TY - JOUR AU - Joyce, M. Caroline AU - Saulsgiver, Kathryn AU - Mohanty, Salini AU - Bachireddy, Chethan AU - Molfetta, Carin AU - Steffy, Mary AU - Yoder, Alice AU - Buttenheim, M. Alison PY - 2021/9/30 TI - Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies JO - JMIR Form Res SP - e27801 VL - 5 IS - 9 KW - maternal smoking KW - smoking cessation KW - financial incentives KW - smoking KW - pregnant KW - postpartum KW - incentives KW - mHealth KW - mobile health KW - mobile phone KW - smart devices N2 - Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. UR - https://formative.jmir.org/2021/9/e27801 UR - http://dx.doi.org/10.2196/27801 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591023 ID - info:doi/10.2196/27801 ER - TY - JOUR AU - Biviji, Rizwana AU - Williams, S. Karmen AU - Vest, R. Joshua AU - Dixon, E. Brian AU - Cullen, Theresa AU - Harle, A. Christopher PY - 2021/9/1 TI - Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis JO - J Med Internet Res SP - e27403 VL - 23 IS - 9 KW - mHealth KW - mobile applications KW - maternal and infant health KW - smartphones KW - mobile phone N2 - 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. UR - https://www.jmir.org/2021/9/e27403 UR - http://dx.doi.org/10.2196/27403 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468323 ID - info:doi/10.2196/27403 ER - TY - JOUR AU - Mackert, Michael AU - Mandell, Dorothy AU - Donovan, Erin AU - Walker, Lorraine AU - Henson-García, Mike AU - Bouchacourt, Lindsay PY - 2021/8/17 TI - Mobile Apps as Audience-Centered Health Communication Platforms JO - JMIR Mhealth Uhealth SP - e25425 VL - 9 IS - 8 KW - health communication KW - mHealth KW - mobile apps KW - mobile health KW - prenatal health KW - pregnancy KW - audience-centered UR - https://mhealth.jmir.org/2021/8/e25425 UR - http://dx.doi.org/10.2196/25425 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402797 ID - info:doi/10.2196/25425 ER - TY - JOUR AU - Artieta-Pinedo, Isabel AU - Paz-Pascual, Carmen AU - Bully, Paola AU - Espinosa, Maite AU - PY - 2021/8/9 TI - Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study JO - JMIR Form Res SP - e28855 VL - 5 IS - 8 KW - prenatal education KW - women KW - patient decision aid KW - decision-making KW - clinical decision support systems KW - action research and pregnancy KW - implementation science KW - health service needs and demands N2 - Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. UR - https://formative.jmir.org/2021/8/e28855 UR - http://dx.doi.org/10.2196/28855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383670 ID - info:doi/10.2196/28855 ER - TY - JOUR AU - Derksen, E. Marloes AU - Jaspers, WM Monique AU - van Strijp, Sander AU - Fransen, P. Mirjam PY - 2021/8/4 TI - Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study JO - JMIR Form Res SP - e24112 VL - 5 IS - 8 KW - think aloud KW - heuristic evaluation KW - usability KW - mHealth KW - game elements KW - smoking prevention KW - user-centered design KW - mobile phone N2 - Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. UR - https://formative.jmir.org/2021/8/e24112 UR - http://dx.doi.org/10.2196/24112 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346895 ID - info:doi/10.2196/24112 ER - TY - JOUR AU - Walter, Bente AU - Indreboe, Hege AU - Lukasse, Mirjam AU - Henriksen, Lena AU - Garnweidner-Holme, Lisa PY - 2021/7/20 TI - Pregnant Women?s Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study JO - JMIR Form Res SP - e28680 VL - 5 IS - 7 KW - intimate partner violence KW - eHealth KW - pregnancy KW - antenatal care, safety behaviors KW - tablet intervention N2 - Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women?s attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women?s attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 UR - https://formative.jmir.org/2021/7/e28680 UR - http://dx.doi.org/10.2196/28680 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283023 ID - info:doi/10.2196/28680 ER - TY - JOUR AU - Burduli, Ekaterina AU - Jones, E. Hendrée AU - Brooks, Olivia AU - Barbosa-Leiker, Celestina AU - Johnson, Kim Ron AU - Roll, John AU - McPherson, Marshall Sterling PY - 2021/4/15 TI - 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 JO - JMIR Res Protoc SP - e27382 VL - 10 IS - 4 KW - neonatal abstinence syndrome KW - opioid use disorder KW - mHealth KW - maternal child outcomes N2 - 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 UR - https://www.researchprotocols.org/2021/4/e27382 UR - http://dx.doi.org/10.2196/27382 UR - http://www.ncbi.nlm.nih.gov/pubmed/33856360 ID - info:doi/10.2196/27382 ER - TY - JOUR AU - Sandborg, Johanna AU - Söderström, Emmie AU - Henriksson, Pontus AU - Bendtsen, Marcus AU - Henström, Maria AU - Leppänen, H. Marja AU - Maddison, Ralph AU - Migueles, H. Jairo AU - Blomberg, Marie AU - Löf, Marie PY - 2021/3/11 TI - Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26091 VL - 9 IS - 3 KW - gestational weight gain KW - physical activity KW - diet KW - pregnancy KW - mHealth KW - smartphone app KW - mobile phone app KW - telemedicine KW - randomized controlled trial N2 - Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (?1.33 kg; 95% CI ?2.92 to 0.26; P=.10) and completers-only analyses (?1.67 kg; 95% CI ?3.26 to ?0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P?.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 UR - https://mhealth.jmir.org/2021/3/e26091 UR - http://dx.doi.org/10.2196/26091 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704075 ID - info:doi/10.2196/26091 ER - TY - JOUR AU - Li, Tiantian AU - Chen, Xiaomin AU - Wang, Jia AU - Chen, Ling AU - Cai, Wenzhi PY - 2021/3/10 TI - Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial JO - JMIR Res Protoc SP - e22771 VL - 10 IS - 3 KW - mHealth KW - stress urinary incontinence KW - pregnancy KW - randomized controlled trial KW - process evaluation KW - mixed methods KW - study protocol N2 - Background: Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective: The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods: This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results: The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions: This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): PRR1-10.2196/22771 UR - https://www.researchprotocols.org/2021/3/e22771 UR - http://dx.doi.org/10.2196/22771 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688842 ID - info:doi/10.2196/22771 ER - TY - JOUR AU - Srinivasan, Balaji AU - Finkelstein, L. Julia AU - Erickson, David AU - Mehta, Saurabh PY - 2021/3/3 TI - Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study JO - JMIR Biomed Eng SP - e23527 VL - 6 IS - 1 KW - alpha-fetoprotein KW - point-of-care testing KW - screening KW - neural tube defects KW - mobile phone N2 - Background: Maternal serum alpha-fetoprotein (MSAFP) concentration typically increases during pregnancy and is routinely measured during the second trimester as a part of screening for fetal neural tube defects and Down syndrome. However, most pregnancy screening tests are not available in the settings they are needed the most. A mobile device?enabled technology based on MSAFP for screening birth defects could enable the rapid screening and triage of high-risk pregnancies, especially where maternal serum screening and fetal ultrasound scan facilities are not easily accessible. Shifting the approach from clinic- and laboratory-dependent care to a mobile platform based on our point-of-care approach will enable translation to resource-limited settings and the global health care market. Objective: The objective of this study is to develop and perform proof-of-concept testing of a lateral flow immunoassay on a mobile platform for rapid, point-of-care quantification of serum alpha-fetoprotein (AFP) levels, from a drop of human serum, within a few minutes. Methods: The development of the immunoassay involved the selection of commercially available antibodies and optimization of their concentrations by an iterative method to achieve the required detection limits. We compared the performance of our method with that of commercially obtained human serum samples, with known AFP concentrations quantified by the Abbott ARCHITECT chemiluminescent magnetic microparticle immunoassay (CMIA). Results: We tested commercially obtained serum samples (N=20) with concentrations ranging from 2.2 to 446 ng/mL to compare the results of our point-of-care assay with results from the Abbott ARCHITECT CMIA. A correlation of 0.98 (P<.001) was observed on preliminary testing and comparison with the CMIA. The detection range of our point-of-care assay covers the range of maternal serum AFP levels observed during pregnancy. Conclusions: The preliminary test results from the AFP test on the mobile platform performed in this study represent a proof of concept that will pave the way for our future work focused on developing a mobile device?enabled quad-screen point-of-care testing with the potential to enable the screening of high-risk pregnancies in various settings. The AFP test on the mobile platform can be applied to enable screening for high-risk pregnancies, within a few minutes, at the point of care even in remote areas where maternal serum tests and fetal ultrasound scans are not easily accessible; assessment of whether clinical follow-up and diagnostic testing may be needed after a positive initial screening evaluation; and development of surveillance tools for birth defects. UR - https://biomedeng.jmir.org/2021/1/e23527 UR - http://dx.doi.org/10.2196/23527 UR - http://www.ncbi.nlm.nih.gov/pubmed/34746648 ID - info:doi/10.2196/23527 ER - TY - JOUR AU - Broome, Brantlee AU - Madisetti, Mohan AU - Prentice, Margaret AU - Williams, Wong Kelli AU - Kelechi, Teresa PY - 2021/3/3 TI - Food Allergy Symptom Self-Management With Technology (FASST) mHealth Intervention to Address Psychosocial Outcomes in Caregivers of Children With Newly Diagnosed Food Allergy: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e25805 VL - 10 IS - 3 KW - caregiver well-being KW - food allergy KW - self-management KW - mhealth, randomizes mixed trial KW - caregiver KW - well-being KW - emergency room KW - smartphone app KW - smartphone KW - children N2 - Background: Approximately 2.4 million children in the United States suffer from food-induced anaphylaxis, a condition that is annually responsible for over 200 deaths and 200,000 emergency room visits. As a result, caregivers of children newly diagnosed with severe and life-threatening food allergic reactions experience clinically significant symptoms of psychological distress, including fatigue, anxiety, depressed mood, social isolation, and substantially reduced quality of life. Despite this recognition, there is a lack of caregiver-centered self-management interventions to address these concerns. Objective: In this protocol, we propose to develop and conduct feasibility testing of a technology-enhanced, self-management, mobile health, smartphone app intervention called Food Allergy Symptom Self-Management with Technology for Caregivers (FASST) designed to meet the psychosocial health needs of caregivers of children with a new diagnosis of food allergy. Methods: This pilot study uses qualitative work (Phase I) to inform a 4-week longitudinal randomized controlled trial (Phase II). In Phase I, 10 caregivers of children (?18 years old) with established food allergy (?1 year from diagnosis) will participate in semistructured interviews to inform the development of the FASST app. In Phase II, 30 caregivers of children (?18 years old) with a newly diagnosed food allergy (?90 days from diagnosis) will be randomized 2:1 to receive the FASST intervention (n=20) or control condition (basic app with educational resources; n=10). Process measures include feasibility, caregiver acceptability, adherence, and satisfaction. Outcome measures include caregiver fatigue, anxiety, depression, sleep, self-efficacy, and quality of life measured at baseline, week 4, and 3 months post study completion. Results: Phase I study activities have been completed, and Phase II participant enrollment into the randomized controlled trial is expected to commence in 2021. Conclusions: With limited readily available resources at their disposal, the results from this study have the potential to provide caregivers of children with a newly diagnosed food allergy a tool to help them self-manage and mitigate negative psychosocial factors during a critical time period in the caregiving/condition trajectory. Trial Registration: ClinicalTrials.gov Identifier NCT04512924: https://clinicaltrials.gov/ct2/show/NCT04512924 International Registered Report Identifier (IRRID): DERR1-10.2196/25805 UR - https://www.researchprotocols.org/2021/3/e25805 UR - http://dx.doi.org/10.2196/25805 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656448 ID - info:doi/10.2196/25805 ER - TY - JOUR AU - Clouse, Kate AU - Phillips, K. Tamsin AU - Mogoba, Phepo AU - Ndlovu, Linda AU - Bassett, Jean AU - Myer, Landon PY - 2021/2/8 TI - Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study JO - JMIR Form Res SP - e19243 VL - 5 IS - 2 KW - HIV/AIDS KW - South Africa KW - smartphone KW - mobile health KW - pregnancy KW - GPS tracking N2 - Background: Peripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time. Objective: The aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users? attitudes toward the proposed app. Methods: We conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized ?positive,? ?neutral,? or ?negative? reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations. Results: In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual?s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. Conclusions: Women living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. UR - https://formative.jmir.org/2021/2/e19243 UR - http://dx.doi.org/10.2196/19243 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555261 ID - info:doi/10.2196/19243 ER - TY - JOUR AU - Yang, Siyu AU - Chen, Yijing AU - Zhou, Leshan AU - Huang, Yuting AU - Dai, Jiahui PY - 2021/1/27 TI - Willingness to Adopt mHealth Among Chinese Parents During the COVID-19 Outbreak: Cross-sectional Questionnaire Study JO - JMIR Mhealth Uhealth SP - e23155 VL - 9 IS - 1 KW - mHealth KW - parents KW - child health at home KW - COVID-19 N2 - Background: Parental involvement in mobile health (mHealth) to consult with medical professionals appears to be prevalent in China with the rapid development of the internet. More parents with busy jobs have chosen to use mHealth. During the ongoing COVID-19 outbreak, mHealth can assist with health promotion, directions for medication use, and disease diagnosis via online chat and video consultation without contacting others. To our knowledge, no studies have been performed to explore the role of mHealth in parents? attitudes toward child health care at home during the COVID-19 outbreak. Objective: This study aims to identify the associated factors of willingness to adopt mHealth among Chinese parents during the COVID-19 outbreak and to explore the correlation between the frequency of adopting mHealth and parents? attitudes toward child health care at home. Methods: Chinese parents were asked to complete an online survey from January 25 to February 15, 2020. The questionnaire comprised of two parts with a total of 16 items, including parents? demographic variables and attitudes toward child health care at home. By multivariate logistic regression, we explored factors associated with parents? willingness to adopt mHealth during the COVID-19 outbreak. Pearson chi-square tests were used to reveal the correlation between the frequency of adopting mHealth and parents? attitudes toward child health care at home. Results: A total of 254 parents enrolled, and 202 (79.5%) parents were willing to adopt mHealth during the COVID-19 outbreak. Parents? age (26-35 years: adjusted odds ratio [AOR] 8.114, 95% CI 1.471-44.764), parents? interest in the COVID-19 pandemic (moderate: AOR 8.753, 95% CI 2.009-38.127; high: AOR 22.194, 95% CI 5.509-89.411), the source that recommended mHealth (medical health providers: AOR 4.257, 95% CI 1.439-12.596), the presence of chronic disease in their children (yes: AOR 20.844, 95% CI 4.600-94.443), parents? duration of daily internet use (4-6 hours: AOR 6.487, 95% CI 1.870-22.495; >6 hours: AOR 8.766, 95% CI 1.883-40.804), and adoption of mHealth before the COVID-19 outbreak (yes: AOR 3.413, 95% CI 1.234-9.444) were significantly correlated with the parents? willingness to adopt mHealth during the COVID-19 outbreak. The frequency of mHealth use among parents was correlated with their behaviors in regard to handwashing (?26=18.967, P=.004), mask wearing (?26=45.364, P<.001), frequency of leaving the home (?26=16.767, P=.01), room disinfection and ventilation (?26=19.515, P=.003), temperature checking (?26=17.47, P=.007), and mental health care of children (?26=63.810, P<.001) during the COVID-19 pandemic. Conclusions: We found various objective factors that were associated with parents? willingness to adopt mHealth during the COVID-19 outbreak. Overall, parents? willingness to adopt mHealth was high. The frequency of mHealth use among parents was correlated with their attitudes toward child health care at home. The option of mHealth to patients at home during the COVID-19 outbreak would be beneficial for education and improvement in self-management of child health care at home. UR - http://mhealth.jmir.org/2021/1/e23155/ UR - http://dx.doi.org/10.2196/23155 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406052 ID - info:doi/10.2196/23155 ER - TY - JOUR AU - Bonciani, Manila AU - De Rosis, Sabina AU - Vainieri, Milena PY - 2021/1/19 TI - Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma JO - JMIR Res Protoc SP - e19073 VL - 10 IS - 1 KW - mHealth KW - maternal care pathway KW - impact evaluation KW - quasiexperimental study N2 - 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 UR - http://www.researchprotocols.org/2021/1/e19073/ UR - http://dx.doi.org/10.2196/19073 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464218 ID - info:doi/10.2196/19073 ER - TY - JOUR AU - Rhodes, Alexandra AU - Kheireddine, Sara AU - Smith, D. Andrea PY - 2020/12/9 TI - Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e23157 VL - 8 IS - 12 KW - pregnancy KW - parenting KW - app KW - COVID-19 KW - pregnancy support KW - postnatal support KW - perinatal KW - mental well-being KW - physical well-being KW - support KW - well-being KW - experience KW - attitude KW - needs N2 - Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service?approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users? needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby?s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. UR - http://mhealth.jmir.org/2020/12/e23157/ UR - http://dx.doi.org/10.2196/23157 UR - http://www.ncbi.nlm.nih.gov/pubmed/33264100 ID - info:doi/10.2196/23157 ER - TY - JOUR AU - Doty, L. Jennifer AU - Brady, S. Sonya AU - Monardez Popelka, Javiera AU - Rietveld, Laura AU - Garcia-Huidobro, Diego AU - Doty, J. Matthew AU - Linares, Roxana AU - Svetaz, Veronica Maria AU - Allen, L. Michele PY - 2020/1/24 TI - Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach JO - JMIR Form Res SP - e12618 VL - 4 IS - 1 KW - mobile application KW - eHealth KW - community-based participatory research KW - Hispanic Americans, family N2 - Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent?s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents? technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. UR - https://formative.jmir.org/2020/1/e12618 UR - http://dx.doi.org/10.2196/12618 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012034 ID - info:doi/10.2196/12618 ER -