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  - Ishaque, Sana
AU  - Ela, Ola
AU  - Dowling, Anna
AU  - Rissel, Chris
AU  - Canuto, Karla
AU  - Hall, Kerry
AU  - Bidargaddi, Niranjan
AU  - Briley, Annette
AU  - Roberts, T. Claire
AU  - Bonevski, Billie
PY  - 2025/4/30
TI  - Mobile Health Interventions for Modifying Indigenous Maternal and Child?Health Related Behaviors: Systematic Review
JO  - J Med Internet Res
SP  - e57019
VL  - 27
KW  - Indigenous
KW  - co-design
KW  - mother
KW  - children
KW  - digital health
KW  - mobile health
KW  - mHealth
KW  - interventions
KW  - child health
KW  - maternal health
KW  - behavior
KW  - systematic review
KW  - effectiveness
KW  - lifestyle
KW  - postpartum
KW  - articles
KW  - literature
KW  - screening
KW  - PRISMA
N2  - Background: Mobile health (mHealth) interventions promoting healthy lifestyle changes offer an adaptable and inexpensive method for accessing health information but require cultural appropriateness and suitability for acceptance and effectiveness in Indigenous populations. No systematic review on effective mHealth interventions for Indigenous women during pregnancy and the early childhood years has been conducted. Objective: This review evaluated the effectiveness of mHealth interventions promoting healthy behaviors for Indigenous mothers and children from conception to 5 years post partum. It also aimed to explore the observed effectiveness differences based on participant engagement, intervention design, and provision of context. Further, the review explored if the interventions were co-designed. Methods: A systematic search of 5 databases was conducted: SCOPUS, MEDLINE, CINAHL, PsycINFO, and ProQuest (Dissertation or Thesis). Studies were included if they were either a randomized controlled trial, pre-post comparison, or a cohort study using mHealth with Indigenous women for maternal and child health following a preregistered PROSPERO protocol (CRD42023395710). HealthInfoNet was searched for gray literature and the reference lists of included studies were hand searched. The initial title and abstract screen for eligibility were performed by 1 reviewer. A full-text screen of eligible studies and a quality appraisal of included studies was performed by 2 reviewers independently. The appraisal tools used were the Mixed Methods Quality Appraisal Tool and the Centre of Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). A descriptive synthesis of the extracted data was performed. Results: Of the 663 articles screened, only 3 met the eligibility criteria. Each paper evaluated a different mHealth intervention: Remote Prenatal Education; the SMS Parent Action Intervention (two-way text messaging); and the Screening, Brief Intervention and Referral to Treatment (SBIRT) eCHECKUP To Go (web-based screening and intervention). Statistically significant changes were reported in some outcomes, including an increase in the parental participation rate in face-to-face prenatal education; increased rate of breastfeeding initiation and exclusive breastfeeding (2-12 months); improved overall children?s behavior related to sleep, diet, physical activity, screen time, and intake of sugary beverages; improved individual children?s behavior related to physical activity and sleep; and decrease in alcohol drinks per week and binge drinking episodes per 2 weeks due to time effect. However, no study provided a sample size calculation for the reported significant outcomes. Also, due to the small number of included studies and each study evaluating a different intervention, it was not possible to combine results to ascertain if the participant engagement, intervention design, or community context had any impact on the effectiveness. Conclusions: Due to the lack of sample size calculation, it was not possible to establish whether differences in the effectiveness were due to the interventions or a type I statistical error. Therefore, caution is required in the interpretation of these findings. Trial Registration: PROSPERO CRD42023395710; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395710 
UR  - https://www.jmir.org/2025/1/e57019
UR  - http://dx.doi.org/10.2196/57019
UR  - http://www.ncbi.nlm.nih.gov/pubmed/40305103
ID  - info:doi/10.2196/57019
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  - Kola, Lola
AU  - Fatodu, Tobi
AU  - Kola, Manasseh
AU  - Olayemi, A. Bisola
AU  - Adefolarin, O. Adeyinka
AU  - Dania, Simpa
AU  - Kumar, Manasi
AU  - Ben-Zeev, Dror
PY  - 2025/4/9
TI  - Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study
JO  - JMIR Form Res
SP  - e42406
VL  - 9
KW  - adolescent perinatal depression
KW  - primary care
KW  - mHealth app
KW  - user centered design
KW  - smartphone
KW  - human-centered design
KW  - HCD
KW  - depression
KW  - postpartum
KW  - perinatal
KW  - postnatal
KW  - teenage
KW  - adolescent
KW  - youth
KW  - low-middle-income countries
KW  - LMIC
KW  - middle income
KW  - adoption
KW  - acceptability
KW  - mobile health
KW  - mHealth
KW  - mobile app
KW  - women?s health
KW  - mental health
KW  - depressive
N2  - Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants? knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients? relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. 
UR  - https://formative.jmir.org/2025/1/e42406
UR  - http://dx.doi.org/10.2196/42406
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/42406
ER  - 

TY  - JOUR
AU  - McAlister, Kelsey
AU  - Baez, Lara
AU  - Huberty, Jennifer
AU  - Kerppola, Marianna
PY  - 2025/4/8
TI  - Chatbot to Support the Mental Health Needs of Pregnant and Postpartum Women (Moment for Parents): Design and Pilot Study
JO  - JMIR Form Res
SP  - e72469
VL  - 9
KW  - perinatal support
KW  - human-centered design
KW  - digital health
KW  - maternal health
KW  - chatbot
KW  - digital tool
N2  - Background: Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. Objective: This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. Methods: This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Results: Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6%) re-engaged 3 or more times. Overall, 28/30 (93.3%) found the chatbot relevant for them, though some noted repetitive content and limited response options. Conclusions: The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness. 
UR  - https://formative.jmir.org/2025/1/e72469
UR  - http://dx.doi.org/10.2196/72469
ID  - info:doi/10.2196/72469
ER  - 

TY  - JOUR
AU  - Dol, Justine
AU  - Campbell-Yeo, Marsha
AU  - Aston, Megan
AU  - McMillan, Douglas
AU  - Grant, K. Amy
PY  - 2025/4/2
TI  - Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial
JO  - JMIR Pediatr Parent
SP  - e62841
VL  - 8
KW  - mHealth
KW  - mobile health
KW  - SMS text message
KW  - text messages
KW  - messaging
KW  - self-efficacy
KW  - postpartum depression
KW  - postpartum anxiety
KW  - social support
KW  - intervention
KW  - postpartum
KW  - postnatal
KW  - mental health
KW  - parenting
KW  - mother
KW  - depression
KW  - anxiety
KW  - RCT
KW  - randomized controlled trial
N2  - Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 
UR  - https://pediatrics.jmir.org/2025/1/e62841
UR  - http://dx.doi.org/10.2196/62841
ID  - info:doi/10.2196/62841
ER  - 

TY  - JOUR
AU  - Atukunda, Cathyln Esther
AU  - Mugyenyi, Rwambuka Godfrey
AU  - Haberer, E. Jessica
AU  - Siedner, J. Mark
AU  - Musiimenta, Angella
AU  - Najjuma, N. Josephine
AU  - Obua, Celestino
AU  - Matthews, T. Lynn
PY  - 2025/3/19
TI  - Integration of a Patient-Centered mHealth Intervention (Support-Moms) Into Routine Antenatal Care to Improve Maternal Health Among Pregnant Women in Southwestern Uganda: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e67049
VL  - 14
KW  - social support
KW  - intervention development
KW  - maternal health
KW  - antenatal care attendance
KW  - skilled births
KW  - Uganda
N2  - Background: Mobile health (mHealth) interventions that leverage social support (SS) can improve partner involvement and pregnancy experiences and promote antenatal care (ANC) attendance and skilled births. In our previous studies, we used behavioral frameworks to develop a user-centered mHealth-based, audio SMS text messaging app to support pregnant individuals to use maternity care services in rural Uganda (Support-Moms app). In our pilot study, we observed high intervention uptake, acceptability, and feasibility, as well as increased ANC attendance and skilled births. Objective: With the promising pilot data, we propose a type 1 hybrid implementation-effectiveness trial to test if this novel patient-centered automated and customized mHealth-based SS intervention is effective and cost-effective enough to warrant future large-scale implementation into Uganda?s routine maternity care. Methods: We will physically recruit 824 pregnant women at <20 weeks of gestation living in Mbarara and Mitooma districts, southwestern Uganda, and randomize them (1:1) to receive standard of care or the Support-Moms app, with at least 2 of their identified social supporters. Our primary outcome will be the proportion of skilled births. Secondary outcomes will include number of ANC visits<strong>,</strong> institution-based delivery, mode of infant delivery, preterm birth, birth weight, SS, obstetric complications, and deaths (maternal, fetal, and newborn). We will assess other implementation, service, and client outcomes through study records, the mHealth platform, and questionnaires with all women in the intervention, their social supporters, health care providers (HCPs), and managers from participating facilities. We will conduct face-to-face in-depth exit interviews with 30 purposively selected intervention participants and 15 facility HCPs and managers to explore implementation strategies for scale-up. Annual maternity resource allocations, costs, number of ANC visits, and deliveries will be assessed from facility records up to 36 months after implementation. We will estimate incremental cost-effectiveness ratios concerning cost per additional HCP-led delivery, per death averted, and per quality-adjusted life year gained as cost-effectiveness measures. Results: This study was funded in September 2023. Ethics approval was obtained in February 2024, and actual data collection started in March 2024. As of January 2025, 75% (618/824) of all projected study participants provided consent and were recruited into the study. Participants are expected to be followed up until delivery, and 15% (124/824) have so far exited. Data analysis for the trial is expected to start as soon as the last participant exits from the study. The qualitative interviews will start in April 2025, and data will be analyzed and published as soon as data collection is done, which is expected in March 2027. Conclusions: We are testing the feasibility, acceptability, and cost-effectiveness of implementing Support-Moms into routine maternity care from individual and facility perspectives. We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service use for women in rural Uganda and similar settings. Trial Registration: ClinicalTrials.gov NCT05940831; https://clinicaltrials.gov/study/NCT05940831 International Registered Report Identifier (IRRID): DERR1-10.2196/67049 
UR  - https://www.researchprotocols.org/2025/1/e67049
UR  - http://dx.doi.org/10.2196/67049
UR  - http://www.ncbi.nlm.nih.gov/pubmed/40105879
ID  - info:doi/10.2196/67049
ER  - 

TY  - JOUR
AU  - Decataldo, Alessandra
AU  - Paleardi, Federico
AU  - Lauritano, Giacomo
AU  - Figlino, Francesca Maria
AU  - Russo, Concetta
AU  - Novello, Mino
AU  - Fiore, Brunella
AU  - Ciuffo, Giulia
AU  - Ionio, Chiara
PY  - 2025/3/18
TI  - Preventing Premature Family Maladjustment: Protocol for a Multidisciplinary eHealth Study on Preterm Parents? Well-Being
JO  - JMIR Res Protoc
SP  - e63483
VL  - 14
KW  - preterm birth
KW  - parental well-being
KW  - sociology of health
KW  - digital-based monitoring
KW  - mixed methods research
KW  - eHealth
N2  - Background: The consequences of preterm birth extend beyond the clinical conditions of the newborn, profoundly impacting the functioning and well-being of families. Parents of preterm infants often describe the experience of preterm birth and subsequent admission to the neonatal intensive care unit (NICU) as a disruptive event in their lives, triggering feelings of guilt, helplessness, and fear. Although various research examines changes in parents? well-being and perception of self-efficacy during the stay in the NICU, there is a lack of research analyzing what happens in the transition phase at home after the baby?s discharge. Recently, scholars have advocated for the use of web-based support programs to monitor and prevent preterm family maladjustment and assist parents. Objective: This interdisciplinary research will develop a sociopsychological model focused on assessing the well-being of parents of premature infants during and after their stay in a NICU. Specifically, the study aims to (1) monitor the mental health of parents of premature infants both at the time of the child?s discharge from the NICU and in the first 6 months after discharge to prevent family maladjustment, (2) deepen our understanding of the role of digital tools in monitoring and supporting preterm parents? well-being, and (3) study the potential impact of the relationship with health care professionals on the overall well-being of parents. Methods: This project combines mixed methods of social research and psychological support with an eHealth approach. The well-being of parents of premature infants will be assessed using validated scales administered through a questionnaire to parents of preterm infants within 6 NICUs at the time of the child?s discharge. Subsequently, a follow-up assessment of parental well-being will be implemented through the administration of the validated scales in a web application. In addition, an ethnographic phase will be conducted in the NICUs involving observation of the interaction between health care professionals and parents as well as narrative interviews with health care staff. Finally, interactions within the digital environment of the web application will be analyzed using a netnographic approach. We expect to shed light on the determinants of well-being among parents of premature infants in relation to varying levels of prematurity severity; sociodemographic characteristics such as gender, age, and socioeconomic status; and parental involvement in NICU care practices. With the follow-up phase via web application, this project also aims to prevent family maladjustment by providing psychological support and using an eHealth tool. Results: The results are expected by October 2025, the expiration date of the Project of Relevant National Interest. Conclusions: The eHealth Study on Preterm Parents? Well-Being aims to improve preterm parents? well-being and, indirectly, children?s health by reducing social costs. Furthermore, it promotes standardized neonatal care protocols, reducing regional disparities and strengthening collaboration between parents and health care staff. International Registered Report Identifier (IRRID): PRR1-10.2196/63483 
UR  - https://www.researchprotocols.org/2025/1/e63483
UR  - http://dx.doi.org/10.2196/63483
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/63483
ER  - 

TY  - JOUR
AU  - Wang, Jianing
AU  - Tang, Nu
AU  - Jin, Congcong
AU  - Yang, Jianxue
AU  - Zheng, Xiangpeng
AU  - Jiang, Qiujing
AU  - Li, Shengping
AU  - Xiao, Nian
AU  - Zhou, Xiaojun
PY  - 2025/3/14
TI  - Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis
JO  - J Med Internet Res
SP  - e66580
VL  - 27
KW  - digital health
KW  - telemedicine
KW  - telehealth
KW  - mobile health
KW  - mHealth
KW  - mobile phone
KW  - intervention
KW  - meta-analysis
KW  - pregnant women
KW  - systematic review
N2  - Background: Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes. Objective: This study aimed to investigate the effect of digital health interventions among pregnant women and newborns. Methods: A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data. Results: We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference?0.19, 95% CI ?0.25 to ?0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05). Conclusions: The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful. Trial Registration: PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt 
UR  - https://www.jmir.org/2025/1/e66580
UR  - http://dx.doi.org/10.2196/66580
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/66580
ER  - 

TY  - JOUR
AU  - Downs, Symons Danielle
AU  - Pauley, M. Abigail
AU  - Rivera, E. Daniel
AU  - Savage, S. Jennifer
AU  - Moore, M. Amy
AU  - Shao, Danying
AU  - Chow, Sy-Miin
AU  - Lagoa, Constantino
AU  - Pauli, M. Jaimey
AU  - Khan, Owais
AU  - Kunselman, Allen
PY  - 2025/3/13
TI  - Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e66637
VL  - 14
KW  - pregnancy
KW  - gestational weight gain
KW  - physical activity
KW  - healthy eating
KW  - overweight
KW  - obesity
KW  - intervention
N2  - Background: Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a ?gold standard? intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform. Objective: The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability. Methods: This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ?30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models. Results: Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028. Conclusions: Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women. International Registered Report Identifier (IRRID): DERR1-10.2196/66637 
UR  - https://www.researchprotocols.org/2025/1/e66637
UR  - http://dx.doi.org/10.2196/66637
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/66637
ER  - 

TY  - JOUR
AU  - Gao, Jing
AU  - Jie, Xu
AU  - Yao, Yujun
AU  - Xue, Jingdong
AU  - Chen, Lei
AU  - Chen, Ruiyao
AU  - Chen, Jiayuan
AU  - Cheng, Weiwei
PY  - 2025/3/10
TI  - Fetal Birth Weight Prediction in the Third Trimester: Retrospective Cohort Study and Development of an Ensemble Model
JO  - JMIR Pediatr Parent
SP  - e59377
VL  - 8
KW  - fetal birthweight
KW  - ensemble learning model
KW  - machine learning
KW  - prediction model
KW  - ultrasonography
KW  - macrosomia
KW  - low birth weight
KW  - birth weight
KW  - fetal
KW  - AI
KW  - artificial intelligence
KW  - prenatal
KW  - prenatal care
KW  - Shanghai
KW  - neonatal
KW  - maternal
KW  - parental
N2  - Background: Accurate third-trimester birth weight prediction is vital for reducing adverse outcomes, and machine learning (ML) offers superior precision over traditional ultrasound methods. Objective: This study aims to develop an ML model on the basis of clinical big data for accurate prediction of birth weight in the third trimester of pregnancy, which can help reduce adverse maternal and fetal outcomes. Methods: From January 1, 2018 to December 31, 2019, a retrospective cohort study involving 16,655 singleton live births without congenital anomalies (>28 weeks of gestation) was conducted in a tertiary first-class hospital in Shanghai. The initial set of data was divided into a train set for algorithm development and a test set on which the algorithm was divided in a ratio of 4:1. We extracted maternal and neonatal delivery outcomes, as well as parental demographics, obstetric clinical data, and sonographic fetal biometry, from electronic medical records. A total of 5 basic ML algorithms, including Ridge, SVM, Random Forest, extreme gradient boosting (XGBoost), and Multi-Layer Perceptron, were used to develop the prediction model, which was then averaged into an ensemble learning model. The models were compared using accuracy, mean squared error, root mean squared error, and mean absolute error. International Peace Maternity and Child Health Hospital's Research Ethics Committee granted ethical approval for the usage of patient information (GKLW2021-20). Results: Train and test sets contained a total of 13,324 and 3331 cases, respectively. From a total of 59 variables, we selected 17 variables that were readily available for the ?few feature model,? which achieved high predictive power with an accuracy of 81% and significantly exceeded ultrasound formula methods. In addition, our model maintained superior performance for low birth weight and macrosomic fetal populations. Conclusions: Our research investigated an innovative artificial intelligence model for predicting fetal birth weight and maximizing health care resource use. In the era of big data, our model improves maternal and fetal outcomes and promotes precision medicine. 
UR  - https://pediatrics.jmir.org/2025/1/e59377
UR  - http://dx.doi.org/10.2196/59377
ID  - info:doi/10.2196/59377
ER  - 

TY  - JOUR
AU  - Zadushlivy, Nina
AU  - Biviji, Rizwana
AU  - Williams, S. Karmen
PY  - 2025/3/5
TI  - Exploration of Reproductive Health Apps? Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis
JO  - J Med Internet Res
SP  - e51517
VL  - 27
KW  - data privacy policy
KW  - reproductive health apps
KW  - Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective
KW  - THESIS
KW  - THESIS evaluation
KW  - women?s health
KW  - menstrual health
KW  - mobile health
KW  - mHealth
KW  - menstruating persons? health
KW  - mobile phone
N2  - Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps?Clue, Flo, Period Tracker by GP Apps, and Stardust?as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps? use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. 
UR  - https://www.jmir.org/2025/1/e51517
UR  - http://dx.doi.org/10.2196/51517
UR  - http://www.ncbi.nlm.nih.gov/pubmed/40053713
ID  - info:doi/10.2196/51517
ER  - 

TY  - JOUR
AU  - Gaynor, Mathew
AU  - Hesketh, Kylie
AU  - Gebremariam, Kidane
AU  - Wynter, Karen
AU  - Laws, Rachel
PY  - 2025/2/21
TI  - Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study
JO  - JMIR Pediatr Parent
SP  - e64171
VL  - 8
KW  - fathers
KW  - parenting resources
KW  - health promotion
KW  - My Baby Now
KW  - MBN
KW  - app
KW  - mobile phone
N2  - Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child?s health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. 
UR  - https://pediatrics.jmir.org/2025/1/e64171
UR  - http://dx.doi.org/10.2196/64171
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39982774
ID  - info:doi/10.2196/64171
ER  - 

TY  - JOUR
AU  - Knowles, Kayla
AU  - Lee, Susan
AU  - Yapalater, Sophia
AU  - Taylor, Maria
AU  - Akers, Y. Aletha
AU  - Wood, Sarah
AU  - Dowshen, Nadia
PY  - 2025/2/19
TI  - Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study
JO  - JMIR Pediatr Parent
SP  - e60315
VL  - 8
KW  - adolescent
KW  - contraception
KW  - telemedicine
KW  - user-centered design
KW  - young adult
KW  - reproductive
KW  - design
KW  - usability
KW  - experience
KW  - mHealth
KW  - mobile health
KW  - app
KW  - youth
KW  - teenager
KW  - drug
KW  - pharmacology
KW  - pharmacotherapy
KW  - pharmaceutics
KW  - medication
KW  - pharmacy
KW  - digital health
KW  - platform
KW  - access
N2  - Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded ?think aloud? interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during ?think aloud? interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. 
UR  - https://pediatrics.jmir.org/2025/1/e60315
UR  - http://dx.doi.org/10.2196/60315
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/60315
ER  - 

TY  - JOUR
AU  - Asadollahi, Fateme
AU  - Ebrahimzadeh Zagami, Samira
AU  - Eslami, Saeid
AU  - Latifnejad Roudsari, Robab
PY  - 2025/2/13
TI  - Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study
JO  - Asian Pac Isl Nurs J
SP  - e66852
VL  - 9
KW  - pregnancy
KW  - prenatal care
KW  - mobile health apps
KW  - mHealth
KW  - women?s health
KW  - health care providers
KW  - quality assessment
KW  - content evaluation
KW  - suitability assessment
KW  - digital health
KW  - smartphones
KW  - eHealth
KW  - telehealth
KW  - telemedicine
KW  - health promotion
KW  - technology
KW  - functionality
KW  - systematic search
N2  - Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term ?pregnancy app? until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 
UR  - https://apinj.jmir.org/2025/1/e66852
UR  - http://dx.doi.org/10.2196/66852
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/66852
ER  - 

TY  - JOUR
AU  - Amhaz, Haneen
AU  - Chen, Xuanping Sally
AU  - Elchehimi, Amanee
AU  - Han, Jialin Kylin
AU  - Gil, Morales Jade
AU  - Yao, Lu
AU  - Vidler, Marianne
AU  - Berry-Einarson, Kathryn
AU  - Dewar, Kathryn
AU  - Tuason, May
AU  - Prestley, Nicole
AU  - Doan, Quynh
AU  - van Rooij, Tibor
AU  - Costa, Tina
AU  - Ogilvie, Gina
AU  - Payne, A. Beth
PY  - 2025/1/30
TI  - The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment
JO  - JMIR Hum Factors
SP  - e60825
VL  - 12
KW  - digital health
KW  - co-design
KW  - digital strategy
KW  - human-centered design
KW  - eHealth
KW  - cocreation
KW  - codevelopment
KW  - perinatal intervention
KW  - quality of care
KW  - digital tools
KW  - pregnancy
KW  - patient autonomy
KW  - patient support
KW  - mobile phone
N2  - Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. 
UR  - https://humanfactors.jmir.org/2025/1/e60825
UR  - http://dx.doi.org/10.2196/60825
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/60825
ER  - 

TY  - JOUR
AU  - Muhammad, Shah
AU  - Soomro, Asif
AU  - Ahmed Khan, Samia
AU  - Najmi, Hina
AU  - Memon, Zahid
AU  - Ariff, Shabina
AU  - Soofi, Sajid
AU  - Bhutta, Ahmed Zufiqar
PY  - 2025/1/29
TI  - Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e56142
VL  - 14
KW  - kangaroo mother care
KW  - scale up intervention
KW  - health facility
KW  - community
KW  - preterm infants
N2  - Background: The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities. Objective: This study aims to achieve at least 80% KMC coverage for premature and low birth weight neonates. Methods: This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes. Results: This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage. Conclusions: The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study?s findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs. International Registered Report Identifier (IRRID): DERR1-10.2196/56142 
UR  - https://www.researchprotocols.org/2025/1/e56142
UR  - http://dx.doi.org/10.2196/56142
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/56142
ER  - 

TY  - JOUR
AU  - Karasek, Deborah
AU  - Williams, C. Jazzmin
AU  - Taylor, A. Michaela
AU  - De La Cruz, M. Monica
AU  - Arteaga, Stephanie
AU  - Bell, Sabra
AU  - Castillo, Esperanza
AU  - Chand, A. Maile
AU  - Coats, Anjeanette
AU  - Hubbard, M. Erin
AU  - Love-Goodlett, Latriece
AU  - Powell, Breezy
AU  - Spellen, Solaire
AU  - Malawa, Zea
AU  - Gomez, Manchikanti Anu
PY  - 2025/1/27
TI  - Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project
JO  - JMIR Form Res
SP  - e60829
VL  - 9
KW  - maternal and child health
KW  - economics
KW  - public health
KW  - qualitative research methods
KW  - programs (evaluation and funding)
KW  - community-centered
KW  - pregnancy
KW  - first pregnancy
KW  - behavioral interventions
KW  - racial health
KW  - financial stress
KW  - Abundant Birth Project
KW  - infant health
KW  - infant
KW  - Black
N2  - Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States?the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP?s program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. 
UR  - https://formative.jmir.org/2025/1/e60829
UR  - http://dx.doi.org/10.2196/60829
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/60829
ER  - 

TY  - JOUR
AU  - Rizzi, Silvia
AU  - Pavesi, Chiara Maria
AU  - Moser, Alessia
AU  - Paolazzi, Francesca
AU  - Marchesoni, Michele
AU  - Poggianella, Stefania
AU  - Gadotti, Erik
AU  - Forti, Stefano
PY  - 2025/1/17
TI  - A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies
JO  - JMIR Form Res
SP  - e58265
VL  - 9
KW  - mindfulness
KW  - promoting well-being
KW  - pregnancy
KW  - eHealth
KW  - mHealth
KW  - mobile apps
KW  - development
KW  - usability
KW  - user-centered design
KW  - well-being
KW  - maternal health
KW  - digital health
KW  - intervention
KW  - design
KW  - preliminary testing
KW  - technology-based
KW  - interview
KW  - multidisciplinary approach
KW  - mother
KW  - women
KW  - WhatsApp
KW  - email
KW  - midwife
N2  - Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention?s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. 
UR  - https://formative.jmir.org/2025/1/e58265
UR  - http://dx.doi.org/10.2196/58265
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/58265
ER  - 

TY  - JOUR
AU  - Martin, M. Lindsay
AU  - McKinney, D. Christine
AU  - Escobar Acosta, Lia
AU  - Coughlin, W. Janelle
AU  - Jeffers, K. Noelene
AU  - Solano-Umaña, Alexandra
AU  - Carson, A. Kathryn
AU  - Wang, Nae-Yuh
AU  - Bennett, L. Wendy
AU  - Bower, M. Kelly
PY  - 2025/1/7
TI  - Remote Lifestyle Intervention to Reduce Postpartum Weight Retention: Protocol for a Community-Engaged Hybrid Type I Effectiveness-Implementation Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e62847
VL  - 14
KW  - pregnancy
KW  - obesity
KW  - postpartum weight retention
KW  - remote lifestyle intervention
KW  - home visiting
KW  - mobile health
KW  - mHealth app
KW  - community-engaged research
KW  - implementation science
KW  - health disparities
KW  - maternal health
N2  - Background: Maternal obesity is associated with significant racial disparities. People who identify as non-Hispanic Black and Latinx are at the highest risk related adverse short- and long-term health outcomes (eg, hypertension in pregnancy and postpartum weight retention). Remote lifestyle interventions delivered during and after pregnancy hold promise for supporting healthy weight outcomes; however, few are tested in groups of people who self-identify as non-Hispanic Black and Latinx or address the neighborhood-level and psychosocial factors driving maternal health disparities. Implementing remote lifestyle interventions within community-based programs that serve birthing people may optimize trust and engagement, promote scalability and sustainability, and have the broadest public health impact. Objective: The goal of this trial is to test the effectiveness of a culturally adapted remote lifestyle intervention (Healthy for Two?Home Visiting) implemented within home visiting compared to usual home visiting services on postpartum weight retention among pregnant or postpartum individuals, in particular those who identify as non-Hispanic Black and Latinx. Facilitators and barriers to implementation of the intervention within home visiting will be examined. Methods: We describe the rationale and protocol for this hybrid type I effectiveness-implementation randomized controlled trial. In this paper, we highlight the community-engaged approach and trial design features that enable the implementation of the intervention within home visiting and demonstrate its applicability to the target population. Participants will be 360 pregnant individuals with overweight or obesity enrolled between 20 and 33 weeks of gestation and randomized 1:1 to Healthy for Two?Home Visiting or usual home visiting services. The primary outcome is weight retention at 6 months post partum, calculated as 6-month postpartum weight minus earliest pregnancy weight (?18 wk of gestation). The measures of implementation include intervention feasibility, acceptability, reach, adoption, and fidelity. Throughout the paper, we highlight the community input used to improve intervention effectiveness and study implementation and as a strategy to promote maternal health equity. Results: This study was funded in June 2021, and recruitment began in April 2023. As of November 2024, we enrolled 90 participants. Data collection to assess the intervention?s effectiveness is expected to end in June 2026. Implementation evaluation is expected to conclude in December 2026. Conclusions: This hybrid type I effectiveness-implementation randomized controlled trial integrates a culturally adapted remote lifestyle intervention into early home visiting services to examine its effectiveness on postpartum weight retention compared to usual home visiting. We anticipate that the study results will enable an understanding of the drivers of successful implementation within a community-based setting to maximize the future sustainability and dissemination of a strategy for reducing long-term obesity and other maternal health disparities. Trial Registration: Clinicaltrials.gov NCT05619705; https://clinicaltrials.gov/study/NCT05619705 International Registered Report Identifier (IRRID): DERR1-10.2196/62847 
UR  - https://www.researchprotocols.org/2025/1/e62847
UR  - http://dx.doi.org/10.2196/62847
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/62847
ER  - 

TY  - JOUR
AU  - Dorney, Edwina
AU  - Hammarberg, Karin
AU  - Rodgers, Raymond
AU  - Black, I. Kirsten
PY  - 2024/12/24
TI  - Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study
JO  - JMIR Hum Factors
SP  - e63334
VL  - 11
KW  - technology
KW  - internet
KW  - eHealth
KW  - user experience
KW  - patient engagement
KW  - self-assessment tool
KW  - preconception
KW  - health communication
N2  - Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18?41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term ?preconception care? and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool?s title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users? feedback informed changes to improve the tool?s acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. 
UR  - https://humanfactors.jmir.org/2024/1/e63334
UR  - http://dx.doi.org/10.2196/63334
ID  - info:doi/10.2196/63334
ER  - 

TY  - JOUR
AU  - Smit, JP Ashley
AU  - Al-Dhahir, Isra
AU  - Schiphof-Godart, Lieke
AU  - Breeman, D. Linda
AU  - Evers, WM Andrea
AU  - Joosten, FM Koen
PY  - 2024/12/20
TI  - Investigating eHealth Lifestyle Interventions for Vulnerable Pregnant Women: Scoping Review of Facilitators and Barriers
JO  - J Med Internet Res
SP  - e54366
VL  - 26
KW  - eHealth
KW  - pregnancy
KW  - vulnerability
KW  - socioeconomic status
KW  - lifestyle intervention
KW  - intervention development
KW  - barriers
KW  - facilitators
KW  - mobile phone
KW  - PRISMA
N2  - Background: The maintenance of a healthy lifestyle significantly influences pregnancy outcomes. Certain pregnant women are more at risk of engaging in unhealthy behaviors due to factors such as having a low socioeconomic position and low social capital. eHealth interventions tailored to pregnant women affected by these vulnerability factors can provide support and motivation for healthier choices. However, there is still a lack of insight into how interventions for this target group are best designed, used, and implemented and how vulnerable pregnant women are best reached. Objective: This review aimed to identify the strategies used in the design, reach, use, and implementation phases of eHealth lifestyle interventions for vulnerable pregnant women; assess whether these strategies acted as facilitators; and identify barriers that were encountered. Methods: We conducted a search on MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar for studies that described an eHealth intervention for vulnerable pregnant women focusing on at least one lifestyle component (diet, physical activity, alcohol consumption, smoking, stress, or sleep) and provided information on the design, reach, use, or implementation of the intervention. Results: The literature search identified 3904 records, of which 29 (0.74%) met our inclusion criteria. These 29 articles described 20 eHealth lifestyle interventions, which were primarily delivered through apps and frequently targeted multiple lifestyle components simultaneously. Barriers identified in the design and use phases included financial aspects (eg, budgetary constraints) and technological challenges for the target group (eg, limited internet connectivity). In addition, barriers were encountered in reaching vulnerable pregnant women, including a lack of interest and time constraints among eligible participants and limited support from health care providers. Facilitators identified in the design and use phases included collaborating with the target group and other stakeholders (eg, health care providers), leveraging existing eHealth platforms for modifications or extensions, and adhering to clinical and best practice guidelines and behavior change frameworks. Furthermore, tailoring (eg, matching the content of the intervention to the target groups? norms and values) and the use of incentives (eg, payments for abstaining from unhealthy behavior) were identified as potential facilitators to eHealth use. Facilitators in the interventions? reach and implementation phases included stakeholder collaboration and a low workload for the intervention deliverers involved in these phases. Conclusions: This scoping review offers a comprehensive overview of strategies used in different phases of eHealth lifestyle interventions for vulnerable pregnant women, highlighting specific barriers and facilitators. Limited reporting on the impact of the strategies used and barriers encountered hinders a complete identification of facilitators and barriers. Nevertheless, this review sheds light on how to optimize the development of eHealth lifestyle interventions for vulnerable pregnant women, ultimately enhancing the health of both future mothers and their offspring. 
UR  - https://www.jmir.org/2024/1/e54366
UR  - http://dx.doi.org/10.2196/54366
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/54366
ER  - 

TY  - JOUR
AU  - Huang, Yi-Yan
AU  - Wang, Rong
AU  - Huang, Wei-Peng
AU  - Wu, Tian
AU  - Wang, Shi-Yun
AU  - R. Redding, Sharon
AU  - Ouyang, Yan-Qiong
PY  - 2024/12/17
TI  - Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e51566
VL  - 26
KW  - breastfeeding
KW  - co-parenting
KW  - randomized controlled
KW  - child
KW  - efficacy
KW  - depressive symptoms
N2  - Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers? support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant?s BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90% vs 65%, P=.02) and T2 (43.6% vs 22.5%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge (?=.07, 95% CI 0.006-0.13; P=.03) and maternal parenting sense of competence (?=5.49, 95% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 (?=.25, 95% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 (?=5.35, 95% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 (?=.25, 95% CI 0.15-0.35, P<.001), and there was a rise in infants? BMI at 42 days post partum (?=.33, 95% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant?s BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 
UR  - https://www.jmir.org/2024/1/e51566
UR  - http://dx.doi.org/10.2196/51566
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/51566
ER  - 

TY  - JOUR
AU  - Ageng, Kidung
AU  - Inthiran, Anushia
PY  - 2024/12/9
TI  - Exploring Pregnancy-Related Information-Sharing Behavior Among First-Time Southeast Asian Fathers: Qualitative Semistructured Interview Study
JO  - JMIR Pediatr Parent
SP  - e58482
VL  - 7
KW  - pregnancy
KW  - first-time fathers
KW  - information sharing
KW  - Southeast Asia
KW  - information-seeking behavior
KW  - cultural factors
N2  - Background: While the benefits of fathers? engagement in pregnancy are well researched, little is known about first-time expectant fathers? information-seeking practices in Southeast Asia regarding pregnancy. In addition, there is a notable gap in understanding their information-sharing behaviors during the pregnancy journey. This information is important, as cultural norms are prevalent in Southeast Asia, and this might influence their information-sharing behavior, particularly about pregnancy. Objective: This study aims to explore and analyze the pregnancy-related information-sharing behavior of first-time expectant fathers in Southeast Asia. This study specifically aims to investigate whether first-time fathers share pregnancy information, with whom they share it, through what means, and the reasons behind the decisions to share the information or not. Methods: We conducted semistructured interviews with first-time Southeast Asian fathers in Indonesia, a sample country in the Southeast Asian region. We analyzed the data using quantitative descriptive analysis and qualitative content theme analysis. A total of 40 first-time expectant fathers were interviewed. Results: The results revealed that 90% (36/40) of the participants shared pregnancy-related information with others. However, within this group, more than half (22/40, 55%) of the participants shared the information exclusively with their partners. Only a small proportion, 10% (4/40), did not share any information at all. Among those who did share, the most popular approach was face-to-face communication (36/40, 90%), followed by online messaging apps (26/40, 65%). The most popular reason for sharing was to validate information (14/40, 35%), while the most frequent reason for not sharing with anyone beyond their partner was because of the preference for asking for information rather than sharing (12/40, 30%). Conclusions: This study provides valuable insights into the pregnancy-related information-sharing behaviors of first-time fathers in Southeast Asia. It enhances our understanding of how first-time fathers share pregnancy-related information and how local cultural norms and traditions influence these practices. In contrast to first-time fathers in high-income countries, the information-sharing behavior of first-time Southeast Asian fathers is defined by cultural nuances. Culture plays a crucial role in their daily decision-making processes. Therefore, this emphasizes the importance of cultural considerations in future discussions and the development of intervention programs related to pregnancy for first-time Southeast Asian fathers. In addition, this study sheds light on the interaction processes that first-time fathers engage in with others, highlighting areas where intervention programs may be necessary to improve their involvement during pregnancy. For example, first-time fathers actively exchange new information found with their partners; therefore, creating features or platforms that facilitate this process could improve their overall experience. Furthermore, health practitioners should take a more proactive approach in engaging with first-time fathers, as currently there is a communication gap between them. 
UR  - https://pediatrics.jmir.org/2024/1/e58482
UR  - http://dx.doi.org/10.2196/58482
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/58482
ER  - 

TY  - JOUR
AU  - Dol, Justine
AU  - Mselle, Teddy Lilian
AU  - Campbell-Yeo, Marsha
AU  - Mbekenga, Columba
AU  - Kohi, Thecla
AU  - McMillan, Douglas
AU  - Dennis, Cindy-Lee
AU  - Tomblin Murphy, Gail
AU  - Aston, Megan
PY  - 2024/12/5
TI  - Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e63454
VL  - 13
KW  - mobile health
KW  - maternal health
KW  - randomized controlled trial
KW  - parenting self-efficacy
KW  - self-efficacy
KW  - maternal
KW  - RCT
KW  - mother
KW  - text message
KW  - coaching
KW  - postnatal
KW  - newborn
KW  - child
KW  - low-income country
KW  - middle-income country
KW  - Africa
KW  - newborn care education
KW  - nurse midwife
KW  - Tanzania
N2  - Background: Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective: We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods: ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results: Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions: This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration: ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID): DERR1-10.2196/63454 
UR  - https://www.researchprotocols.org/2024/1/e63454
UR  - http://dx.doi.org/10.2196/63454
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/63454
ER  - 

TY  - JOUR
AU  - Baer, J. Rebecca
AU  - Bandoli, Gretchen
AU  - Jelliffe-Pawlowski, Laura
AU  - Chambers, D. Christina
PY  - 2024/12/3
TI  - The University of California Study of Outcomes in Mothers and Infants (a Population-Based Research Resource): Retrospective Cohort Study
JO  - JMIR Public Health Surveill
SP  - e59844
VL  - 10
KW  - birth certificate
KW  - vital statistics
KW  - hospital discharge
KW  - administrative data
KW  - linkage
KW  - pregnancy outcome
KW  - birth outcome
KW  - infant outcome
KW  - adverse outcome
KW  - preterm birth
KW  - birth defects
KW  - pregnancy
KW  - prenatal
KW  - California
KW  - policy
KW  - disparities
KW  - children
KW  - data collection
N2  - Background: Population-based databases are valuable for perinatal research. The California Department of Health Care Access and Information (HCAI) created a linked birth file covering the years 1991 through 2012. This file includes birth and fetal death certificate records linked to the hospital discharge records of the birthing person and infant. In 2019, the University of California Study of Outcomes in Mothers and Infants received approval to create similar linked birth files for births from 2011 onward, with 2 years of overlapping birth files to allow for linkage comparison. Objective: This paper aims to describe the University of California Study of Outcomes in Mothers and Infants linkage methodology, examine the linkage quality, and discuss the benefits and limitations of the approach. Methods: Live birth and fetal death certificates were linked to hospital discharge records for California infants between 2005 and 2020. The linkage algorithm includes variables such as birth hospital and date of birth, and linked record selection is made based on a ?link score.? The complete file includes California Vital Statistics and HCAI hospital discharge records for the birthing person (1 y before delivery and 1 y after delivery) and infant (1 y after delivery). Linkage quality was assessed through a comparison of linked files and California Vital Statistics only. Comparisons were made to previous linked birth files created by the HCAI for 2011 and 2012. Results: Of the 8,040,000 live births, 7,427,738 (92.38%) California Vital Statistics live birth records were linked to HCAI records for birthing people, 7,680,597 (95.53%) birth records were linked to HCAI records for the infant, and 7,285,346 (90.61%) California Vital Statistics birth records were linked to HCAI records for both the birthing person and the infant. The linkage rates were 92.44% (976,526/1,056,358) for Asian and 86.27% (28,601/33,151) for Hawaiian or Pacific Islander birthing people. Of the 44,212 fetal deaths, 33,355 (75.44%) had HCAI records linked to the birthing person. When assessing variables in both California Vital Statistics and hospital records, the percentage was greatest when using both sources: the rates of gestational diabetes were 4.52% (329,128/7,285,345) in the California Vital Statistics records, 8.2% (597,534/7,285,345) in the HCAI records, and 9.34% (680,757/7,285,345) when using both data sources. Conclusions: We demonstrate that the linkage strategy used for this data platform is similar in linkage rate and linkage quality to the previous linked birth files created by the HCAI. The linkage provides higher rates of crucial variables, such as diabetes, compared to birth certificate records alone, although selection bias from the linkage must be considered. This platform has been used independently to examine health outcomes, has been linked to environmental datasets and residential data, and has been used to obtain and examine maternal serum and newborn blood spots. 
UR  - https://publichealth.jmir.org/2024/1/e59844
UR  - http://dx.doi.org/10.2196/59844
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39625748
ID  - info:doi/10.2196/59844
ER  - 

TY  - JOUR
AU  - Perme, Natalie
AU  - Reid, Endia
AU  - Eluagu, Chinwenwa Macdonald
AU  - Thompson, John
AU  - Hebert, Courtney
AU  - Gabbe, Steven
AU  - Swoboda, Marie Christine
PY  - 2024/11/8
TI  - Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study
JO  - JMIR Form Res
SP  - e53299
VL  - 8
KW  - health resources
KW  - pregnancy
KW  - patient engagement
KW  - mHealth
KW  - maternal
KW  - mobile health
KW  - app
KW  - focus group
KW  - landscape analysis
KW  - birth
KW  - preterm
KW  - premature
KW  - mortality
KW  - death
KW  - pediatric
KW  - infant
KW  - neonatal
KW  - design
KW  - development
KW  - obstetric
KW  - mobile phone
N2  - Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app?s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. 
UR  - https://formative.jmir.org/2024/1/e53299
UR  - http://dx.doi.org/10.2196/53299
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/53299
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  - Barnwell, Julia
AU  - Hénault Robert, Cindy
AU  - Nguyen, Tuong-Vi
AU  - Davis, P. Kelsey
AU  - Gratton, Chloé
AU  - Elgbeili, Guillaume
AU  - Pham, Hung
AU  - Meaney, J. Michael
AU  - Montreuil, C. Tina
AU  - O'Donnell, J. Kieran
PY  - 2024/10/3
TI  - Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study
JO  - JMIR Pediatr Parent
SP  - e53786
VL  - 7
KW  - perinatal mental health
KW  - digital screening
KW  - maternal depression
KW  - maternal anxiety
KW  - text messaging
KW  - mHealth
KW  - mobile health
KW  - pregnancy
KW  - mobile phone
N2  - Background: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message?based screening protocols before such approaches can be implemented at the population level. Objective: This study aimed to examine sources of selection bias in a texting?based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Methods: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Results: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (e?=0.99; P<.001) and 0.3% (e?=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Conclusions: Findings from this study highlight the feasibility of text message?based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups. 
UR  - https://pediatrics.jmir.org/2024/1/e53786
UR  - http://dx.doi.org/10.2196/53786
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39361419
ID  - info:doi/10.2196/53786
ER  - 

TY  - JOUR
AU  - Delaney, Tessa
AU  - Jackson, K. Jacklyn
AU  - Brown, L. Alison
AU  - Lecathelinais, Christophe
AU  - Wolfenden, Luke
AU  - Hudson, Nayerra
AU  - Young, Sarah
AU  - Groombridge, Daniel
AU  - Pinfold, Jessica
AU  - Craven, David Paul
AU  - Redman, Sinead
AU  - Wiggers, John
AU  - Kingsland, Melanie
AU  - Hayes, Margaret
AU  - Sutherland, Rachel
PY  - 2024/9/24
TI  - Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study
JO  - JMIR Pediatr Parent
SP  - e59191
VL  - 7
KW  - maternal
KW  - postnatal
KW  - postpartum
KW  - acceptability
KW  - technology
KW  - digital health
KW  - first 2000 days
KW  - child health
KW  - experience
KW  - experiences
KW  - attitude
KW  - attitudes
KW  - opinion
KW  - perception
KW  - perceptions
KW  - perspective
KW  - perspectives
KW  - acceptance
KW  - cross sectional
KW  - survey
KW  - surveys
KW  - questionnaire
KW  - questionnaires
KW  - pediatric
KW  - pediatrics
KW  - infant
KW  - infants
KW  - infancy
KW  - baby
KW  - babies
KW  - neonate
KW  - neonates
KW  - neonatal
KW  - newborn
KW  - newborns
KW  - nurse
KW  - nurses
KW  - nursing
N2  - Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child?s birth. The majority of women (n=282-315, 82%-92%) ?strongly agreed or agreed? that receiving information from CFHN via technology would be acceptable, and most (n=308) women ?strongly agreed or agreed? with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. 
UR  - https://pediatrics.jmir.org/2024/1/e59191
UR  - http://dx.doi.org/10.2196/59191
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39316424
ID  - info:doi/10.2196/59191
ER  - 

TY  - JOUR
AU  - Isangula, Ganka Kahabi
AU  - Usiri, Itaeli Aminieli
AU  - Pallangyo, Siaity Eunice
PY  - 2024/9/10
TI  - Capitalizing on Community Groups to Improve Women?s Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania
JO  - JMIR Res Protoc
SP  - e54323
VL  - 13
KW  - maternal and child health
KW  - maternal and child deaths
KW  - human-centered design
KW  - income generating associations
KW  - sub-Saharan Africa
KW  - Tanzania
KW  - community groups
KW  - community
KW  - capitalizing
KW  - resilience
KW  - maternal deaths
KW  - neonatal deaths
KW  - mortality
KW  - co-design
N2  - Background: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. Objective: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. Methods: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women?s engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. Results: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women?s resilience and readiness to handle MCH challenges will be generated. Conclusions: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/54323 
UR  - https://www.researchprotocols.org/2024/1/e54323
UR  - http://dx.doi.org/10.2196/54323
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/54323
ER  - 

TY  - JOUR
AU  - Zahroh, Islamiah Rana
AU  - Cheong, Marc
AU  - Hazfiarini, Alya
AU  - Vazquez Corona, Martha
AU  - Ekawati, Murriya Fitriana
AU  - Emilia, Ova
AU  - Homer, SE Caroline
AU  - Betrán, Pilar Ana
AU  - Bohren, A. Meghan
PY  - 2024/9/6
TI  - The Portrayal of Cesarean Section on Instagram: Mixed Methods Social Media Analysis
JO  - JMIR Form Res
SP  - e46531
VL  - 8
KW  - cesarean section
KW  - social media analysis
KW  - maternal health
KW  - childbirth
KW  - mode of birth
KW  - instagram
N2  - Background: Cesarean section (CS) rates in Indonesia are rapidly increasing for both sociocultural and medical reasons. However, there is limited understanding of the role that social media plays in influencing preferences regarding mode of birth (vaginal or CS). Social media provides a platform for users to seek and exchange information, including information on the mode of birth, which may help unpack social influences on health behavior. Objective: This study aims to explore how CS is portrayed on Instagram in Indonesia. Methods: We downloaded public Instagram posts from Indonesia containing CS hashtags and extracted their attributes (image, caption, hashtags, and objects and texts within images). Posts were divided into 2 periods?before COVID-19 and during COVID-19?to examine changes in CS portrayal during the pandemic. We used a mixed methods approach to analysis using text mining, descriptive statistics, and qualitative content analysis. Results: A total of 9978 posts were analyzed quantitatively, and 720 (7.22%) posts were sampled and analyzed qualitatively. The use of text (527/5913, 8.91% vs 242/4065, 5.95%; P<.001) and advertisement materials (411/5913, 6.95% vs 83/4065, 2.04%; P<.001) increased during the COVID-19 pandemic compared to before the pandemic, indicating growth of information sharing on CS over time. Posts with CS hashtags primarily promoted herbal medicine for faster recovery and services for choosing auspicious childbirth dates, encouraging elective CS. Some private health facilities offered discounts on CS for special events such as Mother?s Day and promoted techniques such as enhanced recovery after CS for comfortable, painless birth, and faster recovery after CS. Hashtags related to comfortable or painless birth (2358/5913, 39.88% vs 278/4065, 6.84%; P<.001), enhanced recovery after CS (124/5913, 2.1% vs 0%; P<.001), feng shui services (110/5913, 1.86% vs 56/4065, 1.38%; P=.03), names of health care providers (2974/5913, 50.3% vs 304/4065, 7.48%; P<.001), and names of hospitals (1460/5913, 24.69% vs 917/4065, 22.56%; P=.007) were more prominent during compared to before the pandemic. Conclusions: This study highlights the necessity of enforcing advertisement regulations regarding birth-related medical services in the commercial and private sectors. Enhanced health promotion efforts are crucial to ensure that women receive accurate, balanced, and appropriate information about birth options. Continuous and proactive health information dissemination from government organizations is essential to counteract biases favoring CS over vaginal birth. 
UR  - https://formative.jmir.org/2024/1/e46531
UR  - http://dx.doi.org/10.2196/46531
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/46531
ER  - 

TY  - JOUR
AU  - Piris-Borregas, Salvador
AU  - Bellón-Vaquerizo, Beatriz
AU  - Velasco-Echeburúa, Leticia
AU  - Niño-Díaz, Lidia
AU  - Sánchez-Aparicio, Susana
AU  - López-Maestro, María
AU  - Pallás-Alonso, Rosa Carmen
PY  - 2024/8/30
TI  - Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study
JO  - JMIR Pediatr Parent
SP  - e55411
VL  - 7
KW  - family-centered care
KW  - neonatal intensive care unit
KW  - kangaroo mother care
KW  - mother
KW  - mothers
KW  - parent
KW  - parents
KW  - parental
KW  - ICU
KW  - intensive care
KW  - training
KW  - education
KW  - educational
KW  - premature
KW  - pediatric
KW  - pediatrics
KW  - paediatric
KW  - paediatrics
KW  - infant
KW  - infants
KW  - infancy
KW  - baby
KW  - babies
KW  - neonate
KW  - neonates
KW  - neonatal
KW  - newborn
KW  - newborns
KW  - intensive care unit
N2  - Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low?birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning ?Take Care of Me? in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5?20 vs 7, IQR 4?10.5 d; P<.001), feeding (median 53.5, IQR 34?68 vs 44.5, IQR 37?62 d; P=.049), and observation of neurobehavior (median 18, IQR 9?33 vs 11, IQR 7?16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7?23 vs 21, IQR 10?31 d; P=.02), diaper change (median 9.5, IQR 4?20 vs 14.5, IQR 9?32 d; P=.04), and infection prevention (median 1, IQR 1?2 vs 6, IQR 3?12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. 
UR  - https://pediatrics.jmir.org/2024/1/e55411
UR  - http://dx.doi.org/10.2196/55411
ID  - info:doi/10.2196/55411
ER  - 

TY  - JOUR
AU  - Mancinelli, Elisa
AU  - Magnolini, Simone
AU  - Gabrielli, Silvia
AU  - Salcuni, Silvia
PY  - 2024/8/14
TI  - A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study
JO  - JMIR Form Res
SP  - e58653
VL  - 8
KW  - chatbot prototype
KW  - co-design
KW  - pregnancy
KW  - prevention
KW  - behavioral activation
KW  - multiple case study
N2  - Background: Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. Objective: Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women?s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. Methods: Using a multiple?case study design, the research aims to uncover similarities and differences in participants? perceptions of the chatbot while also exploring women?s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. Results: Similarities and differences have emerged regarding women?s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot?s limitations. Conclusions: Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring. 
UR  - https://formative.jmir.org/2024/1/e58653
UR  - http://dx.doi.org/10.2196/58653
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/58653
ER  - 

TY  - JOUR
AU  - Mollard, Elizabeth
AU  - Cooper Owens, Deirdre
AU  - Bach, Christina
AU  - Gaines, Cydney
AU  - Maloney, Shannon
AU  - Moore, Tiffany
AU  - Wichman, Christopher
AU  - Shah, Neel
AU  - Balas, Michele
PY  - 2024/8/8
TI  - Protective Assets Reinforced With Integrated Care and Technology (PARITY): Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e58580
VL  - 13
KW  - maternal health
KW  - health disparities
KW  - doula
KW  - African American
KW  - mobile phone
N2  - Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. Trial Registration: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615 International Registered Report Identifier (IRRID): DERR1-10.2196/58580 
UR  - https://www.researchprotocols.org/2024/1/e58580
UR  - http://dx.doi.org/10.2196/58580
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/58580
ER  - 

TY  - JOUR
AU  - Bulcha, Gebeyehu
AU  - Abdissa, Gutema Hordofa
AU  - Noll, Josef
AU  - Sori, Amenu Demisew
AU  - Koricha, Birhanu Zewdie
PY  - 2024/7/23
TI  - Effectiveness of a Mobile Phone Messaging?Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e52395
VL  - 13
KW  - message framing
KW  - mHealth
KW  - digital health
KW  - SMS
KW  - maternal health
KW  - newborn health
KW  - cluster randomized controlled trials
KW  - RCT
KW  - Ethiopia
KW  - mobile phone
KW  - effectiveness
KW  - SMS-based interventions
KW  - text messaging
KW  - maternal
KW  - newborn care practice
KW  - randomized
KW  - controlled trial
KW  - controlled trials
KW  - mobile phone messaging
KW  - phone-based intervention
N2  - Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging?based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging?based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone?based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone?based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 
UR  - https://www.researchprotocols.org/2024/1/e52395
UR  - http://dx.doi.org/10.2196/52395
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/52395
ER  - 

TY  - JOUR
AU  - Li, Qin
AU  - Kanduma, Elsa
AU  - Ramiro, Isaías
AU  - Xu, (Roman) Dong
AU  - Cuco, Manjate Rosa Marlene
AU  - Chaquisse, Eusebio
AU  - Yang, Yili
AU  - Wang, Xiuli
AU  - Pan, Jay
PY  - 2024/7/18
TI  - Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study
JO  - JMIR Public Health Surveill
SP  - e49367
VL  - 10
KW  - continuous maternal and perinatal health care services
KW  - sub-Saharan Africa
KW  - SSA
KW  - spatial access
KW  - resource allocation
KW  - low-resource settings
N2  - Background: Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. Objective: This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. Methods: In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. Results: The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique?s land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique?s land area, including Maputo, could access timely CMPHS. Conclusions: The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities? engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3. 
UR  - https://publichealth.jmir.org/2024/1/e49367
UR  - http://dx.doi.org/10.2196/49367
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/49367
ER  - 

TY  - JOUR
AU  - Furusho, Miku
AU  - Noda, Minami
AU  - Sato, Yoko
AU  - Suetsugu, Yoshiko
AU  - Morokuma, Seiichi
PY  - 2024/6/26
TI  - Association Between Gestational Weeks, Initial Maternal Perception of Fetal Movement, and Individual Interoceptive Differences in Pregnant Women: Cross-Sectional Study
JO  - Asian Pac Isl Nurs J
SP  - e57128
VL  - 8
KW  - fetal movement
KW  - gestational weeks
KW  - gestation
KW  - gestational
KW  - heartbeat counting task
KW  - interoception
KW  - pregnancy
KW  - pregnant
KW  - maternal
KW  - fetus
KW  - fetal
KW  - association
KW  - associations
KW  - correlation
KW  - correlations
KW  - obstetric
KW  - obstetrics
KW  - interoceptive
KW  - perception
KW  - perceptions
KW  - awareness
KW  - sense
KW  - sensing
KW  - senses
KW  - internal stimulus
KW  - internal stimuli
N2  - Background: Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity. Objective: The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women. Methods: A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores. Results: A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=?0.43, P=.01) and among primiparous women (r=?0.53, P=.03) but not among multiparous women. Conclusions: Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement. 
UR  - https://apinj.jmir.org/2024/1/e57128
UR  - http://dx.doi.org/10.2196/57128
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/57128
ER  - 

TY  - JOUR
AU  - Chua, Xin Joelle Yan
AU  - Choolani, Mahesh
AU  - Chee, Ing Cornelia Yin
AU  - Yi, Huso
AU  - Chan, Huak Yiong
AU  - Lalor, Gabrielle Joan
AU  - Chong, Seng Yap
AU  - Shorey, Shefaly
PY  - 2024/6/21
TI  - Parents? Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot?A Digital Healthcare Assistant): Qualitative Process Evaluation
JO  - J Med Internet Res
SP  - e56894
VL  - 26
KW  - perinatal
KW  - parents
KW  - mobile app
KW  - chatbot
KW  - qualitative study
KW  - interviews
KW  - experiences
KW  - mobile phone
N2  - Background: Parents experience many challenges during the perinatal period. Mobile app?based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. Objective: This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app?based intervention with an in-built chatbot titled Parentbot?a Digital Healthcare Assistant (PDA). Methods: A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. Results: Three themes with 10 subthemes describing parents? perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. Conclusions: Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users? experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents. 
UR  - https://www.jmir.org/2024/1/e56894
UR  - http://dx.doi.org/10.2196/56894
UR  - http://www.ncbi.nlm.nih.gov/pubmed/
ID  - info:doi/10.2196/56894
ER  - 

TY  - JOUR
AU  - Frennesson, Felicia Nessie
AU  - Barnett, Julie
AU  - Merouani, Youssouf
AU  - Attwood, Angela
AU  - Zuccolo, Luisa
AU  - McQuire, Cheryl
PY  - 2024/6/20
TI  - Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis
JO  - JMIR Infodemiology
SP  - e58056
VL  - 4
KW  - social media
KW  - web-based forum
KW  - alcohol
KW  - pregnancy
KW  - prenatal health
KW  - prenatal alcohol exposure
N2  - Background: Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings. Objective: This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers? (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020). Methods: All thread starts mentioning alcohol in the ?Pregnancy? forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic. Results: A total of 395 thread starts were analyzed, and key topics included ?Asking for advice on whether it is safe to consume alcohol? or on ?safe limits? and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on ?Research, guidelines, and official information about alcohol in pregnancy.? Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods. Conclusions: Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers. 
UR  - https://infodemiology.jmir.org/2024/1/e58056
UR  - http://dx.doi.org/10.2196/58056
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38900536
ID  - info:doi/10.2196/58056
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  - Padhani, Ali Zahra
AU  - Tessema, A. Gizachew
AU  - Avery, C. Jodie
AU  - Rahim, Abdul Komal
AU  - Boyle, A. Jacqueline
AU  - Meherali, Salima
AU  - Salam, A. Rehana
AU  - Lassi, S. Zohra
PY  - 2024/5/24
TI  - Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map
JO  - JMIR Res Protoc
SP  - e56052
VL  - 13
KW  - preconception health
KW  - adolescent
KW  - young adult
KW  - maternal health
KW  - perinatal outcomes
KW  - child health
KW  - infant health
KW  - evidence gap map
KW  - EGM
KW  - interventions
KW  - perinatal health
KW  - preconception
KW  - young woman
KW  - woman
KW  - evidence gap
KW  - perinatal
KW  - map
KW  - gap
KW  - offspring
KW  - maternal
KW  - infancy
KW  - prepregnancy
N2  - Background: Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby?s health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research. Objective: The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring. Methods: We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London). Results: This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024. Conclusions: This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/56052 
UR  - https://www.researchprotocols.org/2024/1/e56052
UR  - http://dx.doi.org/10.2196/56052
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38788203
ID  - info:doi/10.2196/56052
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  - Sonephet, Souliviengkham
AU  - Kounnavong, Sengchanh
AU  - Zinsstag, Lucienne
AU  - Vonaesch, Pascale
AU  - Sayasone, Somphou
AU  - Siengsounthone, Latsamy
AU  - Odermatt, Peter
AU  - Fink, Günther
AU  - Wallenborn, Tinka Jordyn
PY  - 2024/5/3
TI  - Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People?s Democratic Republic: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e54768
VL  - 13
KW  - breastfeeding
KW  - lactation
KW  - human milk
KW  - breastmilk
KW  - child
KW  - infant
KW  - health
KW  - growth and development
KW  - cash transfer
KW  - incentive
KW  - intervention
N2  - Background: Children in Lao People?s Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. Objective: This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. Methods: A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. Results: As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits. Conclusions: We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. Trial Registration: ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049 International Registered Report Identifier (IRRID): DERR1-10.2196/54768 
UR  - https://www.researchprotocols.org/2024/1/e54768
UR  - http://dx.doi.org/10.2196/54768
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38700928
ID  - info:doi/10.2196/54768
ER  - 

TY  - JOUR
AU  - Gouy, Giulia
AU  - Attali, Luisa
AU  - Voillot, Paméla
AU  - Fournet, Patrick
AU  - Agostini, Aubert
PY  - 2024/5/2
TI  - Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study
JO  - JMIR Infodemiology
SP  - e49335
VL  - 4
KW  - infodemiology
KW  - medical abortion
KW  - patient experience
KW  - real-world evidence
KW  - social media
KW  - abortion
KW  - women's health
KW  - reproduction
KW  - reproductive
KW  - obstetric
KW  - obstetrics
KW  - gynecology
KW  - gynecological
KW  - text mining
KW  - topic model
KW  - topic modeling
KW  - natural language processing
KW  - NLP
N2  - Background: Abortion (also known as termination of pregnancy) is an essential element of women?s reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women?s needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. Objective: This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. Methods: A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. Results: Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. Conclusions: Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women?s feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion. 
UR  - https://infodemiology.jmir.org/2024/1/e49335
UR  - http://dx.doi.org/10.2196/49335
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38696232
ID  - info:doi/10.2196/49335
ER  - 

TY  - JOUR
AU  - Benda, Natalie
AU  - Woode, Sydney
AU  - Niño de Rivera, Stephanie
AU  - Kalish, B. Robin
AU  - Riley, E. Laura
AU  - Hermann, Alison
AU  - Masterson Creber, Ruth
AU  - Costa Pimentel, Eric
AU  - Ancker, S. Jessica
PY  - 2024/4/26
TI  - Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study
JO  - J Med Internet Res
SP  - e47484
VL  - 26
KW  - maternal mortality
KW  - patient-reported outcomes
KW  - patient-reported outcome
KW  - health equity
KW  - qualitative research
KW  - mobile health
KW  - mHealth
KW  - qualitative
KW  - postpartum
KW  - postnatal
KW  - maternity
KW  - maternal
KW  - Black
KW  - women?s health
KW  - ethnic
KW  - design need
KW  - mortality
KW  - death
KW  - decision support
KW  - information need
KW  - informational need
KW  - obstetric
KW  - obstetrics
KW  - mental health
KW  - mobile phone
N2  - Background: Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms. Objective: We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings. Methods: We conducted semistructured interviews with 36 participants?15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process. Results: Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems?level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured. Conclusions: Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources. 
UR  - https://www.jmir.org/2024/1/e47484
UR  - http://dx.doi.org/10.2196/47484
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38669066
ID  - info:doi/10.2196/47484
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  - Kim, Sun-Hee
AU  - Park, Jin-Hwa
AU  - Jung, Sun-Young
AU  - De Gagne, C. Jennie
PY  - 2024/4/2
TI  - Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review
JO  - JMIR Pediatr Parent
SP  - e54788
VL  - 7
KW  - anxiety
KW  - body weight
KW  - depression
KW  - gestational diabetes mellitus
KW  - high-risk behavior
KW  - internet-based interventions
KW  - neonatal outcomes
KW  - pregnancy
KW  - premature birth
KW  - pregnancy outcomes
KW  - stress
KW  - systematic review
N2  - Background: Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. Objective: This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. Methods: A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. Results: This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Conclusions: Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions? effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. Trial Registration: PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847 
UR  - https://pediatrics.jmir.org/2024/1/e54788
UR  - http://dx.doi.org/10.2196/54788
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38564247
ID  - info:doi/10.2196/54788
ER  - 

TY  - JOUR
AU  - Tretter, Max
PY  - 2024/3/25
TI  - Mitigating Health-Related Uncertainties During Pregnancy: The Role of Smart Health Monitoring Technologies
JO  - J Med Internet Res
SP  - e48493
VL  - 26
KW  - stress
KW  - anxiety
KW  - reproductive technologies
KW  - fetal health
KW  - epistemology
KW  - ethics
UR  - https://www.jmir.org/2024/1/e48493
UR  - http://dx.doi.org/10.2196/48493
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38526554
ID  - info:doi/10.2196/48493
ER  - 

TY  - JOUR
AU  - Hollestelle, J. Marieke
AU  - van der Graaf, Rieke
AU  - Sturkenboom, M. Miriam C. J.
AU  - Cunnington, Marianne
AU  - van Delden, M. Johannes J.
PY  - 2024/2/8
TI  - Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers
JO  - JMIR Pediatr Parent
SP  - e47092
VL  - 7
KW  - ethics
KW  - learning health care systems
KW  - pregnancy
KW  - lactation
KW  - real-world data
KW  - governance
KW  - qualitative research
N2  - Background: In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. Objective: This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. Methods: Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. Results: A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. Conclusions: Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS. 
UR  - https://pediatrics.jmir.org/2024/1/e47092
UR  - http://dx.doi.org/10.2196/47092
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38329780
ID  - info:doi/10.2196/47092
ER  - 

TY  - JOUR
AU  - Ronen, Keshet
AU  - Gewali, Anupa
AU  - Dachelet, Kristin
AU  - White, Erica
AU  - Jean-Baptiste, Marimirca
AU  - Evans, N. Yolanda
AU  - Unger, A. Jennifer
AU  - Tandon, Darius S.
AU  - Bhat, Amritha
PY  - 2024/2/2
TI  - Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study
JO  - JMIR Form Res
SP  - e51066
VL  - 8
KW  - perinatal depression
KW  - youth
KW  - mHealth
KW  - digital health
KW  - acceptability
KW  - utility
KW  - depression
KW  - pilot study
KW  - pregnancy
KW  - postpartum
KW  - prevention
KW  - cognitive behavioral therapy
KW  - psychoeducation
KW  - mixed methods
KW  - manage
KW  - mood
KW  - mobile phone
N2  - Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ?80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study?s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. 
UR  - https://formative.jmir.org/2024/1/e51066
UR  - http://dx.doi.org/10.2196/51066
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38306159
ID  - info:doi/10.2196/51066
ER  - 

TY  - JOUR
AU  - Phillips, Craig J.
AU  - Alfano, R. Alliete
AU  - Barfield, C. Latisha
AU  - Cain, Lisa
AU  - Sadjadi, Masoud
AU  - Morales, Eduardo
AU  - Phillips-Beck, Wanda
AU  - Galarza, Grisel M.
AU  - Torres, Maritza
AU  - Zindani, Sadaf
AU  - Rayani, Ahmad
AU  - Edwards, Khalee
AU  - Jones, Gracia Sande
AU  - Hannan, Jean
PY  - 2024/1/26
TI  - Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review
JO  - JMIR Pediatr Parent
SP  - e46973
VL  - 7
KW  - maternal and child health
KW  - smartphone
KW  - mobile health
KW  - mHealth
KW  - eHealth
KW  - app development
KW  - app evaluation
KW  - app effectiveness
KW  - maternal and infant app
KW  - pregnancy, postpartum
KW  - mothers
KW  - mobile phone
KW  - artificial intelligence
KW  - AI
N2  - Background: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. Objective: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. Methods: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences?associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. Results: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. Conclusions: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers? needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps. 
UR  - https://pediatrics.jmir.org/2024/1/e46973
UR  - http://dx.doi.org/10.2196/46973
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38055330
ID  - info:doi/10.2196/46973
ER  - 

TY  - JOUR
AU  - Vanderkruik, C. Rachel
AU  - Ferguson, Craig
AU  - Kobylski, A. Lauren
AU  - Locascio, J. Joseph
AU  - Hamlett, E. Gabriella
AU  - Killenberg, C. Parker
AU  - Lewis, Robert
AU  - Jones, Noah
AU  - Rossa, T. Ella
AU  - Dineen, Hannah
AU  - Picard, Rosalind
AU  - Cohen, S. Lee
PY  - 2024/1/26
TI  - Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study
JO  - JMIR Form Res
SP  - e44029
VL  - 8
KW  - perinatal depression
KW  - pregnancy
KW  - behavioral activation
KW  - mobile app
KW  - digital intervention
KW  - mobile phone
N2  - Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (?=?.35; t61=?3.05; P=.003), number of activities completed (?=?.12; t61=?2.05; P=.04), days played (?=?.12; t58=?2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (?=?3.05; t45=?2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. 
UR  - https://formative.jmir.org/2024/1/e44029
UR  - http://dx.doi.org/10.2196/44029
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38277191
ID  - info:doi/10.2196/44029
ER  - 

TY  - JOUR
AU  - Nguyen, C. Quynh
AU  - Aparicio, M. Elizabeth
AU  - Jasczynski, Michelle
AU  - Channell Doig, Amara
AU  - Yue, Xiaohe
AU  - Mane, Heran
AU  - Srikanth, Neha
AU  - Gutierrez, Marin Francia Ximena
AU  - Delcid, Nataly
AU  - He, Xin
AU  - Boyd-Graber, Jordan
PY  - 2024/1/12
TI  - Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study
JO  - JMIR Form Res
SP  - e51361
VL  - 8
KW  - chatbot
KW  - health information
KW  - maternal and child health
KW  - health disparities
KW  - health equity
KW  - health informatics
KW  - preventive health care
KW  - postpartum care
KW  - patient education
KW  - newborn care
KW  - prenatal care
KW  - mobile phone
N2  - Background: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. Objective: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. Methods: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ?14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children?s book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie?s knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial?s sample size calculations. Results: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie?s answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. Conclusions: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot?s ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515 
UR  - https://formative.jmir.org/2024/1/e51361
UR  - http://dx.doi.org/10.2196/51361
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38214963
ID  - info:doi/10.2196/51361
ER  - 

TY  - JOUR
AU  - Henrich, Natalie
AU  - Brinson, Alison
AU  - Arnold, Alyssa
AU  - Jahnke, R. Hannah
PY  - 2024/1/12
TI  - Digital Health Needs and Preferences During Pregnancy and the Postpartum Period: Mixed Methods Study
JO  - JMIR Form Res
SP  - e48960
VL  - 8
KW  - digital health
KW  - perinatal
KW  - pregnancy
KW  - postpartum
KW  - interviews
KW  - survey
KW  - user needs
KW  - patient centered
KW  - mixed methods
N2  - Background: Digital health is increasingly used to meet the needs of perinatal people, with estimates of pregnancy-related internet use ranging from 90% to 97% of pregnant people. As digital health takes on greater importance during the perinatal period, it is essential that providers and developers of digital health content understand why perinatal people use these resources and the features that enhance their experience. However, gaps remain in understanding the content that is most helpful and how the platforms are navigated. Learning directly from perinatal people about their needs will help ensure alignment between perinatal needs and available content. Objective: This formative study aims to identify the reasons why perinatal people use digital health resources; the features of the digital health platforms that are of greatest importance to them; and how these differ by perinatal stage (pregnancy vs post partum), mental health conditions, parity, and demographics (race and ethnicity). Methods: This mixed methods study used interviews; surveys; and secondary data on demographic, health, and pregnancy characteristics to identify the digital health needs and preferences of pregnant and postpartum people who used the Maven digital health platform in the United States during their pregnancy or postpartum period. The interviews informed the content of the surveys and provided additional insights and examples for interpreting the survey results. The surveys were used to collect data from a sample of Maven users, and the results were linked to the secondary data set. The interviews were thematically analyzed, and survey data were analyzed using descriptive statistics and stratified by parity, race, and mental health status. Results: Overall, 13 people were interviewed (including n=4, 31% pilot interviews), and 147 pregnancy and 110 postpartum survey respondents completed the surveys and had linkable secondary data. Top reasons for using digital health resources during pregnancy were to (1) know what is normal or typical during pregnancy, (2) have access to a health care provider when needed, and (3) know how the baby is developing. Top reasons for postpartum use were to (1) help with breastfeeding, (2) know what normal baby development is, and (3) help with the baby?s health issues. Top platform features during pregnancy and the postpartum period were (1) credible and trustworthy information and providers, (2) nonjudgmental information and support, and (3) no cost to the user. In general, more reasons for using digital resources were identified as extremely important during pregnancy compared with post partum. The results showed minor variations across strata. Conclusions: This formative research found minor differences in digital resource needs and preferences across user characteristics among perinatal people in the United States. Future work should examine whether there are variations in interests within topics by user characteristics, which may provide additional opportunities to better meet user needs. 
UR  - https://formative.jmir.org/2024/1/e48960
UR  - http://dx.doi.org/10.2196/48960
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38214971
ID  - info:doi/10.2196/48960
ER  - 

TY  - JOUR
AU  - Yang, Ting
AU  - Wu, Yihan
AU  - Han, Nuo
AU  - Liu, Tianli
PY  - 2024/1/5
TI  - Chinese Women?s Concept of Childbirth Based on the Social Media Topic ?What Does Childbirth Mean to a Woman?: Content and Thematic Analysis
JO  - JMIR Pediatr Parent
SP  - e50512
VL  - 7
KW  - childbirth willingness
KW  - social media
KW  - risk perception
KW  - childbirth cost
KW  - childbirth benefit
N2  - Background: In recent years, women?s fertility desire has attracted increasing attention in China. Objective: This study aims to detect attitudes toward giving birth among young female users on Douban, a very popular Chinese social media platform. Methods: A total of 2634 valid posts from 2489 users discussing the topic ?What does childbirth mean to a woman? on Douban were crawled and retained for analysis. We utilized content and thematic analysis methods to capture users? concepts of childbirth. Results: The findings reveal that a significant majority of users conveyed generally neutral (1060/2634, 40.24%) or negative (1051/2634, 39.90%) attitudes toward childbirth, while only about one-fifth of users expressed positive (523/2634, 19.86%) sentiments. Notably, posts with negative attitudes garnered more replies and likes, and the proportion of posts expressing negativity exhibited fluctuations over time. Health risk (339/2634, 12.87%) emerged as the most frequently cited aspect of childbirth cost, with subjective happiness and the fulfillment of mental needs identified as primary benefits. Surprisingly, only a minimal number of posts (10/2634, 0.38%) touched upon the traditional objective benefits of raising children for old-age care. Thematic analysis results suggest that discussions about fertility on social media platforms might contribute to an exaggerated perception of health risks among women. Additionally, a lack of knowledge about childbirth was observed, partially attributable to longstanding neglect and avoidance of communication on these matters, likely influenced by traditional cultural biases. Moreover, there is a prevailing assumption that women should naturally sacrifice themselves for childbirth and childcare, influenced by the idealization of the female figure. Consequently, women may harbor hesitations about having a baby, fearing the potential loss of their own identity in the process. Conclusions: The results indicate a shift in the perception of childbirth among modern Chinese women over time, influenced by their increasing social status and the pursuit of self-realization. Implementing strategies such as public education on the health risks associated with pregnancy and delivery, safeguarding women?s rights, and creating a supportive environment for mothers may enhance women?s willingness to undergo childbirth. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.50468 
UR  - https://pediatrics.jmir.org/2024/1/e50512
UR  - http://dx.doi.org/10.2196/50512
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38180784
ID  - info:doi/10.2196/50512
ER  - 

TY  - JOUR
AU  - Balsam, Donna
AU  - Bounds, T. Dawn
AU  - Rahmani, M. Amir
AU  - Nyamathi, Adeline
PY  - 2023/12/25
TI  - Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study
JO  - JMIR Pediatr Parent
SP  - e53933
VL  - 6
KW  - mindfulness app
KW  - pregnancy
KW  - pregnant
KW  - maternal
KW  - obstetric
KW  - obstetrics
KW  - stress
KW  - anxiety
KW  - heart rate variability
KW  - mindfulness
KW  - mHealth
KW  - mobile health
KW  - app
KW  - apps
KW  - applications
KW  - mental health
KW  - meditation
KW  - mind-body
KW  - complementary
KW  - alternative
KW  - heart rate
KW  - sleep
KW  - mobile phone
N2  - Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant?s levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65%  of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ?95%. Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy. 
UR  - https://pediatrics.jmir.org/2023/1/e53933
UR  - http://dx.doi.org/10.2196/53933
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38145479
ID  - info:doi/10.2196/53933
ER  - 

TY  - JOUR
AU  - Hao, Jie
AU  - Yang, Lin
AU  - Wang, Yaxin
AU  - Lan, Yushan
AU  - Xu, Xiaowei
AU  - Wang, Ziyang
AU  - Li, Zanmei
AU  - Ma, Liangkun
AU  - Li, Jiao
AU  - Zhang, Suhan
AU  - Sun, Yin
PY  - 2023/12/20
TI  - Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study
JO  - JMIR Mhealth Uhealth
SP  - e46910
VL  - 11
KW  - adverse pregnancy outcome
KW  - mobile prenatal education
KW  - pregnancy
KW  - real-world study
KW  - retrospective study
N2  - Background: Pregnancy is a pivotal phase in a woman?s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. 
UR  - https://mhealth.jmir.org/2023/1/e46910
UR  - http://dx.doi.org/10.2196/46910
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38117555
ID  - info:doi/10.2196/46910
ER  - 

TY  - JOUR
AU  - Memon, Zahid
AU  - Ahmed, Wardah
AU  - Muhammad, Shah
AU  - Soofi, Sajid
AU  - Chohan, Shanti
AU  - Rizvi, Arjumand
AU  - Barach, Paul
AU  - Bhutta, A. Zulfiqar
PY  - 2023/11/30
TI  - Facility-Based Audit System With Integrated Community Engagement to Improve Maternal and Perinatal Health Outcomes in Rural Pakistan: Protocol for a Mixed Methods Implementation Study
JO  - JMIR Res Protoc
SP  - e49578
VL  - 12
KW  - audit system
KW  - perinatal outcome
KW  - neonatal mortality
KW  - stillbirth
KW  - maternal
KW  - mortality
KW  - implementation research
KW  - death audit
N2  - Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan. Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up. Methods: The implementation of the audit system comprises six phases: (1) identify facility and community leadership through consultative meetings with government district health offices, (2) establish the audit committee under the supervision of district health officer, (3) initiate audit with ongoing community engagement, (4) train the audit committee members, (5) launch the World Health Organization audit cycle (monthly meetings), and (6) quarterly review and refresher training. Data from all deliveries, live births, maternal deaths, maternal near misses, stillbirths, and neonatal deaths will be identified and recorded from four sources: (1) secondary-level care rural health facilities, (2) lady health workers? registers, (3) community representatives, and (4) project routine survey team. Concurrent quantitative and qualitative data will be drawn from case assessments, process analysis, and recommendations as components of iterative improvement cycles during the project. Outcomes will be the geographic distribution of mortality to measure the reach, proportion of facilities initiated to implement an audit system for measuring the adoption, proportion of audit committees with community representation, and proportion of audit committee members? sharing feedback regularly to measure acceptability and feasibility. In addition, outcomes of effectiveness will be measured based on data recording and reporting trends, identified modifiable factors for mortality and morbidity as underpinned by the Three Delays framework. Qualitative data will be analyzed based on perceived facilitators, barriers, and lessons learned for policy implications. Results will be summarized in frequencies and percentages and triangulated by the project team. Data will be analyzed using Stata (version 16; StataCorp) and NVivo (Lumivero) software. Results: The study will be implemented for 20 months, followed by an additional 4-month period for follow-up. Initial results will be presented to the district health office and the District Health Program Management Team Meeting in the districts. Conclusions: This study will generate evidence about the feasibility and potential scale-up of a facility-based mortality audit system with integrated community engagement in rural Pakistan. Audit committees will complete the feedback loop linking health care providers, community representatives, and district health officials (policy makers). This implementation approach will serve decision makers in improving maternal and perinatal health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49578 
UR  - https://www.researchprotocols.org/2023/1/e49578
UR  - http://dx.doi.org/10.2196/49578
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38032708
ID  - info:doi/10.2196/49578
ER  - 

TY  - JOUR
AU  - Ajayi, Toluwalase
AU  - Pawelek, Jeff
AU  - Bhargava, Hansa
AU  - Faksh, Arij
AU  - Radin, Jennifer
PY  - 2023/11/28
TI  - Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study
JO  - JMIR Form Res
SP  - e50867
VL  - 7
KW  - prenatal care
KW  - maternal health
KW  - digital study
KW  - underrepresented in biomedical research
KW  - pregnant
KW  - pregnancy
KW  - medications
KW  - vaccinations
KW  - vitamins
N2  - Background: Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care?including the use of medications, immunizations, and prenatal vitamins?are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. Objective: We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. Methods: We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. Results: Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. Conclusions: A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities. 
UR  - https://formative.jmir.org/2023/1/e50867
UR  - http://dx.doi.org/10.2196/50867
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38015604
ID  - info:doi/10.2196/50867
ER  - 

TY  - JOUR
AU  - Lewkowitz, K. Adam
AU  - Rubin-Miller, Lily
AU  - Jahnke, R. Hannah
AU  - Clark, A. Melissa
AU  - Zlotnick, Caron
AU  - Miller, S. Emily
AU  - Henrich, Natalie
PY  - 2023/11/20
TI  - Demographic and Support Interest Differences Among Nonbirthing Parents Using a Digital Health Platform With Parenthood-Related Anxiety: Cross-Sectional Study
JO  - JMIR Pediatr Parent
SP  - e46152
VL  - 6
KW  - nonbirthing parent
KW  - paternal mental health
KW  - perinatal anxiety
KW  - parenting anxiety
KW  - digital health
KW  - anxiety
KW  - perinatal
KW  - mental health support
KW  - digital platform
KW  - pregnancy
KW  - parents
KW  - spouse
KW  - partners
KW  - support
KW  - support groups
KW  - online support
N2  - Background: The transition to parenthood is a period of major stressors and increased risk of anxiety for all parents. Though rates of perinatal anxiety are similar among women (4%-25%) and men (3%-25%), perinatal anxiety research on nonbirthing partners remains limited. Objective: We aimed to examine whether demographic characteristics or digital perinatal support preferences differed among nonbirthing partners with compared to without self-reported high parenthood-related anxiety. Methods: In this large cross-sectional study of nonbirthing partners using a digital perinatal health platform during their partner?s pregnancy, users reported their parenthood-related anxiety through a 5-item Likert scale in response to the prompt ?On a scale of 1=None to 5=Extremely, how anxious are you feeling about parenthood?? High parenthood-related anxiety was defined as reporting being very or extremely anxious about parenthood. During the onboarding survey, in response to the question ?Which areas are you most interested in receiving support in?? users selected as many support interests as they desired from a list of options. Chi-square and Fisher exact tests were used to compare demographic characteristics and support interests of nonbirthing partners with low versus high parenthood anxiety. Logistic regression models estimated the odds ratios (ORs), with 95% CIs, of high parenthood-related anxiety with each user characteristic or digital support interest. Results: Among 2756 nonbirthing partners enrolled in the digital platform during their partner?s pregnancy, 2483 (90.1%) were men, 1668 (71.9%) were first-time parents, 1159 (42.1%) were non-Hispanic White, and 1652 (50.9%) endorsed an annual household income of >US $100,000. Overall, 2505 (91.9%) reported some amount of parenthood-related anxiety, and 437 (15.9%) had high parenthood-related anxiety. High parenthood-related anxiety was more common among non-White nonbirthing partners: compared to those who identified as non-Hispanic White, those who identified as Asian, Black, or Hispanic had 2.39 (95% CI 1.85-3.08), 2.01 (95% CI 1.20-3.23), and 1.68 (95% CI 1.15-2.41) times the odds of high parenthood-related anxiety, respectively. Lower household income was associated with increased odds of reporting high parenthood anxiety, with the greatest effect among those with annual incomes of <US $50,000 compared to >US $100,000 (OR 2.13, 95% CI 1.32-3.34). In general, nonbirthing partners were interested in receiving digital support during their partner?s pregnancy, but those with high parenthood-related anxiety were more likely to desire digital support for all support interests compared to those without high parenthood anxiety. Those with high parenthood-related anxiety had more than 2 times higher odds of requesting digital education about their emotional health compared to those without high parenthood-related anxiety (OR 2.06, 95% CI 1.67-2.55). Conclusions: These findings demonstrate the need for perinatal anxiety-related support for all nonbirthing partners and identify nonbirthing partners? demographic characteristics that increase the odds of endorsing high parenthood-related anxiety. Additionally, these findings suggest that most nonbirthing partners using a digital health platform with high parenthood-related anxiety desire to receive perinatal mental health support. 
UR  - https://pediatrics.jmir.org/2023/1/e46152
UR  - http://dx.doi.org/10.2196/46152
ID  - info:doi/10.2196/46152
ER  - 

TY  - JOUR
AU  - Koenig, R. Leah
AU  - Becker, Andréa
AU  - Ko, Jennifer
AU  - Upadhyay, D. Ushma
PY  - 2023/11/7
TI  - The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis
JO  - JMIR Public Health Surveill
SP  - e45671
VL  - 9
KW  - telehealth
KW  - abortion
KW  - spatial analysis
KW  - health equity
KW  - barriers
KW  - abortion access
KW  - legal
KW  - young people
KW  - remote
KW  - rural
N2  - Background: Even preceding the Supreme Court?s 2022 Dobbs v. Jackson Women?s Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. Objective: We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. Methods: We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients? residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. Results: The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). Conclusions: These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity. 
UR  - https://publichealth.jmir.org/2023/1/e45671
UR  - http://dx.doi.org/10.2196/45671
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37934583
ID  - info:doi/10.2196/45671
ER  - 

TY  - JOUR
AU  - Mills-Koonce, Roger W.
AU  - Grewen, Karen
AU  - O?Shea, Gottredson Nisha
AU  - Pearson, Brenda
AU  - Strange, Grace Chelsea
AU  - Meltzer-Brody, E. Samantha
AU  - Guintivano, Dolph Jerry
AU  - Stuebe, M. Alison
PY  - 2023/10/26
TI  - The Mood, Mother and Child Study: Protocol for a Prospective Longitudinal Study and Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e51132
VL  - 12
KW  - maternal depression
KW  - oxytocin
KW  - hypothalamic-pituitary-adrenal axis
KW  - HPA axis
KW  - parenting
KW  - executive functioning
KW  - socioemotional development
N2  - Background: Perinatal depression affects >400,000 mother-child dyads in the United States every year and is associated with numerous adverse maternal and child developmental outcomes. Previous research implicates the dysregulation of oxytocin and the hypothalamic-pituitary-adrenal (HPA) axis functioning in mothers and children as potential mechanisms mediating or moderating the transmission of risk associated with maternal depression. Objective: The Mood, Mother and Child study will examine the psychobiological sources of risk and resilience within mother-child dyads affected by maternal depression. This manuscript describes (1) the study rationale and aims, (2) the research design and procedures and how they were altered in response to the COVID-19 pandemic, and (3) the data analysis plan to test the study hypotheses. Methods: This is a prospective longitudinal study with an embedded randomized controlled trial that examines (1) correlations among postpartum depression and anxiety symptoms, maternal and child oxytocin and HPA axis functioning, and child developmental outcomes and (2) the causal relationship between exogenous oxytocin and HPA reactivity. This study is funded by the National Institute of Child Health and Human Development with institutional review board approval. Results: Recruitment and data collection have commenced, and the expected results will be available in 2024. Analyses are presented for testing the proposed hypotheses. Conclusions: The unique combination of a prospective longitudinal research design with an embedded randomized controlled trial will allow the Mood, Mother and Child study to apply a developmental lens to the study of maternal depression and anxiety symptoms from birth to middle childhood and the psychobiological mechanisms promoting risk and resiliency for both mother and child outcomes. This will be the first study that simultaneously evaluates (1) the role of oxytocin using multiple methodologies, (2) the causal relationships between exogenous oxytocin and HPA axis functioning among mothers with differing levels of depression and anxiety symptoms, and (3) the multiple mediating and moderating roles of parenting behaviors and maternal and child psychobiological characteristics. The goals of these aims are to provide insights into the psychobiological effects of oxytocin in women and inform future clinical trials to treat perinatal mood disorders. Trial Registration: ClinicalTrials.gov NCT03593473; https://classic.clinicaltrials.gov/ct2/show/NCT03593473 International Registered Report Identifier (IRRID): DERR1-10.2196/51132 
UR  - https://www.researchprotocols.org/2023/1/e51132
UR  - http://dx.doi.org/10.2196/51132
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37883133
ID  - info:doi/10.2196/51132
ER  - 

TY  - JOUR
AU  - Facca, Danica
AU  - Hall, Jodi
AU  - Hiebert, Bradley
AU  - Donelle, Lorie
PY  - 2023/10/25
TI  - Understanding the Tensions of ?Good Motherhood? Through Women?s Digital Technology Use: Descriptive Qualitative Study
JO  - JMIR Pediatr Parent
SP  - e48934
VL  - 6
KW  - motherhood
KW  - parenting
KW  - digital health
KW  - apps
KW  - social media
KW  - mother
KW  - parent
KW  - technology use
KW  - use
KW  - computer use
KW  - interview
KW  - interviews
KW  - perspective
KW  - perspectives
KW  - mothers
KW  - mobile phone
N2  - Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of ?good motherhood.? Given the ways in which digital technologies can both support and hinder women?s perceptions of their parenting abilities, understanding expectant and new mothers? experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers? use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants? experiences of using digital technologies in the transition to parenting period were captured within the overarching theme ?balancing the tensions of digital technology use in the transition to parenting? and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered ?in-the-moment? access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. 
UR  - https://pediatrics.jmir.org/2023/1/e48934
UR  - http://dx.doi.org/10.2196/48934
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37878372
ID  - info:doi/10.2196/48934
ER  - 

TY  - JOUR
AU  - Cheung, Wang Ka
AU  - Au, Sin-Tung Tiffany
AU  - Wai, On Joan Kar
AU  - Seto, Tin-Yan Mimi
PY  - 2023/9/19
TI  - Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study
JO  - J Med Internet Res
SP  - e46663
VL  - 25
KW  - delivery
KW  - digital
KW  - portable electronic applications
KW  - smartphone
KW  - pregnancy
KW  - virtual clinics
KW  - telehealth
KW  - telemedicine
N2  - Background: Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women?s concerns. Objective: This study aimed to assess pregnant women?s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods: We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women?s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results: The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions: Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care. 
UR  - https://www.jmir.org/2023/1/e46663
UR  - http://dx.doi.org/10.2196/46663
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37725425
ID  - info:doi/10.2196/46663
ER  - 

TY  - JOUR
AU  - Sewpaul, Ronel
AU  - Resnicow, Ken
AU  - Crutzen, Rik
AU  - Dukhi, Natisha
AU  - Ellahebokus, Afzal
AU  - Reddy, Priscilla
PY  - 2023/9/13
TI  - A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e43654
VL  - 12
KW  - antenatal care
KW  - adolescent girls and young women
KW  - AGYW
KW  - adolescent pregnancy
KW  - mobile health
KW  - mHealth
KW  - tailoring
KW  - motivational interviewing
KW  - South Africa
KW  - mobile phone
N2  - Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention?s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants? clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention?s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 
UR  - https://www.researchprotocols.org/2023/1/e43654
UR  - http://dx.doi.org/10.2196/43654
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37703092
ID  - info:doi/10.2196/43654
ER  - 

TY  - JOUR
AU  - Lanssens, Dorien
AU  - Vandenberk, Thijs
AU  - Storms, Valerie
AU  - Thijs, Inge
AU  - Grieten, Lars
AU  - Bamelis, Lotte
AU  - Gyselaers, Wilfried
AU  - Tang, Eileen
AU  - Luyten, Patrick
PY  - 2023/9/6
TI  - Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study
JO  - J Med Internet Res
SP  - e42686
VL  - 25
KW  - intrapersonal factors
KW  - peripartum period
KW  - pregnancy
KW  - pregnancy-induced hypertension
KW  - remote monitoring
N2  - Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one?s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 
UR  - https://www.jmir.org/2023/1/e42686
UR  - http://dx.doi.org/10.2196/42686
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37672324
ID  - info:doi/10.2196/42686
ER  - 

TY  - JOUR
AU  - Haramati, Sharon
AU  - Firsow, Anastasia
AU  - Navarro, Abigail Daniela
AU  - Shechter, Ravid
PY  - 2023/8/22
TI  - Novel At-Home Mother?s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment
JO  - JMIR Pediatr Parent
SP  - e43837
VL  - 6
KW  - breastfeeding
KW  - feasibility
KW  - human milk
KW  - biomarker
KW  - remote sensing technology
KW  - mobile health
KW  - retrospective
KW  - secretory activation
KW  - lactogenesis
KW  - milk supply
KW  - milk
KW  - sensing technology
KW  - monitoring tool
KW  - lactation
KW  - exclusive breastfeeding
KW  - breastfeed
KW  - maternal health
KW  - maternal and infant health
KW  - infant health
KW  - maternal and child health
KW  - prolactin
KW  - lactation consultant
KW  - lactation support provider
KW  - mother
KW  - milk maturation
N2  - Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth?dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system?s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth?dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. 
UR  - https://pediatrics.jmir.org/2023/1/e43837
UR  - http://dx.doi.org/10.2196/43837
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37464893
ID  - info:doi/10.2196/43837
ER  - 

TY  - JOUR
AU  - Adams, Joyce Yenupini
AU  - Agbenyo, Stephen John
PY  - 2023/8/22
TI  - Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e47519
VL  - 12
KW  - postpartum care
KW  - postnatal care
KW  - maternal mortality
KW  - Ghana
KW  - randomized controlled trial
KW  - protocol
N2  - Background: Although the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. Objective: We describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). Methods: Focused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. Results: The Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. Conclusions: Focused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. Trial Registration: ClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951 International Registered Report Identifier (IRRID): DERR1-10.2196/47519 
UR  - https://www.researchprotocols.org/2023/1/e47519
UR  - http://dx.doi.org/10.2196/47519
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37606965
ID  - info:doi/10.2196/47519
ER  - 

TY  - JOUR
AU  - Kötting, Lukas
AU  - Derksen, Christina
AU  - Keller, Maria Franziska
AU  - Lippke, Sonia
PY  - 2023/7/24
TI  - Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial
JO  - JMIR Pediatr Parent
SP  - e44701
VL  - 6
KW  - Health Action Process Approach
KW  - HAPA
KW  - intention
KW  - safe communication behavior
KW  - patient safety
KW  - obstetric patients
KW  - digital intervention
KW  - web-based app
N2  - Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women?s safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ?p2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ?p2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women?s communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 
UR  - https://pediatrics.jmir.org/2023/1/e44701
UR  - http://dx.doi.org/10.2196/44701
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37486755
ID  - info:doi/10.2196/44701
ER  - 

TY  - JOUR
AU  - Gilbert, Stephanie
AU  - Irvine, Rachel
AU  - D'or, Melissa
AU  - Adam, P. Marc T.
AU  - Collins, E. Clare
AU  - Marriott, Rhonda
AU  - Rollo, Megan
AU  - Walker, Roz
AU  - Rae, Kym
PY  - 2023/7/6
TI  - Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study
JO  - JMIR Res Protoc
SP  - e45983
VL  - 12
KW  - co-design
KW  - community-based participatory research
KW  - mHealth
KW  - Aboriginal and Torres Strait Islander
KW  - maternal health
KW  - pregnancy
KW  - nutrition
KW  - Indigenous women
KW  - diet
KW  - health literacy
KW  - Indigenous
KW  - Indigenous people
KW  - mobile phone
N2  - Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people?s food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 
UR  - https://www.researchprotocols.org/2023/1/e45983
UR  - http://dx.doi.org/10.2196/45983
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37147188
ID  - info:doi/10.2196/45983
ER  - 

TY  - JOUR
AU  - Varma, S. Deepthi
AU  - Mualem, Maya
AU  - Goodin, Amie
AU  - Gurka, K. Kelly
AU  - Wen, Soo-Tung Tony
AU  - Gurka, J. Matthew
AU  - Roussos-Ross, Kay
PY  - 2023/6/7
TI  - Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers
JO  - JMIR Form Res
SP  - e44500
VL  - 7
KW  - perinatal mental health
KW  - mobile health
KW  - mHealth
KW  - mobile apps
KW  - ecological momentary assessment
KW  - EMA
KW  - mobile phone
N2  - Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. 
UR  - https://formative.jmir.org/2023/1/e44500
UR  - http://dx.doi.org/10.2196/44500
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37285185
ID  - info:doi/10.2196/44500
ER  - 

TY  - JOUR
AU  - Chetty, Terusha
AU  - Singh, Yages
AU  - Odendaal, Willem
AU  - Mianda, Solange
AU  - Abdelatif, Nada
AU  - Manda, Samuel
AU  - Schneider, Helen
AU  - Goga, Ameena
PY  - 2023/6/5
TI  - Intervention in Mothers and Newborns to Reduce Maternal and Perinatal Mortality in 3 Provinces in South Africa Using a Quality Improvement Approach: Protocol for a Mixed Method Type 2 Hybrid Evaluation
JO  - JMIR Res Protoc
SP  - e42041
VL  - 12
KW  - health systems
KW  - quality improvement
KW  - antenatal
KW  - postnatal
KW  - maternal
KW  - child
KW  - HIV
KW  - mixed methods evaluation
N2  - Background: The COVID-19 pandemic undermined gains in reducing maternal and perinatal mortality in South Africa. The Mphatlalatsane Initiative is a health system intervention to reduce mortality and morbidity in women and newborns to desired levels. Objective: Our evaluation aims to determine the effect of various exposures, including the COVID-19 pandemic, and a system-level, complex, patient-centered quality improvement (QI) intervention (the Mphatlalatsane Initiative) on maternal and neonatal health services at 21 selected South African facilities. The objectives are to determine whether Mphatlalatsane reduces the institutional maternal mortality ratio, neonatal mortality rate, and stillbirth rate (objective 1) and improves patients? experiences (objective 2) and quality of care (objective 3). Objective 4 assesses the contextual and implementation process factors, including the COVID-19 pandemic, that shape Mphatlalatsane uptake and variation. Methods: This study is an implementation science type 2 hybrid effectiveness, controlled before-and-after design with quantitative and qualitative components. The Mphatlalatsane intervention commenced at the end of 2019. For objective 1, intervention and control facility-level data from the District Health Information System are compared for changes in institutional maternal and neonatal mortality and stillbirth rates and associations with QI, the COVID-19 pandemic, and both. This first analysis includes data from 18 facilities, regardless of their allocation to intervention or comparison, to obtain a general idea of the effect of the COVID-19 pandemic. For objectives 2 to 3, data collectors abstract data from maternal and neonatal records, interview participants, and conduct neonatal facility assessments. For objective 4, interviews, program documentation, surveys, and observations are used to assess how contextual factors at the macro-, meso-, and microlevels explain variation in intervention uptake and outcome. The intervention dose is measured at the microlevel only in the intervention facilities. The study assesses the Mphatlalatsane Initiative from 2020 to 2022. Results: From preliminary analysis, across the 3 provinces, maternal and neonatal deaths increased during the COVID-19 pandemic, whereas stillbirths remained unchanged. Maternal satisfaction with quality of care was >90%. The COVID-19 pandemic severely disrupted the QI teams functioning. However, the QI teams regained their pre?COVID-19 momentum by adapting the QI model, with advisers providing mentoring and support. Variation in adoption at the mesolevel was related to stable and motivated leadership (particularly at the facility level), poor integration into routine processes, and buy-in from senior district managers who were affected by competing priorities. Varying referral and specialist outreach systems, staff availability and development, and service delivery infrastructure are plausible factors in variable outcomes. Conclusions: Few evaluations rigorously evaluated the effect of health system interventions on improving health services and outcomes. Results will inform the scaling up of successful intervention components and strategies to mitigate the effects of the COVID-19 pandemic or similar emerging epidemics on maternal and neonatal mortality. International Registered Report Identifier (IRRID): DERR1-10.2196/42041 
UR  - https://www.researchprotocols.org/2023/1/e42041
UR  - http://dx.doi.org/10.2196/42041
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37000902
ID  - info:doi/10.2196/42041
ER  - 

TY  - JOUR
AU  - Rhodes, Alexandra
AU  - Pimprikar, Arya
AU  - Baum, Alison
AU  - Smith, D. Andrea
AU  - Llewellyn, H. Clare
PY  - 2023/5/26
TI  - Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study
JO  - JMIR Form Res
SP  - e44082
VL  - 7
KW  - digital
KW  - app
KW  - dietary
KW  - physical activity
KW  - lifestyle
KW  - pregnancy
KW  - prenatal
KW  - person-based approach
KW  - behavior change habit formation
KW  - intervention
N2  - Background: In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective: The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods: The intervention?s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings? objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results: Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions: This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy. 
UR  - https://formative.jmir.org/2023/1/e44082
UR  - http://dx.doi.org/10.2196/44082
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37234026
ID  - info:doi/10.2196/44082
ER  - 

TY  - JOUR
AU  - Haricharan, Jensen Hanne
AU  - Hacking, Damian
AU  - Lau, Kwan Yan
AU  - Heap, Marion
PY  - 2023/5/22
TI  - Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging?Based Information Campaign: Mixed Methods Study
JO  - JMIR Pediatr Parent
SP  - e40561
VL  - 6
KW  - SMS text messages
KW  - cell phones
KW  - mobile health
KW  - mHealth
KW  - health information
KW  - health literacy
KW  - healthy behavior
KW  - maternal health
KW  - antenatal care
KW  - Deaf
KW  - South Africa
N2  - Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging?based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants? knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging?based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women?s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people?s health knowledge. However, attention should be paid to Deaf participants? specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe 
UR  - https://pediatrics.jmir.org/2023/1/e40561
UR  - http://dx.doi.org/10.2196/40561
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37213174
ID  - info:doi/10.2196/40561
ER  - 

TY  - JOUR
AU  - Wilson, A. Lindsay
AU  - Gandhi, Preet
PY  - 2023/5/10
TI  - Opioid Agonist Therapies and Pregnancy Outcomes for Pregnant People With Opioid Use Disorder: Protocol for a Systematic Review
JO  - JMIR Res Protoc
SP  - e42417
VL  - 12
KW  - opioid agonist therapies
KW  - opioid use disorder
KW  - pregnancy
KW  - opioid
KW  - drug
KW  - symptoms
KW  - treatment
KW  - screening
KW  - data
KW  - risk
KW  - clinical
KW  - policy makers
KW  - community
N2  - Background: Opioid use disorder (OUD) during pregnancy presents a significant risk to maternal, fetal, and neonatal health, increasing the likelihood of adverse events, such as maternal overdose, pregnancy loss, stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome. In order to reduce the risk of these outcomes, the standard of care for OUD during pregnancy in many jurisdictions within the United States and Canada is opioid agonist therapy (OAT). OAT refers to prescription medications that alleviate or eliminate opioid withdrawal symptoms, so that opioid use can be managed more safely. Although OAT has been recognized as a safe option for pregnant people with OUD, many jurisdictions do not have treatment guidelines regarding pharmacological options, dosing recommendations, side effect management, and individual preferences. There is currently a lack of systematic evidence on the impacts of different OAT regimens on pregnancy outcomes. Objective: We aim to evaluate the impacts of specific OAT agents on pregnancy outcomes and inform recommendations for practitioners treating pregnant people with OUD. Methods: The MEDLINE, Embase, CINAHL, and PsycINFO databases will be searched for published quantitative studies assessing pregnancy outcomes for individuals on OAT. Given the substantially increased risk of preterm birth, low birth weight, small for gestational age, and stillbirth among pregnant people with OUD, these four end points will comprise our primary outcomes. Database searches will not be restricted by date, and conference abstracts will be restricted to the past 2 years. Titles, abstracts, and full-text articles will be independently screened by 2 reviewers. Data will be extracted independently and in duplicate, using a data extraction form to reduce the risk of reviewer bias. The risk of bias within individual studies will be assessed by using the appropriate CASP (Critical Appraisal Skills Programme) checklists. For studies that consider the same research questions, interventions, or outcomes, meta-analyses will be conducted to synthesize the pooled effect size. In the event that studies cannot be compared directly, results will be synthesized in a narrative account. Between-study heterogeneity will be measured by using the ?2 statistic. If more than 10 studies are available for pooling, publication bias will be evaluated by using the Egger regression test. Results: As of January 2023, a total of 3266 abstracts have been identified for screening. Data extraction is expected to commence in February 2023. Conclusions: The topic of OAT and its effect on pregnancy is an understudied area that has the potential to improve health outcomes, clinical practice, education, and community advocacy. The results of our review will be used to inform clinical practice guidelines and improve health outcomes for pregnant people. Findings will be disseminated to diverse groups of stakeholders, including policy makers, clinicians, community partners, and individuals with lived experience of drug use. Trial Registration: PROSPERO CRD42022332082; https://tinyurl.com/2p94pkx5 International Registered Report Identifier (IRRID): DERR1-10.2196/42417 
UR  - https://www.researchprotocols.org/2023/1/e42417
UR  - http://dx.doi.org/10.2196/42417
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37163329
ID  - info:doi/10.2196/42417
ER  - 

TY  - JOUR
AU  - d'Halluin, Arnaud
AU  - Costa, Marie
AU  - Morgiève, Margot
AU  - Sebbane, Déborah
PY  - 2023/5/2
TI  - Attitudes of Children, Adolescents, and Their Parents Toward Digital Health Interventions: Scoping Review
JO  - J Med Internet Res
SP  - e43102
VL  - 25
KW  - eHealth
KW  - mental health
KW  - children and adolescents
KW  - attitude
KW  - scoping review
KW  - mobile phone
KW  - digital health intervention
KW  - DHI
N2  - Background: The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population?s developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. Objective: This study aimed to establish an inventory of children?s, adolescents?, and their parents? attitudes toward DHIs. Methods: A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: ?child and adolescent mental health service users,? ?digital health interventions,? and ?attitudes.? Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. Results: Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. Conclusions: The results of this study provide a better understanding of the factors influencing children?s and adolescents? attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care. 
UR  - https://www.jmir.org/2023/1/e43102
UR  - http://dx.doi.org/10.2196/43102
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37129931
ID  - info:doi/10.2196/43102
ER  - 

TY  - JOUR
AU  - Mwenda, Valerian
AU  - Makena, Ireen
AU  - Ogweno, Vincent
AU  - Obonyo, James
AU  - Were, Vincent
PY  - 2023/5/1
TI  - The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study
JO  - JMIR Pediatr Parent
SP  - e37359
VL  - 6
KW  - text messages
KW  - adolescent pregnancy
KW  - milestones
KW  - mHealth
KW  - psychosocial support
KW  - Kenya
KW  - nurturing care
N2  - Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers? knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers? knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse 
UR  - https://pediatrics.jmir.org/2023/1/e37359
UR  - http://dx.doi.org/10.2196/37359
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37126373
ID  - info:doi/10.2196/37359
ER  - 

TY  - JOUR
AU  - Murray, B. Jennifer
AU  - Sharp, Alexander
AU  - Munro, Sarah
AU  - Janssen, A. Patricia
PY  - 2023/4/18
TI  - Expectant Parents? Preferences for Teaching by Texting: Development and Usability Study of SmartMom
JO  - JMIR Form Res
SP  - e44661
VL  - 7
KW  - pregnancy
KW  - pregnant
KW  - prenatal
KW  - patient education
KW  - text message
KW  - SMS text messaging
KW  - prenatal education
KW  - mHealth
KW  - evidence-based health care
KW  - mobile app
KW  - Canada
KW  - mobile health
KW  - preference
KW  - focus group
KW  - information need
KW  - user need
N2  - Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that ?having reliable information is the most important thing? (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (?It was nice to have that [information] fed to you?; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom?s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology?based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. 
UR  - https://formative.jmir.org/2023/1/e44661
UR  - http://dx.doi.org/10.2196/44661
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37071451
ID  - info:doi/10.2196/44661
ER  - 

TY  - JOUR
AU  - Cluxton-Keller, Fallon
AU  - Olson, Ardis
PY  - 2023/4/13
TI  - A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study
JO  - JMIR Pediatr Parent
SP  - e45616
VL  - 6
KW  - anxiety
KW  - depression
KW  - family treatment
KW  - infant care
KW  - maternal health
KW  - parenting
KW  - pediatric primary care
KW  - perinatal anxiety
KW  - perinatal care
KW  - perinatal depression
KW  - video therapy
KW  - women's health
N2  - Background: Untreated perinatal depression and anxiety can have detrimental consequences on family function. Logistical barriers prevent many perinatal women from accessing treatment, and these barriers are compounded for women residing in rural areas. This paper describes a Family-Based Collaborative Care Model (FBCCM) that is designed to bypass barriers to increase access to care for depressed and anxious perinatal women in rural regions of the United States. The FBCCM includes the following two components: (1) a 10-session video-delivered family therapy treatment for perinatal depression and anxiety and (2) a video-delivered infant care provider training on addressing the parenting needs of depressed and anxious mothers. Objective: This paper describes the feasibility of implementing the FBCCM with families and infant care providers. Findings are presented on the preliminary effectiveness of the video-delivered family therapy treatment in reducing maternal depressive and anxiety symptoms, and family conflict. Methods: This pilot study was carried out using an implementation-effectiveness hybrid trial design without a comparison group. Changes in maternal depressive symptoms, maternal anxiety symptoms, and family conflict were measured at posttreatment, 3 months, and 6 months later. Results: On average, mothers (n=24) attended 9.79 (SD 1.02) sessions. On average, their family members (n=24) attended 9.42 (SD 1.28) sessions. A total of 31 infant care providers attended the training on addressing the parenting needs of depressed and anxious mothers. Mothers reported a significant reduction in depressive symptoms (P<.001) and anxiety symptoms (P<.001) from baseline to the 6-month follow-up. Mothers reported a significant reduction in conflict (P<.001), and their family members also reported a significant reduction in conflict (P=.007) from baseline to the 6-month follow-up. Conclusions: The findings from this study provide support for the feasibility and preliminary effectiveness of the FBCCM. The findings will be used to inform a larger study of the FBCCM. 
UR  - https://pediatrics.jmir.org/2023/1/e45616
UR  - http://dx.doi.org/10.2196/45616
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37052997
ID  - info:doi/10.2196/45616
ER  - 

TY  - JOUR
AU  - Bahorski, Jessica
AU  - Romano, Mollie
AU  - McDougal, May Julie
AU  - Kiratzis, Edie
AU  - Pocchio, Kinsey
AU  - Paek, Insu
PY  - 2023/2/28
TI  - Development of an Individualized Responsive Feeding Intervention?Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study
JO  - JMIR Res Protoc
SP  - e44329
VL  - 12
KW  - responsive feeding
KW  - infant growth
KW  - infant nutrition
N2  - Background: Responsive infant feeding occurs when a parent recognizes the infant?s cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding. Objective: The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR (?super,? Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads. Methods: This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement. Results: This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023. Conclusions: After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations?those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding. International Registered Report Identifier (IRRID): DERR1-10.2196/44329 
UR  - https://www.researchprotocols.org/2023/1/e44329
UR  - http://dx.doi.org/10.2196/44329
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36853761
ID  - info:doi/10.2196/44329
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Chong, Seng Yap
AU  - Shi, Luming
AU  - Chua, Shi Jing
AU  - 
AU  - Mathews, Jancy
AU  - Lim, Hoon Siew
AU  - Du, Ruochen
AU  - Chan, Huak Yiong
AU  - Tan, Chye Thiam
AU  - Chee, Cornelia
AU  - Law, Evelyn
PY  - 2023/2/22
TI  - Evaluating the Effects of the Supportive Parenting App on Infant Developmental Outcomes: Longitudinal Study
JO  - JMIR Mhealth Uhealth
SP  - e43885
VL  - 11
KW  - infant development
KW  - parenting
KW  - mobile health technology
KW  - social support
KW  - psychoeducation
KW  - peer support
KW  - mobile phone
N2  - Background: Previous studies have investigated the various effects of parenting on infant developmental outcomes. In particular, parental stress and social support have been found to significantly affect the growth of the newborn. Although many parents today use mobile apps to obtain more support in parenting and perinatal care, few studies have examined how these apps could affect infant development. Objective: This study aimed to examine the effectiveness of the Supportive Parenting App (SPA) in improving infant developmental outcomes during the perinatal period. Methods: This study adopted a 2-group parallel prospective longitudinal design and recruited 200 infants and their parents (N=400 mothers and fathers). The parents were recruited at 24 weeks of gestation for a randomized controlled trial conducted from February 2020 to July 2022. They were randomly allocated to either the intervention or control group. The infant outcome measures included cognition, language, motor skills, and social-emotional development. Data were collected from the infants when they were aged 2, 4, 6, 9, and 12 months. Linear and modified Poisson regressions were used to analyze the data to examine between- and within-group changes. Results: At 9 and 12 months post partum, the infants in the intervention group were found to have better communication and language skills than those in the control group. An analysis of motor development revealed that a larger proportion of the infants in the control group fell under the at-risk category, where they scored approximately 2 SDs below the normative scores. The control group infants scored higher on the problem solving domain at 6 months post partum. However, at 12 months postpartum, the infants in the intervention group performed better on cognitive tasks than those in the control group. Despite not being statistically significant, the intervention group infants were found to have consistently scored better on the social components of the questionnaires than the control group infants. Conclusions: Overall, the infants whose parents had received the SPA intervention tended to fare better in most developmental outcome measures than those whose parents had received standard care only. The findings of this study suggest that the SPA intervention exerted positive effects on the communication, cognition, motor, and socioemotional development of the infants. Further research is needed to improve the content and support provided by the intervention to maximize the benefits gained by infants and their parents. Trial Registration: ClinicalTrials.gov NCT04706442; https://clinicaltrials.gov/ct2/show/NCT04706442 
UR  - https://mhealth.jmir.org/2023/1/e43885
UR  - http://dx.doi.org/10.2196/43885
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36811952
ID  - info:doi/10.2196/43885
ER  - 

TY  - JOUR
AU  - Nwoke, Nmanma Chinenye
AU  - Awosoga, A. Oluwagbohunmi
AU  - McDonald, Sheila
AU  - Bonifacio, T. Glenda
AU  - Leung, Y. Brenda M.
PY  - 2023/2/20
TI  - Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study
JO  - JMIR Form Res
SP  - e43800
VL  - 7
KW  - African women
KW  - immigrant women
KW  - mental health
KW  - pregnancy
KW  - postpartum health
KW  - depression
KW  - anxiety
N2  - Background: Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. Objective: The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. Methods: This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. Results: Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). Conclusions: Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors. 
UR  - https://formative.jmir.org/2023/1/e43800
UR  - http://dx.doi.org/10.2196/43800
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36808093
ID  - info:doi/10.2196/43800
ER  - 

TY  - JOUR
AU  - Tenfelde, Kim
AU  - Antheunis, Marjolijn
AU  - Krahmer, Emiel
AU  - Bunt, Erik Jan
PY  - 2023/2/7
TI  - Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment
JO  - JMIR Pediatr Parent
SP  - e38435
VL  - 6
KW  - mobile health
KW  - mHealth
KW  - physician-patient communication
KW  - questions asking
KW  - needs assessment
KW  - explorative
KW  - mobile phone
N2  - Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents? personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. 
UR  - https://pediatrics.jmir.org/2023/1/e38435
UR  - http://dx.doi.org/10.2196/38435
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36749606
ID  - info:doi/10.2196/38435
ER  - 

TY  - JOUR
AU  - Mogaka, Nyabiage Jerusha
AU  - Otieno, Abuna Felix
AU  - Akim, Eunita
AU  - Beima-Sofie, Kristin
AU  - Dettinger, Julia
AU  - Gomez, Lauren
AU  - Marwa, Mary
AU  - Odhiambo, Ben
AU  - Ngure, Kenneth
AU  - Ronen, Keshet
AU  - Sharma, Monisha
AU  - John-Stewart, Grace
AU  - Richardson, Barbra
AU  - Stern, Joshua
AU  - Unger, Jennifer
AU  - Udren, Jenna
AU  - Watoyi, Salphine
AU  - Pintye, Jillian
AU  - Kinuthia, John
PY  - 2023/1/30
TI  - A Text Messaging?Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e41170
VL  - 12
KW  - pre-exposure prophylaxis
KW  - text messaging
KW  - text message
KW  - mobile technology
KW  - PrEP adherence
KW  - adherence
KW  - prevention
KW  - pregnancy
KW  - pregnant
KW  - breastfeeding
KW  - maternal
KW  - randomized
KW  - RCT
KW  - peripartum
KW  - patient-provider
KW  - postpartum
KW  - HIV prevention
KW  - SMS
KW  - HIV
KW  - mHealth
KW  - mobile health
N2  - Background: Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. Objective: We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women?s and Children?s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. Methods: The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Results: Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. Conclusions: This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial Registration: ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884 International Registered Report Identifier (IRRID): DERR1-10.2196/41170 
UR  - https://www.researchprotocols.org/2023/1/e41170
UR  - http://dx.doi.org/10.2196/41170
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36716092
ID  - info:doi/10.2196/41170
ER  - 

TY  - JOUR
AU  - Nwoke, Nmanma Chinenye
AU  - Awosoga, A. Oluwagbohunmi
AU  - McDonald, Sheila
AU  - Bonifacio, T. Glenda
AU  - Leung, Y. Brenda M.
PY  - 2023/1/27
TI  - African Immigrant Mothers? Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study
JO  - JMIR Form Res
SP  - e40008
VL  - 7
KW  - African women
KW  - perinatal mental health
KW  - screening
KW  - anxiety
KW  - mental health literacy
KW  - pregnancy
KW  - postpartum
KW  - depression
KW  - acceptability
KW  - knowledge
N2  - Background: Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. Objective: The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers? views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers? views regarding perinatal mental health screening and to determine factors associated with those views. Methods: A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ?18 years, had a live birth, and the infant was aged ?2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. Results: Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. Conclusions: Although African mothers? knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health. 
UR  - https://formative.jmir.org/2023/1/e40008
UR  - http://dx.doi.org/10.2196/40008
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36705944
ID  - info:doi/10.2196/40008
ER  - 

TY  - JOUR
AU  - Shrivastava, Rahul
AU  - Singhal, Manmohan
AU  - Gupta, Mansi
AU  - Joshi, Ashish
PY  - 2023/1/27
TI  - Development of an Artificial Intelligence?Guided Citizen-Centric Predictive Model for the Uptake of Maternal Health Services Among Pregnant Women Living in Urban Slum Settings in India: Protocol for a Cross-sectional Study With a Mixed Methods Design
JO  - JMIR Res Protoc
SP  - e35452
VL  - 12
KW  - citizen centric
KW  - maternal health
KW  - informatics
KW  - predictive model
KW  - artificial intelligence
KW  - development
KW  - evaluation
KW  - machine learning
N2  - Background: Pregnant women are considered a ?high-risk? group with limited access to health facilities in urban slums in India. Barriers to using health services appropriately may lead to maternal and child mortality, morbidity, low birth weight, and children with stunted growth. With the increase in the use of artificial intelligence (AI) and machine learning in the health sector, we plan to develop a predictive model that can enable substantial uptake of maternal health services and improvements in adverse pregnancy health care outcomes from early diagnostics to treatment in urban slum settings. Objective: The objective of our study is to develop and evaluate the AI-guided citizen-centric platform that will support the uptake of maternal health services among pregnant women seeking antenatal care living in urban slum settings. Methods: We will conduct a cross-sectional study using a mixed methods approach to enroll 225 pregnant women aged 18-44 years, living in the urban slums of Delhi for more than 6 months, seeking antenatal care, and who have smartphones. Quantitative and qualitative data will be collected using an Open Data Kit Android-based tool. Variables gathered will include sociodemographics, clinical history, pregnancy history, dietary history, COVID-19 history, health care facility data, socioeconomic status, and pregnancy outcomes. All data gathered will be aggregated into a common database. We will use AI to predict the early at-risk pregnancy outcomes (in terms of the type of delivery method, term, and related complications) depending on the needs of the beneficiaries translating into effective service-delivery improvements in enhancing the use of maternal health services among pregnant women seeking antenatal care. The proposed research will help policy makers to prioritize resource planning, resource allocation, and the development of programs and policies to enhance maternal health outcomes. The academic research study has received ethical approval from the University Research Ethics Committee of Dehradun Institute of Technology (DIT) University, Dehradun, India. Results: The study was approved by the University Research Ethics Committee of DIT University, Dehradun, on July 4, 2021. Enrollment of the eligible participants will begin by April 2022 followed by the development of the predictive model by October 2022 till January 2023. The proposed AI-guided citizen-centric tool will be designed, developed, implemented, and evaluated using principles of human-centered design that will help to predict early at-risk pregnancy outcomes. Conclusions: The proposed internet-enabled AI-guided prediction model will help identify the potential risk associated with pregnancies and enhance the uptake of maternal health services among those seeking antenatal care for safer deliveries. We will explore the scalability of the proposed platform up to different geographic locations for adoption for similar and other health conditions. International Registered Report Identifier (IRRID): PRR1-10.2196/35452 
UR  - https://www.researchprotocols.org/2023/1/e35452
UR  - http://dx.doi.org/10.2196/35452
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36705968
ID  - info:doi/10.2196/35452
ER  - 

TY  - JOUR
AU  - Kikuchi, Kimiyo
AU  - Islam, Rafiqul
AU  - Sato, Yoko
AU  - Nishikitani, Mariko
AU  - Izukura, Rieko
AU  - Jahan, Nusrat
AU  - Yokota, Fumihiko
AU  - Ikeda, Subaru
AU  - Sultana, Nazneen
AU  - Nessa, Meherun
AU  - Nasir, Morshed
AU  - Ahmed, Ashir
AU  - Kato, Kiyoko
AU  - Morokuma, Seiichi
AU  - Nakashima, Naoki
PY  - 2022/12/15
TI  - Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study
JO  - JMIR Res Protoc
SP  - e41586
VL  - 11
IS  - 12
KW  - telehealth care
KW  - continuum of care
KW  - maternal, newborn, and child health
KW  - portable health clinic
KW  - parenting
KW  - prenatal
KW  - pediatrics
N2  - Background: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Objective: Our study will examine the telehealth care system?s effectiveness in improving women?s and infants? care uptake and detecting their health problems. Methods: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (?16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants? health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants? health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention?s effectiveness. Results: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Conclusions: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women?s and infants? health status. Trial Registration: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621 International Registered Report Identifier (IRRID): DERR1-10.2196/41586 
UR  - https://www.researchprotocols.org/2022/12/e41586
UR  - http://dx.doi.org/10.2196/41586
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36520523
ID  - info:doi/10.2196/41586
ER  - 

TY  - JOUR
AU  - Yan, Qin
AU  - Gong, Yanhong
AU  - Luo, Qing
AU  - Yin, Xiaoxv
AU  - Yang, Ling
AU  - Wang, Honglin
AU  - Feng, Juan
AU  - Xing, Kaihui
AU  - Huang, Yan
AU  - Huang, Chuican
AU  - Fan, Lichun
PY  - 2022/11/23
TI  - Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e37843
VL  - 24
IS  - 11
KW  - eHealth
KW  - mHealth
KW  - mobile apps
KW  - maternal anxiety
KW  - neonatal jaundice
KW  - neonatal readmission
KW  - neonatal screening
KW  - mobile phone
N2  - Background: Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission?especially severe hyperbilirubinemia and its complications?and it influences disease burden as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care service and maternal health outcomes is still unknown. Objective: The aim of this study was to evaluate the impact of a smartphone-based out-of-hospital neonatal jaundice screening program on neonatal readmission rates for jaundice and related maternal anxiety. Methods: This was a 2-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on-site from 3 public hospitals in Hainan, China. Intervention group mothers used the smartphone app to routinely monitor neonatal jaundice at home under the web-based guidance of pediatricians. Control group participants received routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of the first hospital discharge. The secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data were collected through a self-assessed questionnaire. All participants were included in the analysis (intention-to-treat). Results: In this study, 1424 mother-infant dyads were recruited, comprising 1424 mothers and 1424 newborns. The median ageof the mothers was 29 (IQR 26-32) years, and there were 714 (50.1%) male neonates. These mother-infant dyads were randomlyassigned to the intervention group and the control group, with 712 dyads in each group; only 1187 of these dyads completed thefollow-up. We found that the adjusted 30-day neonatal readmission rate due to jaundice reduced by 10.5% (71/605, 11.7% vs141/582, 24.2%; 95% CI 5%-15.9%; odds ratio 0.4, 95% CI 0.3-0.5; P<.001) and the relevant maternal anxiety mean scoredecreased by 3.6 (95% CI ?4.4 to ?2.8; ?=?3.6, 95% CI ?4.5 to ?2.8; P<.001) in the intervention group compared to those in theroutine care group. Conclusions: Our study shows that the smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased the neonatal readmission rate within 30 days from the first discharge and improved maternal mental health to some degree, thus demonstrating the usefulness of this screening app for follow-up in pediatric care. Trial Registration: China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245 
UR  - https://www.jmir.org/2022/11/e37843
UR  - http://dx.doi.org/10.2196/37843
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36416882
ID  - info:doi/10.2196/37843
ER  - 

TY  - JOUR
AU  - Dinour, M. Lauren
AU  - Pole, Antoinette
PY  - 2022/10/26
TI  - Evaluation of Breastfeeding App Features: Content Analysis Study
JO  - JMIR Pediatr Parent
SP  - e37581
VL  - 5
IS  - 4
KW  - breastfeeding
KW  - breastmilk expression
KW  - bottle feeding
KW  - infant food
KW  - infant health
KW  - infant care
KW  - consumer health informatics
KW  - mobile apps
KW  - smartphone
KW  - cross-sectional study
N2  - Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (?4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. 
UR  - https://pediatrics.jmir.org/2022/4/e37581
UR  - http://dx.doi.org/10.2196/37581
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36287596
ID  - info:doi/10.2196/37581
ER  - 

TY  - JOUR
AU  - Jawad, Danielle
AU  - Cheng, Heilok
AU  - Wen, Ming Li
AU  - Rissel, Chris
AU  - Baur, Louise
AU  - Mihrshahi, Seema
AU  - Taki, Sarah
PY  - 2022/10/7
TI  - Interactivity, Quality, and Content of Websites Promoting Health Behaviors During Infancy: 6-Year Update of the Systematic Assessment
JO  - J Med Internet Res
SP  - e38641
VL  - 24
IS  - 10
KW  - breastfeeding
KW  - bottle feeding
KW  - websites
KW  - web-based platform
KW  - infant food
KW  - readability
KW  - accuracy
KW  - consumer
KW  - health information
KW  - interactivity
KW  - solid food
KW  - quality
KW  - grading
KW  - comprehensibility
KW  - infant
KW  - baby
KW  - babies
KW  - feeding
KW  - food
KW  - eating
KW  - nutrition
KW  - health behavior
KW  - web-based information
KW  - health website
KW  - sleep
KW  - screen time
KW  - rating
N2  - Background: As of 2021, 89% of the?Australian population are active internet users. Although the internet is widely used, there are concerns about the quality, accuracy, and credibility of health-related websites. A 2015 systematic assessment of infant feeding websites and apps available in Australia found that 61% of websites were of poor quality and readability, with minimal coverage of infant feeding topics and lack of author credibility. Objective: We aimed to systematically assess the quality, interactivity, readability, and comprehensibility of information targeting infant health behaviors on websites globally and provide an update of the 2015 systematic assessment. Methods: Keywords related to infant milk feeding behaviors, solid feeding behaviors, active play, screen time, and sleep were used to identify websites targeting infant health behaviors on the Google search engine on Safari. The websites were assessed by a subset of the authors using predetermined criteria between July 2021 and February 2022 and assessed for information content based on the Australian Infant Feeding Guidelines and National Physical Activity Recommendations. The Suitability Assessment of Materials, Quality Component Scoring System, the Health-Related Website Evaluation Form, and the adherence to the Health on the Net code were used to evaluate the suitability and quality of information. Readability was assessed using 3 web-based readability tools. Results: Of the 450 websites screened, 66 were included based on the selection criteria and evaluated. Overall, the quality of websites was mostly adequate. Media-related sources, nongovernmental organizations, hospitals, and privately owned websites had the highest median quality scores, whereas university websites received the lowest median score (35%). The information covered within the websites was predominantly poor: 91% (60/66) of the websites received an overall score of ?74% (mean 53%, SD 18%). The suitability of health information was mostly rated adequate for literacy demand, layout, and learning and motivation of readers. The median readability score for the websites was grade 8.5, which is higher than the government recommendations (<grade 8). Overall, 74% (49/66) of the websites obtained a poor rating for interactivity, measuring active control, 2-way communication, and synchronicity. The most common features found on websites were social media links (61/66, 92%), frequently asked questions (48/66, 73%), and videos (44/66, 67%). Only 14% (9/66) of websites presented culturally responsive information. Conclusions: Quality, content, readability, and interactivity of websites promoting health behaviors during infancy ranged between poor and adequate. Since the 2015 systematic assessment, there was a slight improvement in the quality of websites but no difference in the Suitability Assessment of Materials rating and readability of information. There is a need for researchers and health care providers to leverage innovative web-based platforms to provide culturally competent evidence-based information based on government guidelines that are accessible to those with limited English proficiency. 
UR  - https://www.jmir.org/2022/10/e38641
UR  - http://dx.doi.org/10.2196/38641
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36206031
ID  - info:doi/10.2196/38641
ER  - 

TY  - JOUR
AU  - Cena, Loredana
AU  - Trainini, Alice
AU  - Tralli, Nella
AU  - Nodari, Silvia Luisa
AU  - Iacona, Erika
AU  - Ronconi, Lucia
AU  - Testoni, Ines
PY  - 2022/9/12
TI  - The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e38866
VL  - 11
IS  - 9
KW  - COVID-19 pandemic
KW  - perinatal loss
KW  - bereavement care
KW  - mourning
KW  - anxiety
KW  - depression
KW  - posttraumatic stress disorder
KW  - COVID-19
KW  - pandemic
KW  - psychological
KW  - bereavement
KW  - miscarriage
KW  - stillbirth
KW  - neonatal death
KW  - parent
KW  - experience
KW  - coping
KW  - grief
N2  - Background: At the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple?the baby dies and the couple?s plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief. Objective: The main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief. Methods: This longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases?a baseline and a follow-up after 6 months. Results: This protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation. Conclusions: This study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health. International Registered Report Identifier (IRRID): DERR1-10.2196/38866 
UR  - https://www.researchprotocols.org/2022/9/e38866
UR  - http://dx.doi.org/10.2196/38866
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36044641
ID  - info:doi/10.2196/38866
ER  - 

TY  - JOUR
AU  - Lori, R. Jody
AU  - Williams, O. John E.
AU  - Kukula, A. Vida
AU  - Apetorgbor, A. Veronica E.
AU  - Awini, A. Elizabeth
AU  - Amankwah, Georgina
AU  - Zielinski, Ruth
AU  - Lockhart, Nancy
AU  - James, H. Katherine
AU  - Moyer, A. Cheryl
PY  - 2022/9/9
TI  - Group Antenatal Care in Ghana: Protocol for a Cluster Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e40828
VL  - 11
IS  - 9
KW  - group care
KW  - antenatal care
KW  - group antenatal care
KW  - health literacy
KW  - maternal health literacy
KW  - Ghana
KW  - sub-Saharan Africa
KW  - care seeking
KW  - maternal outcomes
KW  - neonatal outcomes
N2  - Background: While group antenatal care (ANC) has been delivered and studied in high-income countries for over a decade, it has only recently been introduced as an alternative to individual care in sub-Saharan Africa. Although the experimental design of the studies from high-resource countries have been scientifically rigorous, findings cannot be generalized to low-resource countries with low literacy rates and high rates of maternal and newborn morbidity and mortality. The Group Antenatal Care Delivery Project (GRAND) is a collaboration between the University of Michigan in the United States and the Dodowa Health Research Centre in Ghana. GRAND is a 5-year, cluster randomized controlled trial (RCT). Our intervention?group ANC?consists of grouping women by similar gestational ages of pregnancy into small groups at the first ANC visit. They then meet with the same group and the same midwife at the recommended intervals for care. Objective: This study aims to improve health literacy, increase birth preparedness and complication readiness, and optimize maternal and newborn outcomes among women attending ANC at seven rural health facilities in the Eastern Region of Ghana. Methods: Quantitative data will be collected at four time points using a secure web application for data collection and a database management tool. Data will be analyzed on an intention-to-treat basis to test the differences between the two arms: women randomized to group-based ANC and women randomized to routine individual ANC. We will conduct a process evaluation concurrently to identify and document patient, provider, and system barriers and facilitators to program implementation. Results: The study was funded in September 2018. Recruitment and enrollment of participants and data collection started in July 2019. In November 2021, we completed participant enrollment in the study (n=1761), and we completed data collection at the third trimester in May 2022 (n=1284). Data collection at the additional three time points is ongoing: 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Conclusions: This study is significant and timely because it is among the first RCTs to be conducted to examine the effects of group ANC among low-literacy and nonliterate participants. Our findings have the potential to impact how clinical care is delivered to low-literacy populations, both globally and domestically, to improve maternal and newborn outcomes. Trial Registration: ClinicalTrials.gov NCT04033003; https://clinicaltrials.gov/ct2/show/NCT04033003 International Registered Report Identifier (IRRID): DERR1-10.2196/40828 
UR  - https://www.researchprotocols.org/2022/9/e40828
UR  - http://dx.doi.org/10.2196/40828
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36083608
ID  - info:doi/10.2196/40828
ER  - 

TY  - JOUR
AU  - Ma, Tony
AU  - Chang, Katie
AU  - Alyusuf, Amal
AU  - Bajracharya, Elina
AU  - Washio, Yukiko
AU  - Kelly, J. Patricia
AU  - Bellad, M. Roopa
AU  - Mahantashetti, S. Niranjana
AU  - Charantimath, Umesh
AU  - Short, L. Vanessa
AU  - Lalakia, Parth
AU  - Jaeger, Frances
AU  - Goudar, Shivaprasad
AU  - Derman, Richard
PY  - 2022/9/8
TI  - Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study
JO  - JMIR Form Res
SP  - e32795
VL  - 6
IS  - 9
KW  - mobile health
KW  - mHealth
KW  - peer counselors
KW  - breastfeeding
KW  - rural
KW  - usability
KW  - low- and middle-income countries
KW  - agile
KW  - task shifting
KW  - user-centered design
KW  - mobile phone
N2  - Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby?s design and development, including the app?s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby?s usability from the PCs? perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group?s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 
UR  - https://formative.jmir.org/2022/9/e32795
UR  - http://dx.doi.org/10.2196/32795
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36074546
ID  - info:doi/10.2196/32795
ER  - 

TY  - JOUR
AU  - Agbadje, Tatiana Titilayo
AU  - Pilon, Chantale
AU  - Bérubé, Pierre
AU  - Forest, Jean-Claude
AU  - Rousseau, François
AU  - Rahimi, Abbasgholizadeh Samira
AU  - Giguère, Yves
AU  - Légaré, France
PY  - 2022/9/6
TI  - User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study
JO  - JMIR Pediatr Parent
SP  - e35381
VL  - 5
IS  - 3
KW  - shared decision-making
KW  - computer-based decision aid
KW  - prenatal screening
KW  - trisomy
KW  - Down syndrome
KW  - mixed methods
N2  - Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants? reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice. 
UR  - https://pediatrics.jmir.org/2022/3/e35381
UR  - http://dx.doi.org/10.2196/35381
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35896164
ID  - info:doi/10.2196/35381
ER  - 

TY  - JOUR
AU  - Shinde, Sachin
AU  - Wang, Dongqing
AU  - Yussuf, H. Mashavu
AU  - Mwanyika-Sando, Mary
AU  - Aboud, Said
AU  - Fawzi, W. Wafaie
PY  - 2022/8/30
TI  - Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal and Infant Nutritional Status in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-analysis
JO  - JMIR Res Protoc
SP  - e40134
VL  - 11
IS  - 8
KW  - antenatal care
KW  - multiple micronutrient supplementation
KW  - pregnant and lactating women
KW  - systematic review and meta-analysis
KW  - review
KW  - meta-analysis
KW  - meta-analyses
KW  - low- and middle-income countries
KW  - LMIC
KW  - low income
KW  - middle income
KW  - women's health
KW  - pregnant
KW  - pregnancy
KW  - natal
KW  - maternal
KW  - maternity
KW  - infant
KW  - baby
KW  - babies
KW  - lactation
KW  - lactating
KW  - breastfeed
KW  - nutrition
KW  - vitamin
KW  - nutrient
KW  - supplement
N2  - Background: Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs.  Objective: The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs. Methods: Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. Results: We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity. Conclusions: This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence. Trial Registration: PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr. International Registered Report Identifier (IRRID): PRR1-10.2196/40134 
UR  - https://www.researchprotocols.org/2022/8/e40134
UR  - http://dx.doi.org/10.2196/40134
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36040761
ID  - info:doi/10.2196/40134
ER  - 

TY  - JOUR
AU  - Binda, Victoria
AU  - Olhaberry, Marcia
AU  - Castañon, Carla
AU  - Abarca, Constanza
AU  - Caamaño, Catalina
PY  - 2022/8/15
TI  - A Group  Videoconferencing Intervention (C@nnected) to Improve Maternal Sensitivity: Protocol for a Randomized Feasibility Trial
JO  - JMIR Res Protoc
SP  - e35881
VL  - 11
IS  - 8
KW  - maternal sensitivity
KW  - group intervention
KW  - primary care
KW  - eHealth
KW  - responsive caregiving
KW  - videoconferencing
KW  - Early childhood
KW  - caregiver
KW  - eHealth intervention
KW  - health intervention
KW  - parenting
KW  - children
KW  - peer-support
N2  - Background: Early childhood development is highly dependent on the sensitive care provided by caregivers, and interventions focused on supporting parents to improve their sensitivity have shown to be effective. The COVID-19 pandemic has had a significant impact on mental health, with pregnant women and mothers of infants being an especially vulnerable group and maternal sensitivity particularly affected. However, access to face-to-face interventions is restricted; thus, it is important to have remote interventions to support this group of mothers. Objective: The objective of this study is to evaluate the feasibility and acceptability of C@nnected, a group videoconferencing intervention to improve maternal sensitivity aimed at mother-infant dyads attending primary health care centers in vulnerable areas of Santiago, Chile. Methods: This is a randomized feasibility single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation ratio (with more people allocated to the intervention arm). The intervention consists of 4 group videoconferencing sessions adapted from a face-to-face intervention with proven effectiveness. The control group will receive treatment as usual, along with educational brochures. The feasibility and acceptability of this study will be quantitatively and qualitatively assessed. Changes in clinical outcomes relating to maternal sensitivity, depressive symptoms, postpartum maternal attachment, and infant socioemotional development will also be evaluated. Results: We finished adapting the face-to-face intervention to the videoconferencing format in July 2021. The study began recruitment in August 2021, and enrollment is expected to end in August 2022, with final study results expected in December 2022. Conclusions: This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. Trial Registration: ClinicalTrials.gov NCT04904861; https://clinicaltrials.gov/ct2/show/NCT04904861 International Registered Report Identifier (IRRID): DERR1-10.2196/35881 
UR  - https://www.researchprotocols.org/2022/8/e35881
UR  - http://dx.doi.org/10.2196/35881
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35969451
ID  - info:doi/10.2196/35881
ER  - 

TY  - JOUR
AU  - Waselewski, Marika
AU  - Plegue, Melissa
AU  - Sonneville, Kendrin
AU  - Resnicow, Ken
AU  - Ghumman, Aisha
AU  - Ebbeling, Cara
AU  - Mahmoudi, Elham
AU  - Sen, Ananda
AU  - Wolfson, A. Julia
AU  - Chang, Tammy
PY  - 2022/8/5
TI  - Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e40568
VL  - 11
IS  - 8
KW  - pregnancy
KW  - weight
KW  - diet
KW  - grocery delivery
N2  - Background: Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective: This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods: A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results: This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions: This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration: ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID): DERR1-10.2196/40568 
UR  - https://www.researchprotocols.org/2022/8/e40568
UR  - http://dx.doi.org/10.2196/40568
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35930351
ID  - info:doi/10.2196/40568
ER  - 

TY  - JOUR
AU  - Depla, Louise Anne
AU  - Lamain-de Ruiter, Marije
AU  - Laureij, T. Lyzette
AU  - Ernst-Smelt, E. Hiske
AU  - Hazelzet, A. Jan
AU  - Franx, Arie
AU  - Bekker, N. Mireille
AU  - 
PY  - 2022/7/5
TI  - Patient-Reported Outcome and Experience Measures in Perinatal Care to Guide Clinical Practice: Prospective Observational Study
JO  - J Med Internet Res
SP  - e37725
VL  - 24
IS  - 7
KW  - perinatal care
KW  - patient-reported outcomes
KW  - patient-reported experiences
KW  - patient-centered outcome measures
KW  - value-based health care
KW  - shared decision-making
KW  - personalized care
KW  - integrated care
N2  - Background: The International Consortium for Health Outcomes Measurement has published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on the patient level for shared decision-making and on an aggregated level for quality improvement. Objective: This study aims to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice. Methods: In total, 7 obstetric care networks across the Netherlands, each consisting of 1 or 2 hospitals and multiple community midwifery practices (ranging in number from 2 to 18), implemented the PROM and PREM domains of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROMs and PREMs were assessed with questionnaires at 5 time points: 2 during pregnancy and 3 post partum. Clinical threshold values (alerts) supported care professionals interpreting the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 to September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results: In total, 1923 questionnaires were collected across the 5 time points: 816 (42.43%) at T1 (first trimester), 793 (41.23%) at T2 (early third trimester), 125 (6.5%) at T3 (maternity week), 170 (8.84%) at T4 (6 weeks post partum), and 19 (1%) at T5 (6 months post partum). Of these, 84% (1615/1923) were filled out completely. Missing items per domain ranged from 0% to 13%, with the highest missing rates for depression, pain with intercourse, and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and post partum for incontinence (469/1798, 26.08%), pain with intercourse (229/1005, 22.79%), breastfeeding self-efficacy (175/765, 22.88%), and mother-child bonding (122/288, 42.36%). Regarding the PREM domains, the highest alert rates were found for birth experience (37/170, 21.76%), shared decision-making (101/982, 10.29%), and discussing pain relief ante partum (310/793, 39.09%). Some domains showed very little clinical variation; for example, role of the mother and satisfaction with care. Conclusions: The PCB set is a useful tool to assess patient-reported outcomes and experiences that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations regarding methods and timeline of measurements based on our findings. This study supports the implementation of the PCB set in clinical practice, thereby advancing the transformation toward patient-centered, value-based health care for pregnancy and childbirth. 
UR  - https://www.jmir.org/2022/7/e37725
UR  - http://dx.doi.org/10.2196/37725
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35787519
ID  - info:doi/10.2196/37725
ER  - 

TY  - JOUR
AU  - Huang, Xinyu
AU  - Sun, Weiwei
AU  - Wang, Renyu
AU  - Wu, Huailiang
AU  - Yu, Shinning
AU  - Fang, Xuanbi
AU  - Liu, Yiyan
AU  - Akinwunmi, Babatunde
AU  - Huang, Jian
AU  - Ming, Wai-kit
PY  - 2022/6/30
TI  - Present Situation and the Future Development of Web-Based Prenatal Education in China: Cross-sectional Web-Based Survey
JO  - J Med Internet Res
SP  - e28637
VL  - 24
IS  - 6
KW  - web-based prenatal education
KW  - pregnancy
KW  - prenatal
KW  - information technology
N2  - Background: Pregnancy serves as an important chapter in the life of women since more attention needs to be paid to both their physical and psychological health during this period. Adequate prenatal knowledge plays a key role in ensuring the health and safety of not only the pregnant women but also their fetuses and the entire family. With the development of information technology, web-based prenatal education has been brought into focus owing to its accessibility to comprehensive information, with high-quality information available to improve the quality of the overall gestation period, labor process, perinatal outcomes, and fetal outcomes. Objective: This study aims to investigate the present situation of web-based prenatal education and to predict the future research direction of web-based prenatal education in China, thereby providing insights into improving the quality of health care of pregnant women. Methods: A national cross-sectional study was conducted on 590,912 pregnant women in 31 provincial administrations of mainland China between August 2018 and August 2019. These pregnant women were initially recruited from local hospitals across the nation during antenatal and postnatal periods via a web-based education school. Demographic information and course completion status (including the categories and the number of courses they completed) of all the participants were collected. Results: A total of 590,912 pregnant women participated in the web-based prenatal education in 2018. Among them, 188,508 (31.90%) participants were excluded because they did not complete any course, while 17,807 (3.01%) actively participated in web-based prenatal education and completed more than 100 courses. There were 5 categories of web-based courses; almost half of the pregnant women attended the courses on first and second trimesters (293,262/590,912, 49.63% and 298,168/590,912, 50.46%, respectively). We found that pregnant women were more concerned about the gestational diet, fetal-related knowledge, and other precautions before the labor. Conclusions: In the era of digitalization where information is rapidly disseminated, web-based prenatal education could become a more convenient, productive, and effective pathway for pregnant women since it could help them obtain adequate and optimal pregnancy-related information and gain more intellectual awareness about their pregnancy or preparation for pregnancy. 
UR  - https://www.jmir.org/2022/6/e28637
UR  - http://dx.doi.org/10.2196/28637
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35771613
ID  - info:doi/10.2196/28637
ER  - 

TY  - JOUR
AU  - Siddhpuria, Shailee
AU  - Breau, Genevieve
AU  - Lackie, E. Madison
AU  - Lavery, M. Brynn
AU  - Ryan, Deirdre
AU  - Shulman, Barbara
AU  - Kennedy, L. Andrea
AU  - Brotto, A. Lori
PY  - 2022/6/23
TI  - Women?s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: User Involvement Study
JO  - JMIR Form Res
SP  - e33411
VL  - 6
IS  - 6
KW  - postpartum
KW  - depression
KW  - perinatal mental health
KW  - patient engagement
KW  - women?s health
KW  - qualitative
KW  - psychoeducation
KW  - digital tools
N2  - Background: Postpartum depression (PPD) is one of the leading causes of maternal morbidity, affecting up to 18% of Canadian new mothers. Yet, PPD often remains untreated due to numerous barriers in access to care, including location and cost. Development of eHealth interventions in collaboration with patient partners offers an exciting opportunity to fill this care gap and provide effective and affordable care to new parents across British Columbia. Objective: Our aim was to determine the content and design preferences of women previously diagnosed with PPD to inform changes to the development of a web-enabled intervention for education and management of PPD. Methods: Webpage prototypes were created to mimic the web-enabled resource using findings from completed focus group research that assessed what women want in a web-enabled support resource for PPD. A convenience sample of women aged >18 years and previously diagnosed with PPD was recruited. Feedback was collected on the content and design of the prototypes via semistructured interviews and online surveys. Qualitative, inductive analytic, and quantitative methods were used. Results: A total of 9 women (mean age 37.2 years, SD 4.8 years) completed the interview and a majority of the survey. The following 6 themes were identified: (1) inefficacy of text-heavy layouts, (2) highlighting key information, (3) clarity/understandability of the language, (4) finding support groups, (5) validation and immediate help for feelings of isolation, and (6) helpfulness and accessibility of the resource. Each theme identified elements of content or design that were either effective or may be improved upon. Most women (8/9, 89%) favored content relating to foundational knowledge of PPD, such as symptoms and management options. The layout, language, and content were found to be generally easy to understand, clear, trustworthy, and helpful. Conclusions: Six key areas were identified by women previously diagnosed with PPD, as requiring focus in a web-enabled psychoeducation program. Consistent with past research, this study also found that support and enthusiasm for web-enabled programs support PPD management as an adjunct to other evidence-based treatments. 
UR  - https://formative.jmir.org/2022/6/e33411
UR  - http://dx.doi.org/10.2196/33411
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35737435
ID  - info:doi/10.2196/33411
ER  - 

TY  - JOUR
AU  - Sadural, Ernani
AU  - Riley, E. Kristen
AU  - Zha, Peijia
AU  - Pacquiao, Dula
AU  - Faust, Amanda
PY  - 2022/6/13
TI  - Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders
JO  - JMIR Form Res
SP  - e37777
VL  - 6
IS  - 6
KW  - maternal mortality
KW  - health disparity
KW  - mHealth
KW  - patient engagement
KW  - postbirth warning signs
N2  - Background: Maternal morbidity and mortality in the United States continue to be a worsening public health crisis, with persistent racial disparities among Black women during the COVID-19 pandemic. Innovations in mobile health (mHealth) technology are being developed as a strategy to connect birthing women to their health care providers during the first 6 weeks of the postpartum period. Objective: This study aimed to inform a process to evaluate the barriers to mHealth implementation in the context of the COVID-19 pandemic by exploring the experiences of mothers and stakeholders who were directly involved in the pilot program. Methods: The qualitative design used GoToMeeting (GoTo) individual interviews of 13 mothers and 7 stakeholders at a suburban teaching hospital in New Jersey. Mothers were aged ?18 years, able to read and write in English or Spanish, had a vaginal or cesarean birth at >20 weeks of estimated gestational age, and were admitted for delivery at the hospital with at least a 24-hour postpartum stay. Stakeholders were part of the hospital network?s obstetrics collaborative subcommittee comprising administrators, physicians, registered nurses, and informatics. Responses were transcribed verbatim and analyzed for emerging themes. The socioecological framework provided a holistic lens for analyzing the multilevel influences on individual experiences. Results: A total of 3 major themes were identified: mothers experienced barriers from personal situations at home and with services in the hospital and community, which were intensified by the COVID-19 pandemic; the COVID-19 pandemic negatively impacted hospital services, priorities, and individual staff; and mothers and stakeholders had positive experiences and perceptions of the mHealth intervention. Conclusions: The use and reach of the mHealth intervention were negatively influenced by interrelated factors operating at multiple levels. The system-wide and multilevel impact of the pandemic was reflected in participants? responses, providing evidence for the need to re-evaluate mHealth implementation with more adaptable systems and structures in place using a socioecological framework. 
UR  - https://formative.jmir.org/2022/6/e37777
UR  - http://dx.doi.org/10.2196/37777
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35699998
ID  - info:doi/10.2196/37777
ER  - 

TY  - JOUR
AU  - Harrison, L. Cheryce
AU  - Brammall, R. Bonnie
AU  - Garad, Rhonda
AU  - Teede, Helena
PY  - 2022/6/9
TI  - OptimalMe Intervention for Healthy Preconception, Pregnancy, and Postpartum Lifestyles: Protocol for a Randomized Controlled Implementation Effectiveness Feasibility Trial
JO  - JMIR Res Protoc
SP  - e33625
VL  - 11
IS  - 6
KW  - preconception
KW  - pregnancy
KW  - postpartum
KW  - weight
KW  - obesity prevention
KW  - womens health
KW  - intervention
KW  - implementation
N2  - Background: Reproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. Objective: We aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. Methods: This randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. Results: The study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. Conclusions: The study?s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial Registration: Australian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/33625 
UR  - https://www.researchprotocols.org/2022/6/e33625
UR  - http://dx.doi.org/10.2196/33625
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35679115
ID  - info:doi/10.2196/33625
ER  - 

TY  - JOUR
AU  - Denis, Fabrice
AU  - Maurier, Laura
AU  - Carillo, Kevin
AU  - Ologeanu-Taddei, Roxana
AU  - Septans, Anne-Lise
AU  - Gepner, Agnes
AU  - Le Goff, Florian
AU  - Desbois, Madhu
AU  - Demurger, Baptiste
AU  - Silber, Denise
AU  - Zeitoun, Jean-David
AU  - Assuied, Peretz Guedalia
AU  - Bonnot, Olivier
PY  - 2022/5/16
TI  - Early Detection of Neurodevelopmental Disorders of Toddlers and Postnatal Depression by Mobile Health App: Observational Cross-sectional Study
JO  - JMIR Mhealth Uhealth
SP  - e38181
VL  - 10
IS  - 5
KW  - early detection
KW  - NDD
KW  - neurodevelopmental disorder
KW  - ASD
KW  - autism spectrum disorder
KW  - PND
KW  - postnatal depression
KW  - mHealth
KW  - mobile health
KW  - real-world study
KW  - autism
KW  - parenting
KW  - pediatric
KW  - children
KW  - mobile phone
KW  - smartphone
KW  - mobile health app
KW  - digital health intervention
KW  - digital product
KW  - algorithm
N2  - Background: Delays in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) in mothers are major public health issues. In both cases, early intervention is crucial. Objective: We aimed to assess if a mobile app named Malo can reduce delay in the recognition of NDD and PND. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents with a minimum of 1 child under 3 years of age at the time of inclusion and using Malo on a regular basis. We included the first 4000 users matching the criteria and agreeing to participate between November 11, 2021, and January 14, 2022. Parents received monthly questionnaires via the app, assessing skills on sociability, hearing, vision, motricity, language of their infants, and possible autism spectrum disorder. Mothers were also requested to answer regular questionnaires regarding PND, from 4-28 weeks after childbirth. When any patient-reported outcomes matched predefined criteria, an in-app notification was sent to the user, recommending the booking of an appointment with their family physician or pediatrician.The main outcomes were the median age of the infant at the time of notification for possible NDD and the median time of PND notifications after childbirth. One secondary outcome was the relevance of the NDD notification for a consultation as assessed by the physicians. Results: Among 4242 children assessed by 5309 questionnaires, 613 (14.5%) had at least 1 disorder requiring a consultation. The median age of notification for possible autism spectrum, vision, audition, socialization, language, or motor disorders was 11, 9, 17, 12, 22, and 4 months, respectively. The sensitivity of the alert notifications of suspected NDDs as assessed by the physicians was 100%, and the specificity was 73.5%. Among 907 mothers who completed a PND questionnaire, highly probable PND was detected in 151 (16.6%) mothers, and the median time of detection was 8-12 weeks. Conclusions: The algorithm-based alert suggesting NDD was highly sensitive with good specificity as assessed by real-life practitioners. The app was also efficient in the early detection of PND. Our results suggest that the regular use of this multidomain familial smartphone app would permit the early detection of NDD and PND. Trial Registration: ClinicalTrials.gov NCT04958174; https://clinicaltrials.gov/ct2/show/NCT04958174 
UR  - https://mhealth.jmir.org/2022/5/e38181
UR  - http://dx.doi.org/10.2196/38181
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35576565
ID  - info:doi/10.2196/38181
ER  - 

TY  - JOUR
AU  - Dol, Justine
AU  - Aston, Megan
AU  - McMillan, Douglas
AU  - Tomblin Murphy, Gail
AU  - Campbell-Yeo, Marsha
PY  - 2022/5/13
TI  - Participants? Perceptions of Essential Coaching for Every Mother?a Canadian Text Message?Based Postpartum Program: Process Evaluation of a Randomized Controlled Trial
JO  - JMIR Form Res
SP  - e36821
VL  - 6
IS  - 5
KW  - mHealth
KW  - text messaging
KW  - postpartum
KW  - process evaluation
KW  - mobile health
KW  - SMS
KW  - text message
KW  - digital health
KW  - randomized control trial
KW  - postnatal
N2  - Background: ?Essential Coaching for Every Mother? is a Canadian text message?based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program?s effectiveness in terms of the participants? experience to guide refinement and modification. Objective: This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality. Methods: Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program?s text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. ?Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis. Results: Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement. Conclusions: Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program. Trial Registration: ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 
UR  - https://formative.jmir.org/2022/5/e36821
UR  - http://dx.doi.org/10.2196/36821
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35559855
ID  - info:doi/10.2196/36821
ER  - 

TY  - JOUR
AU  - Pezley, Lacey
AU  - Tussing-Humphreys, Lisa
AU  - Koenig, Dawn Mary
AU  - Maki, Pauline
AU  - Odoms-Young, Angela
AU  - Freels, Sally
AU  - DiPiazza, Brittany
AU  - Cann, Felicity
AU  - Cares, Kate
AU  - Depa, Courtney
AU  - Klejka, Gintare
AU  - Lima Oliveira, Manoela
AU  - Prough, Jilian
AU  - Roe, Taylor
AU  - Buscemi, Joanna
AU  - Duffecy, Jennifer
PY  - 2022/5/3
TI  - Feasibility of a Web-Based Intervention to Prevent Perinatal Depression and Promote Human Milk Feeding: Randomized Pilot Trial
JO  - JMIR Form Res
SP  - e32226
VL  - 6
IS  - 5
KW  - breastfeeding
KW  - chestfeeding
KW  - perinatal
KW  - depression
KW  - anxiety
N2  - Background: Mothers who identify as Black or African American are more likely to report depressed moods in late pregnancy and early postpartum and have the lowest rates of human milk feeding compared with all other racial groups in the United States. Internet interventions offer the potential to extend preventative and supportive services as they address key barriers, particularly for those navigating the complex and vulnerable early postpartum period. However, there is limited evidence on the feasibility of such interventions for preventing perinatal mental health disorders and improving human milk feeding outcomes in Black mothers. Objective: This pilot study aimed to assess the feasibility and preliminary findings of a web-based cognitive behavioral therapy?based internet intervention, with and without human milk feeding education and support, to prevent perinatal depression and promote human milk feeding in Black mothers. Methods: Participants were Black-identifying individuals between 20 and 28 weeks of pregnancy with human milk feeding intention and mild to moderate depressive symptoms (Patient Health Questionnaire scores 5-14). Participants were randomized to either Sunnyside, a 6-week cognitive behavioral therapy?based web-based intervention, or Sunnyside Plus, which included additional education and support to promote human milk feeding. Assessments occurred at baseline, third trimester (end of antenatal treatment), 6 weeks postpartum (end of postpartum treatment), and 12 weeks postpartum. The primary focus of this randomized pilot trial was the feasibility and preliminary outcomes of mental health and human milk feeding. Results: A total of 22 tertiary-educated participants were randomized. The mean number of log-ins was 7.3 (SD 5.3) for Sunnyside and 13.8 (SD 10.5) for Sunnyside Plus. Scores of depression and anxiety measures remained below the clinical threshold for referral to treatment in both groups. All the participants initiated human milk feeding (18/18, 100%). Most participants reported at least some human milk feeding at both 6 and 12 weeks postpartum (6/7, 86%; 11/11, 100%, or 10/10, 100%, for Sunnyside and Sunnyside Plus, respectively). Conclusions: The results suggest that tertiary-educated Black mothers at risk for perinatal depression and who intended to human milk feed were receptive to and satisfied with a web-based cognitive behavioral therapy?based internet intervention, with and without human milk feeding education and support. Preliminary findings indicate that both Sunnyside and Sunnyside Plus interventions have the potential to affect symptoms of depression, anxiety, and human milk feeding outcomes. Trial Registration: ClinicalTrials.gov NCT04128202; https://www.clinicaltrials.gov/ct2/show/NCT04128202 
UR  - https://formative.jmir.org/2022/5/e32226
UR  - http://dx.doi.org/10.2196/32226
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35503244
ID  - info:doi/10.2196/32226
ER  - 

TY  - JOUR
AU  - Fuchs-Neuhold, Bianca
AU  - Staubmann, Wolfgang
AU  - Peterseil, Marie
AU  - Rath, Anna
AU  - Schweighofer, Natascha
AU  - Kronberger, Anika
AU  - Riederer, Monika
AU  - van der Kleyn, Moenie
AU  - Martin, Jochen
AU  - Hörmann-Wallner, Marlies
AU  - Waldner, Irmgard
AU  - Konrad, Manuela
AU  - Aufschnaiter, Lena Anna
AU  - Siegmund, Barbara
AU  - Berghold, Andrea
AU  - Holasek, Sandra
AU  - Pail, Elisabeth
PY  - 2022/4/27
TI  - Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study
JO  - JMIR Res Protoc
SP  - e37279
VL  - 11
IS  - 4
KW  - taste
KW  - preferences
KW  - nutrition
KW  - biomarkers
KW  - body composition
KW  - air displacement plethysmography
KW  - Baby Facial Actions Coding System
KW  - mother
KW  - infant
KW  - parenting
KW  - pediatrics
KW  - prenatal
KW  - postnatal
N2  - Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI?18.5 kg/m2 to ?30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants? reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26?066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 
UR  - https://www.researchprotocols.org/2022/4/e37279
UR  - http://dx.doi.org/10.2196/37279
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35475790
ID  - info:doi/10.2196/37279
ER  - 

TY  - JOUR
AU  - Rahman, Obaidur Md
AU  - Yamaji, Noyuri
AU  - Nagamatsu, Yasuko
AU  - Ota, Erika
PY  - 2022/4/22
TI  - Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis
JO  - J Med Internet Res
SP  - e34061
VL  - 24
IS  - 4
KW  - mobile health
KW  - ANC
KW  - skilled delivery care
KW  - LMICs
KW  - systematic review and meta-analysis
N2  - Background: The poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear. Objective: This review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs. Methods: We conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach. Results: A total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty). Conclusions: mHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses. Trial Registration: PROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7 
UR  - https://www.jmir.org/2022/4/e34061
UR  - http://dx.doi.org/10.2196/34061
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35451987
ID  - info:doi/10.2196/34061
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  - Zusman, Z. Enav
AU  - Lavu, Alekhya
AU  - Pawliuk, Colleen
AU  - Pawluski, Jodi
AU  - Hutchison, M. Sarah
AU  - Platt, W. Robert
AU  - Oberlander, F. Tim
PY  - 2022/3/28
TI  - Associations Between Prenatal Exposure to Serotonergic Medications and Biobehavioral Stress Regulation: Protocol for a Systematic Review and Meta-analysis
JO  - JMIR Res Protoc
SP  - e33363
VL  - 11
IS  - 3
KW  - pregnancy
KW  - serotonergic medications
KW  - antidepressants
KW  - stress regulation
KW  - systematic review
KW  - meta-analysis
N2  - Background: Up to 20% of mothers experience antenatal depression and approximately 30% of these women are treated with serotonergic psychotropic pharmacological therapy during pregnancy. Serotonergic antidepressants readily cross the placenta and the fetal blood-brain barrier, altering central synaptic serotonin signaling and potentially altering serotonin levels in the developing fetal brain. Objective: The aim of this study is to assess the impact of prenatal exposure to serotonergic antidepressants, accounting for maternal mood disturbances, on markers of stress regulation during childhood. Methods: We will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and will search MEDLINE, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov for full-length studies that assessed physiological (eg, cortisol level, heart rate variability, salivary amylase, pupillary size, C-reactive protein) indices of stress regulation in children of pregnant people who were treated with a serotonergic antidepressant at any point during pregnancy. We will assess the quality of observational studies using the Newcastle-Ottawa Scale and the quality of experimental studies using the Cochrane risk-of-bias tool. When possible, we will conduct a random-effects meta-analysis. If meta-analysis is not possible, we will conduct a narrative review. If a sufficient number of studies are found, we will perform subgroup analysis and assess outcomes measured by drug class, dose, trimester of exposure, and child?s age and gender. Results: We registered our review protocol with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021275750), completed the literature search, and initiated title and abstract review in August 2021. We expect to finalize this review by April 2022. Conclusions: Findings should identify the impact of prenatal antidepressant effects on stress regulation and distinguish it from the impact of prenatal exposure to maternal mood disturbances. This review should inform decisions about serotonergic antidepressant use during pregnancy. Trial Registration: PROSPERO CRD42021275750; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275750 International Registered Report Identifier (IRRID): PRR1-10.2196/33363 
UR  - https://www.researchprotocols.org/2022/3/e33363
UR  - http://dx.doi.org/10.2196/33363
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35343913
ID  - info:doi/10.2196/33363
ER  - 

TY  - JOUR
AU  - Zheng, Qishi
AU  - Shi, Luming
AU  - Zhu, Lixia
AU  - Jiao, Nana
AU  - Chong, Seng Yap
AU  - Chan, Wai-Chi Sally
AU  - Chan, Huak Yiong
AU  - Luo, Nan
AU  - Wang, Wenru
AU  - He, Honggu
PY  - 2022/3/11
TI  - Cost-effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-time Mothers: Economic Evaluation Alongside Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e25821
VL  - 24
IS  - 3
KW  - anxiety
KW  - cost-effectiveness
KW  - depression
KW  - first-time mother
KW  - home-based
KW  - postnatal
KW  - psychoeducational
KW  - self-efficacy
KW  - social support
KW  - web-based
N2  - Background: The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers? postnatal health outcomes, very limited studies have reported their cost-effectiveness. Objective: The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. Methods: A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care?s perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated. Results: The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively. Conclusions: The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support. Trial Registration: ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278 
UR  - https://www.jmir.org/2022/3/e25821
UR  - http://dx.doi.org/10.2196/25821
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35275078
ID  - info:doi/10.2196/25821
ER  - 

TY  - JOUR
AU  - Lok, YW Kris
AU  - Ko, WT Rachel
AU  - Fan, SL Heidi
AU  - Chau, PH
AU  - Wong, YH Janet
AU  - Wang, MP
AU  - Tsang, Vicky
PY  - 2022/3/9
TI  - Feasibility and Acceptability of an Online WhatsApp Support Group on Breastfeeding: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e32338
VL  - 11
IS  - 3
KW  - mHealth
KW  - breastfeeding
KW  - peer support
KW  - mobile health
KW  - parenting
KW  - instant messaging
KW  - online support
KW  - women's health
KW  - postpartum health
KW  - postpartum support
N2  - Background: Mobile health, the use of mobile technology in delivering health care, has been found to be effective in changing health behaviors, including improving breastfeeding practices in postpartum women. With the widespread use of smartphones and instant messaging apps in Hong Kong, instant messaging groups could be a useful channel for delivering breastfeeding peer support. Objective: The aim of this paper is to study the feasibility and acceptability of an online instant messaging peer support group by trained peer counselors on improving breastfeeding outcome in primiparous women in Hong Kong. Methods: A two-arm, assessor-blind, randomized controlled feasibility study will be conducted on 40 primiparous women with the intention to breastfeed. Participants are recruited from the antenatal obstetrics and gynecology clinic of a public hospital in Hong Kong and randomly assigned at a 1:1 ratio to either intervention or control group. The intervention group receives peer support in an online instant messaging group with trained peer counselors on top of standard care, whereas the control group receives standard care. Breastfeeding outcome will be assessed for 6 months post partum or until weaned. The breastfeeding status, the proportion and duration of exclusive and any breastfeeding in each group, and the self-efficacy and attitude of participants will be assessed. The feasibility and acceptability of the study would also be assessed in preparation for a full randomized controlled trial. Results: This study (protocol version 1 dated January 5, 2021) has been reviewed and approved by the institutional review board of the University of Hong Kong, Hospital Authority Hong Kong West Cluster (reference UW 21-039), on January 26, 2021. Data collection is ongoing and expected to be completed in December 2021. The findings will be updated on clinical trial registry and disseminated in peer-reviewed journals. Conclusions: This study aims to assess the feasibility and effectiveness of an online instant messaging peer support group in improving the breastfeeding outcome of primiparous women in Hong Kong. Its findings could inform the feasibility of a full-scale trial with this intervention design. Trial Registration: ClinicalTrials.gov NCT04826796; https://clinicaltrials.gov/ct2/show/NCT04826796 International Registered Report Identifier (IRRID): DERR1-10.2196/32338 
UR  - https://www.researchprotocols.org/2022/3/e32338
UR  - http://dx.doi.org/10.2196/32338
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35262504
ID  - info:doi/10.2196/32338
ER  - 

TY  - JOUR
AU  - Lu, Yu
AU  - Barrett, A. Laura
AU  - Lin, Z. Rebecca
AU  - Amith, Muhammad
AU  - Tao, Cui
AU  - He, Zhe
PY  - 2022/2/21
TI  - Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review
JO  - JMIR Pediatr Parent
SP  - e32235
VL  - 5
IS  - 1
KW  - pregnancy
KW  - information needs
KW  - ontology
KW  - systematic review
KW  - fertility
KW  - parenting
KW  - pregnancy information
KW  - online information
KW  - health database
N2  - Background: Understanding consumers? health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information. Objective: The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources. Methods: We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal. Results: A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers? pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships. Conclusions: Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available. 
UR  - https://pediatrics.jmir.org/2022/1/e32235
UR  - http://dx.doi.org/10.2196/32235
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35188477
ID  - info:doi/10.2196/32235
ER  - 

TY  - JOUR
AU  - Ando, Tomohisa
AU  - Mori, Rintaro
AU  - Takehara, Kenji
AU  - Asukata, Mari
AU  - Ito, Shuichi
AU  - Oka, Akira
PY  - 2022/2/17
TI  - Effectiveness of Pediatric Teleconsultation to Prevent Skin Conditions in Infants and Reduce Parenting Stress in Mothers: Randomized Controlled Trial
JO  - JMIR Pediatr Parent
SP  - e27615
VL  - 5
IS  - 1
KW  - teleconsultation
KW  - email newsletters
KW  - eHealth
KW  - pediatrician
KW  - infant
KW  - mother
KW  - atopic dermatitis
KW  - parenting stress
KW  - randomized controlled trial
KW  - stress
KW  - dermatitis
KW  - parenting
KW  - pediatrics
KW  - email
KW  - children
KW  - Japan
N2  - Background: In Japan, eHealth for infants and mothers is currently an important aspect, but its effectiveness has rarely been examined. For infants, skin problems, including atopic dermatitis (AD), which is known to lead to other allergic diseases, are one of the most common conditions. Mothers of infants are prone to experiencing parenting stress, which adversely affects mothers? and children?s well-being. Additionally, studies have reported that AD among offspring enhances parenting stress, and postnatal maternal psychological problems can increase the risk of AD in children. Objective: This study evaluated the effectiveness of pediatric teleconsultation for preventing AD in infants and reducing parenting stress in mothers in Japan. Methods: The study was an open-label, randomized, parallel-armed controlled trial. In total, 318 pairs of infants and mothers in the Yokohama City Sakae Ward were recruited when they submitted birth cards to the ward, received the explanation about the trial, and provided informed consent on the website for this trial. Eligible pairs of infants and mothers were randomly assigned to the intervention group (n=140) or the control group (n=138). Participants in the intervention and control groups received routine postnatal care from local government services. In addition, participants in the intervention group had the option to combine routine pediatric services with teleconsultation and email newsletters without charge from the date of registration until the infant turned 4 months. Primary outcomes were (1) the prevalence of AD in infants diagnosed based on the United Kingdom Working Party criteria and (2) parenting stress and mental status of mothers assessed using the Parenting Stress Index-Short Form (PSI-SF) and General Health Questionnaire-12 (GHQ-12). Data were collected by the ward office staff and researcher during the 4-month checkup. Results: The prevalence of AD in infants was significantly lower in the intervention group than in the control group during the 4-month checkup (20% vs 33%, P=.02; relative risk ratio, 0.709 [95% CI 0.519-0.969]). No significant differences were observed in the PSI-SF and GHQ-12 scores between the 2 groups. There was a significant difference in the prevalence of AD between participants who used teleconsultation services and email newsletters, participants who did not use teleconsultation services but received email newsletters, and participants who neither received nor used either service (18% vs 22% vs 33%, P=.048). Conclusions: This is the first randomized controlled trial demonstrating that routine pediatric care combined with teleconsultation and email newsletters was effective in reducing the prevalence of AD in infants. The findings highlight the potential of pediatric eHealth to become a useful new strategy for preventing AD. Trial Registration: University Hospital Medical Information Network ClinicalTrials Registry UMIN000029774; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034022 
UR  - https://pediatrics.jmir.org/2022/1/e27615
UR  - http://dx.doi.org/10.2196/27615
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34678753
ID  - info:doi/10.2196/27615
ER  - 

TY  - JOUR
AU  - Gonzalez-Plaza, Elena
AU  - Bellart, Jordi
AU  - Arranz, Ángela
AU  - Luján-Barroso, Leila
AU  - Crespo Mirasol, Esther
AU  - Seguranyes, Gloria
PY  - 2022/2/15
TI  - Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e28886
VL  - 10
IS  - 2
KW  - obesity
KW  - maternal
KW  - pregnancy
KW  - mHealth
KW  - mobile apps
KW  - telemedicine
KW  - telenursing
KW  - physical activity
KW  - gestational weight gain
KW  - lifestyle
KW  - mobile phone
N2  - Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire?Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI ?0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks?minutes per week vs 1386 metabolic equivalents of tasks?minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 
UR  - https://mhealth.jmir.org/2022/2/e28886
UR  - http://dx.doi.org/10.2196/28886
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35166684
ID  - info:doi/10.2196/28886
ER  - 

TY  - JOUR
AU  - Sowon, Karen
AU  - Maliwichi, Priscilla
AU  - Chigona, Wallace
PY  - 2022/1/27
TI  - The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review
JO  - JMIR Mhealth Uhealth
SP  - e22093
VL  - 10
IS  - 1
KW  - human-technology interaction
KW  - maternal health
KW  - mHealth
KW  - mobile phone
KW  - utilization
KW  - Kenya
N2  - Background: The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective: This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods: Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results: A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions: In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness. 
UR  - https://mhealth.jmir.org/2022/1/e22093
UR  - http://dx.doi.org/10.2196/22093
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35084356
ID  - info:doi/10.2196/22093
ER  - 

TY  - JOUR
AU  - Zhang, Puhong
AU  - Chen, Huan
AU  - Shang, Jie
AU  - Ge, Jun
AU  - Zhang, Huichen
AU  - Xu, Mingjun
AU  - Bian, Cui
AU  - Zhao, Yang
AU  - Chen, Minyuan
AU  - Hirst, Elizabeth Jane
PY  - 2022/1/25
TI  - Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study
JO  - JMIR Form Res
SP  - e29644
VL  - 6
IS  - 1
KW  - maternal and child health
KW  - mHealth
KW  - mobile apps
KW  - retrospective study
KW  - pregnancy outcomes
N2  - Background: Maternal and child health (MCH)?related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks? gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women?s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. 
UR  - https://formative.jmir.org/2022/1/e29644
UR  - http://dx.doi.org/10.2196/29644
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35076402
ID  - info:doi/10.2196/29644
ER  - 

TY  - JOUR
AU  - Ariff, Shabina
AU  - Maznani, Ikram
AU  - Bhura, Maria
AU  - Memon, Zahid
AU  - Arshad, Tayyaba
AU  - Samejo, Ahmed Tariq
AU  - Zaidi, Shujaat
AU  - Umer, Muhammad
AU  - Ahmed, Imran
AU  - Habib, Atif Muhammad
AU  - Soofi, Bashir Sajid
AU  - Bhutta, A. Zulfiqar
PY  - 2022/1/7
TI  - Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study
JO  - JMIR Form Res
SP  - e30663
VL  - 6
IS  - 1
KW  - kangaroo mother care
KW  - low birth weight
KW  - neonatal mortality formative research
KW  - Pakistan
KW  - newborn care
N2  - Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant?s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice. 
UR  - https://formative.jmir.org/2022/1/e30663
UR  - http://dx.doi.org/10.2196/30663
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34994692
ID  - info:doi/10.2196/30663
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Tan, Chye Thiam
AU  - 
AU  - Mathews, Jancy
AU  - Yu, Yan Chun
AU  - Lim, Hoon Siew
AU  - Shi, Luming
AU  - Ng, Debby Esperanza
AU  - Chan, Huak Yiong
AU  - Law, Evelyn
AU  - Chee, Cornelia
AU  - Chong, Seng Yap
PY  - 2021/12/24
TI  - Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study
JO  - J Med Internet Res
SP  - e27033
VL  - 23
IS  - 12
KW  - depression
KW  - development
KW  - education
KW  - parent
KW  - perinatal
KW  - support
KW  - telehealth
KW  - mobile phone
N2  - Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child?s development. Given the rise in technology and parents? preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles?the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. 
UR  - https://www.jmir.org/2021/12/e27033
UR  - http://dx.doi.org/10.2196/27033
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36260376
ID  - info:doi/10.2196/27033
ER  - 

TY  - JOUR
AU  - Kavanagh, John David
AU  - Connolly, Jennifer
AU  - Fisher, Jane
AU  - Halford, Kim W.
AU  - Hamilton, Kyra
AU  - Hides, Leanne
AU  - Milgrom, Jeannette
AU  - Rowe, Heather
AU  - Scuffham, A. Paul
AU  - White, M. Katherine
AU  - Wittkowski, Anja
AU  - Appleton, Shelley
AU  - Sanders, Davina
PY  - 2021/11/26
TI  - The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e23659
VL  - 23
IS  - 11
KW  - perinatal
KW  - depression
KW  - prevention
KW  - men
KW  - self-guided
KW  - internet
N2  - Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks? gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples? randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ?50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 
UR  - https://www.jmir.org/2021/11/e23659
UR  - http://dx.doi.org/10.2196/23659
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34842534
ID  - info:doi/10.2196/23659
ER  - 

TY  - JOUR
AU  - Barrera, Z. Alinne
AU  - Hamil, Jaime
AU  - Tandon, Darius
PY  - 2021/11/18
TI  - Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study
JO  - JMIR Form Res
SP  - e30995
VL  - 5
IS  - 11
KW  - perinatal mental health
KW  - postpartum depression
KW  - public health
KW  - SMS
KW  - technology
N2  - Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors? adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants? usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 
UR  - https://formative.jmir.org/2021/11/e30995
UR  - http://dx.doi.org/10.2196/30995
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34792478
ID  - info:doi/10.2196/30995
ER  - 

TY  - JOUR
AU  - Nuruddin, Rozina
AU  - Vadsaria, Khadija
AU  - Mohammed, Nuruddin
AU  - Sayani, Saleem
PY  - 2021/11/16
TI  - The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e31611
VL  - 10
IS  - 11
KW  - coaching
KW  - compliance
KW  - diet
KW  - maternal health
KW  - mobile health
KW  - offspring health
KW  - physical activity
KW  - pregnancy
KW  - supplement use
KW  - usability
N2  - Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program?s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We  expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 
UR  - https://www.researchprotocols.org/2021/11/e31611
UR  - http://dx.doi.org/10.2196/31611
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34783675
ID  - info:doi/10.2196/31611
ER  - 

TY  - JOUR
AU  - Chin, Samuel
AU  - Carlin, Rebecca
AU  - Mathews, Anita
AU  - Moon, Rachel
PY  - 2021/11/15
TI  - Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study
JO  - JMIR Pediatr Parent
SP  - e27297
VL  - 4
IS  - 4
KW  - sleep position
KW  - bed-sharing
KW  - social norms
KW  - social media
KW  - safe sleep
KW  - bedding
N2  - Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of ?likes? for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of ?likes? for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of ?likes? was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. 
UR  - https://pediatrics.jmir.org/2021/4/e27297
UR  - http://dx.doi.org/10.2196/27297
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34779783
ID  - info:doi/10.2196/27297
ER  - 

TY  - JOUR
AU  - Soltys, Coyle Frank
AU  - Spilo, Kimi
AU  - Politi, C. Mary
PY  - 2021/10/19
TI  - The Content and Quality of Publicly Available Information About Congenital Diaphragmatic Hernia: Descriptive Study
JO  - JMIR Pediatr Parent
SP  - e30695
VL  - 4
IS  - 4
KW  - congenital diaphragmatic hernia
KW  - prenatal counseling
KW  - fetal care
KW  - online information
KW  - parental decision making
N2  - Background: Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making. Objective: We aimed to examine the content and quality of publicly available, internet-based CDH information. Methods: We conducted internet searches across 2 popular search engines (Google and Bing). Websites were included if they contained CDH information and were publicly available. We developed a coding instrument to evaluate websites. Two coders (FS and KS) were trained, achieved interrater reliability, and rated remaining websites independently. Descriptive statistics were performed. Results: Searches yielded 520 websites; 91 met inclusion criteria and were analyzed. Most websites provided basic CDH information including describing the defect (86/91, 95%), need for neonatal intensive care (77/91, 85%), and surgical correction (79/91, 87%). Few mentioned palliative care, decisions about pregnancy termination (13/91, 14%), or support resources (21/91, 23%). Conclusions: Findings highlight the variability of information about CDH on the internet. Clinicians should work to develop or identify reliable, comprehensive information about CDH to support parents. 
UR  - https://pediatrics.jmir.org/2021/4/e30695
UR  - http://dx.doi.org/10.2196/30695
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34665147
ID  - info:doi/10.2196/30695
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  - Myhre, Leren Enid
AU  - Garnweidner-Holme, Lisa
AU  - Dahl, Bente
AU  - Reigstad, Myhre Marte
AU  - Lukasse, Mirjam
PY  - 2021/9/27
TI  - Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study
JO  - JMIR Form Res
SP  - e28698
VL  - 5
IS  - 9
KW  - early labor
KW  - latent phase
KW  - think aloud
KW  - usability
KW  - website
KW  - labor
KW  - pregnancy
KW  - user-friendliness
KW  - eHealth
KW  - user satisfaction
N2  - Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users? experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website?s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants? feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants? experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website?s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. 
UR  - https://formative.jmir.org/2021/9/e28698
UR  - http://dx.doi.org/10.2196/28698
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34569940
ID  - info:doi/10.2196/28698
ER  - 

TY  - JOUR
AU  - Levey, J. Elizabeth
AU  - Onyeaka, Henry
AU  - Bartles, M. Sophia
AU  - Sanchez Calderon, Elena
AU  - Sanchez, E. Sixto
AU  - Prom, C. Maria
AU  - Fesseha, M. Eden
AU  - Gelaye, Bizu
PY  - 2021/9/17
TI  - Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study
JO  - JMIR Pediatr Parent
SP  - e30240
VL  - 4
IS  - 3
KW  - access to care
KW  - adolescent motherhood
KW  - LMICs
KW  - mobile phone
KW  - perinatal mental health
KW  - telehealth
N2  - Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. 
UR  - https://pediatrics.jmir.org/2021/3/e30240
UR  - http://dx.doi.org/10.2196/30240
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34533473
ID  - info:doi/10.2196/30240
ER  - 

TY  - JOUR
AU  - Gewali, Anupa
AU  - Lopez, Alana
AU  - Dachelet, Kristin
AU  - Healy, Elise
AU  - Jean-Baptiste, Marimirca
AU  - Harridan, Holly
AU  - Evans, Yolanda
AU  - Unger, A. Jennifer
AU  - Bhat, Amritha
AU  - Tandon, Darius
AU  - Ronen, Keshet
PY  - 2021/9/15
TI  - A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design
JO  - JMIR Ment Health
SP  - e26188
VL  - 8
IS  - 9
KW  - depression
KW  - mental health
KW  - perinatal
KW  - pregnancy
KW  - postpartum
KW  - adolescent
KW  - youth
KW  - social media
KW  - group
KW  - mobile phone
N2  - Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths? mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. 
UR  - https://mental.jmir.org/2021/9/e26188
UR  - http://dx.doi.org/10.2196/26188
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34524086
ID  - info:doi/10.2196/26188
ER  - 

TY  - JOUR
AU  - Tzilos Wernette, Golfo
AU  - Countryman, Kristina
AU  - Mmeje, Okeoma
AU  - Ngo, M. Quyen
AU  - Zlotnick, Caron
PY  - 2021/9/10
TI  - Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes
JO  - JMIR Res Protoc
SP  - e30367
VL  - 10
IS  - 9
KW  - COVID-19
KW  - pregnancy
KW  - COVID-19 pandemic
KW  - alcohol use
KW  - drug use
KW  - sexually transmitted infections
KW  - technology-delivered interventions
N2  - Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 
UR  - https://www.researchprotocols.org/2021/9/e30367
UR  - http://dx.doi.org/10.2196/30367
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34351867
ID  - info:doi/10.2196/30367
ER  - 

TY  - JOUR
AU  - Wu, Y. Jania J.
AU  - Ahmad, Nurulhuda
AU  - Samuel, Miny
AU  - Logan, Susan
AU  - Mattar, Z. Citra N.
PY  - 2021/8/26
TI  - The Influence of Web-Based Tools on Maternal and Neonatal Outcomes in Pregnant Adolescents or Adolescent Mothers: Mixed Methods Systematic Review
JO  - J Med Internet Res
SP  - e26786
VL  - 23
IS  - 8
KW  - pregnancy in adolescence
KW  - teenagers
KW  - adolescents
KW  - pregnancy
KW  - postpartum
KW  - internet
KW  - digital health
KW  - digital media
KW  - new digital media
KW  - eHealth
KW  - social media
KW  - social network
KW  - communications media
N2  - Background: Pregnant adolescent women increasingly seek support during pregnancy and the puerperium through digital platforms instead of the traditional support system of family, friends, and the community. However, it is uncertain whether digital, web-based tools are reliable and effective in providing information to the user on a variety of topics such as fetal development, pregnancy outcomes, delivery, and breastfeeding to improve maternal and infant outcomes. Objective: We aimed to identify web-based tools designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers and determine the efficacy of such web-based tools compared with conventional resources in promoting good pregnancy and infant outcomes. Methods: A systematic search was conducted using Medline, Scopus, CINAHL, and PsycINFO for articles published from January 2004 to November 2020 to identify randomized trials and observational studies that evaluated digital, web-based platforms to deliver resources to pregnant adolescents. All articles written in the author?s languages were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. Risk of bias in each study was assessed using appropriate tools recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and the Joanna Briggs Institute. We adopted a qualitative synthesis and presented the results in a narrative format due to the heterogenous nature of the studies. Results: Seven articles met the inclusion criteria and were analyzed. The majority of the studies were graded to be of low to moderate risk for bias. The research methodologies represented were varied, ranging from randomized (n=1) and nonrandomized controlled trials (n=1) and prospective cohort studies (n=1) to mixed methods studies (n=1) and longitudinal surveys (n=3). Four studies included active web-based interventions, and 3 described exposure to web-based tools, including the use of social media and/or other internet content. Web-based tools positively influenced treatment-seeking intentions (intervention 17.1%, control 11.5%, P=.003) and actual treatment-seeking behavior for depression among postpartum adolescents (intervention 14.1%, control 6.5%, P<.001). In contrast, readily available information on the internet may leave adolescents with increased anxiety. The critical difference lies in information curated by health care professionals specifically to address targeted concerns versus self-acquired data sourced from various websites. Conclusions: Despite almost universal web use, few studies have used this platform for health promotion and disease prevention. Social media interventions or web-based tools have the potential to positively influence both maternal and infant outcomes in adolescent pregnancy, but there is a need for more well-conducted studies to demonstrate the effectiveness of these support programs. The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. Thus, it is important to create professionally curated platforms to prevent or limit exposure to potentially misleading or harmful information on the internet while imparting useful knowledge to the user. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195854; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195854 
UR  - https://www.jmir.org/2021/8/e26786
UR  - http://dx.doi.org/10.2196/26786
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34435961
ID  - info:doi/10.2196/26786
ER  - 

TY  - JOUR
AU  - Baggett, M. Kathleen
AU  - Davis, Betsy
AU  - Sheeber, Lisa
AU  - Miller, Katy
AU  - Leve, Craig
AU  - Mosley, A. Elizabeth
AU  - Landry, H. Susan
AU  - Feil, G. Edward
PY  - 2021/8/18
TI  - Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting
JO  - JMIR Res Protoc
SP  - e31072
VL  - 10
IS  - 8
KW  - maternal depression
KW  - parenting
KW  - infant social-emotional and social-communication development
KW  - mobile intervention
KW  - remote coaching
KW  - trial protocol
KW  - mobile phone
N2  - Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)?approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 
UR  - https://www.researchprotocols.org/2021/8/e31072
UR  - http://dx.doi.org/10.2196/31072
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34406122
ID  - info:doi/10.2196/31072
ER  - 

TY  - JOUR
AU  - Swain, Dharitri
AU  - Begum, Jasmina
AU  - Parida, Prangnan Swayam
PY  - 2021/8/16
TI  - Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e28148
VL  - 10
IS  - 8
KW  - preconception care
KW  - maternal nutritional status
KW  - birth outcome
KW  - paternal preconception health
KW  - childbirth
KW  - birth outcomes
KW  - maternal and child health
KW  - maternal health
KW  - maternal and child nutrition
KW  - health education
KW  - pediatrics
N2  - Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India?s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry?India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 
UR  - https://www.researchprotocols.org/2021/8/e28148
UR  - http://dx.doi.org/10.2196/28148
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34398798
ID  - info:doi/10.2196/28148
ER  - 

TY  - JOUR
AU  - Brunelli, Laura
AU  - De Vita, Chiara
AU  - Cenedese, Fabrizio
AU  - Cinello, Michela
AU  - Paris, Marta
AU  - Samogizio, Francesca
AU  - Starec, Anja
AU  - Bava, Michele
AU  - Dal Cin, Margherita
AU  - Zanchiello, Sara
AU  - Stampalija, Tamara
PY  - 2021/8/10
TI  - Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores
JO  - J Med Internet Res
SP  - e29151
VL  - 23
IS  - 8
KW  - pregnancy
KW  - postnatal care
KW  - app
KW  - mHealth
KW  - mobile health
KW  - newborn
N2  - Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children?s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health?related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. 
UR  - https://www.jmir.org/2021/8/e29151
UR  - http://dx.doi.org/10.2196/29151
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34383668
ID  - info:doi/10.2196/29151
ER  - 

TY  - JOUR
AU  - Ariff, Shabina
AU  - Habib, Atif
AU  - Memon, Zahid
AU  - Arshad, Tayyaba
AU  - Samejo, Tariq
AU  - Maznani, Ikram
AU  - Umer, Muhammad
AU  - Hussain, Amjad
AU  - Rizvi, Arjumand
AU  - Ahmed, Imran
AU  - Soofi, Bashir Sajid
AU  - Bhutta, A. Zulfiqar
PY  - 2021/8/10
TI  - Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e28156
VL  - 10
IS  - 8
KW  - community kangaroo mother care
KW  - low birth weight
KW  - KMC champions
KW  - neonatal mortality
KW  - RCT protocol
KW  - Pakistan
N2  - Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. Objective: The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. Methods: We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. Results: The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. Conclusions: This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. Trial Registration: clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204 International Registered Report Identifier (IRRID): DERR1-10.2196/28156 
UR  - https://www.researchprotocols.org/2021/8/e28156
UR  - http://dx.doi.org/10.2196/28156
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34170839
ID  - info:doi/10.2196/28156
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  - Lee, Kyong-No
AU  - Joo, Ji Yeon
AU  - Choi, Yeon So
AU  - Park, Taek Sung
AU  - Lee, Keun-Young
AU  - Kim, Youngmi
AU  - Son, Ga-Hyun
PY  - 2021/7/30
TI  - Content Analysis and Quality Evaluation of Cesarean Delivery?Related Videos on YouTube: Cross-sectional Study
JO  - J Med Internet Res
SP  - e24994
VL  - 23
IS  - 7
KW  - cesarean delivery
KW  - YouTube
KW  - internet
KW  - quality of information
N2  - Background: YouTube is one of the most popular open-access video-sharing websites, and it is also used to obtain health care information. Cesarean delivery is the most common major surgical intervention in many countries. Videos related to cesarean delivery have also been uploaded to YouTube. However, no study has explored the overall quality of cesarean delivery videos on the platform. Objective: The objective of this study was to analyze the content and evaluate the quality of the most frequently viewed videos related to cesarean delivery that are accessible on YouTube. Methods: We searched for a total of 18 terms by combining the 6 terms retrieved from Google AdWords and the 3 terms c section, cesarean section, and cesarean delivery, which are used interchangeably. Videos were sorted by view count, and the 100 videos with the highest view counts were chosen. The number of views, duration, likes and dislikes, content type, and source of each video were recorded. In evaluating the quality of the videos, we referred to a previous study. Additionally, we developed a detailed scoring method that comprehensively evaluates the videos related to cesarean delivery by including the necessary information for each element of the cesarean delivery and whether scientific evidence was presented. Results: Of the 100 videos analyzed, the most prevalent content (n=28) was videos that contained the actual surgical procedure of a cesarean delivery, and the most common source of cesarean delivery videos was physicians (n=30). Videos directly related to cesarean delivery, such as explanation of the surgery and the actual surgical procedure, were mainly uploaded by medical groups and scored higher than the videos indirectly related to cesarean delivery, which were mainly uploaded by nonmedical groups. In addition, videos directly related to cesarean delivery were more often uploaded earlier in time, with lower like ratios compared to indirect videos. Conclusions: YouTube is currently not an appropriate source for patients seeking information on cesarean delivery. 
UR  - https://www.jmir.org/2021/7/e24994
UR  - http://dx.doi.org/10.2196/24994
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34328422
ID  - info:doi/10.2196/24994
ER  - 

TY  - JOUR
AU  - Chivers, R. Bonnie
AU  - Garad, M. Rhonda
AU  - Moran, J. Lisa
AU  - Lim, Siew
AU  - Harrison, L. Cheryce
PY  - 2021/7/15
TI  - Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups
JO  - J Med Internet Res
SP  - e26600
VL  - 23
IS  - 7
KW  - pregnancy
KW  - perinatal
KW  - maternal
KW  - postpartum
KW  - infant
KW  - social support
KW  - qualitative
KW  - health
KW  - online
N2  - Background: The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time. Objective: This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed. Methods: A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines. Results: In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes. Conclusions: Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices. 
UR  - https://www.jmir.org/2021/7/e26600
UR  - http://dx.doi.org/10.2196/26600
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34264198
ID  - info:doi/10.2196/26600
ER  - 

TY  - JOUR
AU  - Pavuluri, Haritha
AU  - Grant, Alicia
AU  - Hartman, Alexander
AU  - Fowler, Lauren
AU  - Hudson, Jennifer
AU  - Springhart, Patrick
AU  - Kennedy, Blair Ann
PY  - 2021/6/15
TI  - Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother?Baby Unit: Retrospective Study
JO  - JMIR Pediatr Parent
SP  - e18830
VL  - 4
IS  - 2
KW  - technology
KW  - handheld computers
KW  - workflow
KW  - education
KW  - newborn
KW  - head trauma
N2  - Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother?baby unit resulted in improved rates of parents? acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother?baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (?=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother?baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother?baby unit. 
UR  - https://pediatrics.jmir.org/2021/2/e18830
UR  - http://dx.doi.org/10.2196/18830
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34128809
ID  - info:doi/10.2196/18830
ER  - 

TY  - JOUR
AU  - Stoodley, Cathy
AU  - McKellar, Lois
AU  - Ziaian, Tahereh
AU  - Steen, Mary
AU  - Gwilt, Ian
AU  - Fereday, Jenny
PY  - 2021/6/10
TI  - Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e29770
VL  - 10
IS  - 6
KW  - mother-infant relationship
KW  - mother-infant relations
KW  - mother-infant bonding
KW  - infant development
KW  - midwife
KW  - early postnatal
KW  - co-design
KW  - mixed methods
N2  - Background: The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective: The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods: This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results: Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions: The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period. 
UR  - https://www.researchprotocols.org/2021/6/e29770
UR  - http://dx.doi.org/10.2196/29770
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34110301
ID  - info:doi/10.2196/29770
ER  - 

TY  - JOUR
AU  - Wright, Lynn Amy
AU  - VanEvery, Rachel
AU  - Miller, Vicky
PY  - 2021/5/21
TI  - Indigenous Mothers? Use of Web- and App-Based Information Sources to Support Healthy Parenting and Infant Health in Canada: Interpretive Description
JO  - JMIR Pediatr Parent
SP  - e16145
VL  - 4
IS  - 2
KW  - Indigenous health
KW  - infant health
KW  - mothers
KW  - parenting
KW  - qualitative research
KW  - health education
KW  - health services accessibility
KW  - mobile phone
N2  - Background: Web-based sources of health information are widely used by parents to support healthy parenting and aid in decision making about their infants? health. Although fraught with challenges such as misinformation, if used appropriately, web-based resources can improve access to health education and promote healthy choices. How Indigenous mothers use web-based information to support their parenting and infants? health has not yet been investigated; however, web-based modalities may be important methods for mitigating the reduced access to health care and negative health care interactions that many Indigenous people are known to experience. Objective: This study aims to understand the experience of Indigenous mothers who use web-based information to support the health of their infants. Methods: This interpretive description qualitative study used semistructured interviews and a discussion group to understand how Indigenous mothers living in Hamilton, Ontario and caring for an infant aged <2 years experienced meeting the health needs of their infants. The data presented reflect their experiences of using web-based sources of health information to support their infants? health. The Two-Eyed Seeing approach was applied to the study design, which ensured that both western and Indigenous worldviews were considered throughout. Results: A total of 19 Indigenous mothers participated in this study. The resulting 4 themes included distrusting information, staying anonymous, using visual information to support decision making, and accessing a world of experiences. Although fewer Indigenous mothers used web-based sources of information compared to mothers in the general population in other studies, tailoring web-based modalities to meet the unique needs of Indigenous mothers is an important opportunity for supporting the health and wellness of both mothers and infants. Conclusions: Web-based information sources are commonly used among parents, and ever-evolving web-based technologies make this information increasingly available and accessible. Tailoring web-based modalities to meet the unique preferences and needs of Indigenous mothers is an important method for improving their access to reliable and accurate health care information, thereby supporting healthy parenting and promoting infant health. 
UR  - https://pediatrics.jmir.org/2021/2/e16145
UR  - http://dx.doi.org/10.2196/16145
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34018489
ID  - info:doi/10.2196/16145
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  - Scott, Anne Jane
AU  - Burns, K. Sharyn
AU  - Hauck, L. Yvonne
AU  - Giglia, C. Roslyn
AU  - Jorgensen, M. Anita
AU  - White, Kate Becky
AU  - Martin, Annegret
AU  - Robinson, Suzanne
AU  - Dhaliwal, S. Satvinder
AU  - Binns, W. Colin
AU  - Maycock, R. Bruce
PY  - 2021/4/12
TI  - Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial
JO  - JMIR Pediatr Parent
SP  - e24579
VL  - 4
IS  - 2
KW  - breastfeeding
KW  - fathers
KW  - peer support
KW  - mHealth, smartphone app
KW  - infants
KW  - social support
KW  - feeding
KW  - smartphone
N2  - Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant?s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 
UR  - https://pediatrics.jmir.org/2021/2/e24579
UR  - http://dx.doi.org/10.2196/24579
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33843604
ID  - info:doi/10.2196/24579
ER  - 

TY  - JOUR
AU  - Dol, Justine
AU  - Aston, Megan
AU  - McMillan, Douglas
AU  - Tomblin Murphy, Gail
AU  - Campbell-Yeo, Marsha
PY  - 2021/3/25
TI  - Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e27138
VL  - 10
IS  - 3
KW  - text message
KW  - mobile health
KW  - postpartum education
KW  - self-efficacy
KW  - social support
KW  - postpartum anxiety
KW  - postpartum depression
N2  - Background: Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. Objective: The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. Methods: This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant?s age and the woman?s self-selected preference for breastfeeding or formula feeding and tailored with the infant?s name and gender. Women can enroll in the program if they are ?37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant?s date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. Results: Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. Conclusions: This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 International Registered Report Identifier (IRRID): DERR1-10.2196/27138 
UR  - https://www.researchprotocols.org/2021/3/e27138
UR  - http://dx.doi.org/10.2196/27138
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33764309
ID  - info:doi/10.2196/27138
ER  - 

TY  - JOUR
AU  - de Jersey, Susan
AU  - Meloncelli, Nina
AU  - Guthrie, Taylor
AU  - Powlesland, Hilary
AU  - Callaway, Leonie
AU  - Chang, T. Angela
AU  - Wilkinson, Shelley
AU  - Comans, Tracy
AU  - Eakin, Elizabeth
PY  - 2021/3/18
TI  - Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study
JO  - JMIR Res Protoc
SP  - e27196
VL  - 10
IS  - 3
KW  - implementation study
KW  - pregnancy
KW  - weight
KW  - nutrition
KW  - lifestyle intervention
KW  - physical activity
N2  - Background: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective: This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods: Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ?16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks? gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results: Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions: This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID): DERR1-10.2196/27196 
UR  - https://www.researchprotocols.org/2021/3/e27196
UR  - http://dx.doi.org/10.2196/27196
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33734093
ID  - info:doi/10.2196/27196
ER  - 

TY  - JOUR
AU  - Glassman, Jill
AU  - Humphreys, Kathryn
AU  - Yeung, Serena
AU  - Smith, Michelle
AU  - Jauregui, Adam
AU  - Milstein, Arnold
AU  - Sanders, Lee
PY  - 2021/3/15
TI  - Parents? Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey
JO  - J Med Internet Res
SP  - e19461
VL  - 23
IS  - 3
KW  - parenting
KW  - digital technology
KW  - mobile phone
KW  - child development
KW  - artificial intelligence
N2  - Background: Parents? use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)?based tools that help with mitigating technoference. Objective: This study aims to assess parents? awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors. Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ?5 years. Parents? perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income). Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements ?I am worried about the impact of my mobile electronic device use on my child? and ?Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving? (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents? perceived technoference and sociodemographic factors, parents? perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools. Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful. 
UR  - https://www.jmir.org/2021/3/e19461
UR  - http://dx.doi.org/10.2196/19461
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33720026
ID  - info:doi/10.2196/19461
ER  - 

TY  - JOUR
AU  - Ariff, Shabina
AU  - Soofi, Sajid
AU  - Aamir, Almas
AU  - D'Almeida, Michelle
AU  - Aziz Ali, Arzina
AU  - Alam, Ashraful
AU  - Dibley, Michael
PY  - 2021/3/11
TI  - Bovine Lactoferrin to Prevent Neonatal Infections in Low-Birth-Weight Newborns in Pakistan: Protocol for a Three-Arm Double-Blind Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e23994
VL  - 10
IS  - 3
KW  - bovine lactoferrin
KW  - low birth weight
KW  - sepsis
KW  - human milk
KW  - premature
KW  - mortality
N2  - Background: Sepsis is a common and severe complication in premature neonates, particularly those born with low birth weights (<2500 g). Neonatal sepsis is steadily emerging as a leading cause of neonatal mortality in Pakistan. Lactoferrin is a natural product with broad-spectrum antimicrobial properties and glycoprotein that is actively involved in innate immune host responses. Clinical trials have revealed its protective effect on sepsis, but lactoferrin dosage, duration, and role in the prevention of sepsis are still uncertain. Objective: We aimed to establish the efficacy of bovine lactoferrin in the prevention of late-onset sepsis and to determine the optimal dose and method of administering bovine lactoferrin that may contribute to improvement in overall survival of low birth weight infants. Methods: We will implement the study in 2 phases at the Aga Khan University Hospital. The first phase, which we have completed, was formative research. This phase mainly focused on a qualitative exploration of perceptions about feeding and caring practices of low birth weight newborns and a trial of improved practices for the preparation and administration of bovine lactoferrin to newborns. The second phase is a 3-arm double-blind randomized controlled trial. In this phase, we randomly allocated 2 different daily oral prophylactic doses of bovine lactoferrin (150 mg or 300 mg) and placebo to 300 low?birth weight neonates starting within the first 72 hours of birth and continuing for the first 28 days of life. Results: The study protocol was approved by the Ethics Review Committee of Aga Khan University on August 16, 2017. Data collection began in April 2018 and was completed in September 2020. Data analyses are yet to be completed. We expect the results to be published in peer-reviewed journals by autumn of 2021. Conclusions: This intervention, if effective, has the potential to be translated into a safe, affordable, and widely utilized treatment to prevent sepsis and, subsequently, may improve the survival outcomes of low birth weight neonates in Pakistan and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03431558; https://clinicaltrials.gov/ct2/show/NCT03431558 International Registered Report Identifier (IRRID): PRR1-10.2196/23994 
UR  - https://www.researchprotocols.org/2021/3/e23994
UR  - http://dx.doi.org/10.2196/23994
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33704071
ID  - info:doi/10.2196/23994
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  - Chung, Kyungmi
AU  - Cho, Young Hee
AU  - Park, Young Jin
PY  - 2021/3/3
TI  - A Chatbot for Perinatal Women?s and Partners? Obstetric and Mental Health Care: Development and Usability Evaluation Study
JO  - JMIR Med Inform
SP  - e18607
VL  - 9
IS  - 3
KW  - chatbot
KW  - mobile phone
KW  - instant messaging
KW  - mobile health
KW  - perinatal care
KW  - usability
KW  - user experience
KW  - usability testing
N2  - Background: To motivate people to adopt medical chatbots, the establishment of a specialized medical knowledge database that fits their personal interests is of great importance in developing a chatbot for perinatal care, particularly with the help of health professionals. Objective: The objectives of this study are to develop and evaluate a user-friendly question-and-answer (Q&A) knowledge database?based chatbot (Dr. Joy) for perinatal women?s and their partners? obstetric and mental health care by applying a text-mining technique and implementing contextual usability testing (UT), respectively, thus determining whether this medical chatbot built on mobile instant messenger (KakaoTalk) can provide its male and female users with good user experience. Methods: Two men aged 38 and 40 years and 13 women aged 27 to 43 years in pregnancy preparation or different pregnancy stages were enrolled. All participants completed the 7-day-long UT, during which they were given the daily tasks of asking Dr. Joy at least 3 questions at any time and place and then giving the chatbot either positive or negative feedback with emoji, using at least one feature of the chatbot, and finally, sending a facilitator all screenshots for the history of the day?s use via KakaoTalk before midnight. One day after the UT completion, all participants were asked to fill out a questionnaire on the evaluation of usability, perceived benefits and risks, intention to seek and share health information on the chatbot, and strengths and weaknesses of its use, as well as demographic characteristics. Results: Despite the relatively higher score of ease of learning (EOL), the results of the Spearman correlation indicated that EOL was not significantly associated with usefulness (?=0.26; P=.36), ease of use (?=0.19; P=.51), satisfaction (?=0.21; P=.46), or total usability scores (?=0.32; P=.24). Unlike EOL, all 3 subfactors and the total usability had significant positive associations with each other (all ?>0.80; P<.001). Furthermore, perceived risks exhibited no significant negative associations with perceived benefits (?=?0.29; P=.30) or intention to seek (SEE; ?=?0.28; P=.32) or share (SHA; ?=?0.24; P=.40) health information on the chatbot via KakaoTalk, whereas perceived benefits exhibited significant positive associations with both SEE and SHA. Perceived benefits were more strongly associated with SEE (?=0.94; P<.001) than with SHA (?=0.70; P=.004). Conclusions: This study provides the potential for the uptake of this newly developed Q&A knowledge database?based KakaoTalk chatbot for obstetric and mental health care. As Dr. Joy had quality contents with both utilitarian and hedonic value, its male and female users could be encouraged to use medical chatbots in a convenient, easy-to-use, and enjoyable manner. To boost their continued usage intention for Dr. Joy, its Q&A sets need to be periodically updated to satisfy user intent by monitoring both male and female user utterances. 
UR  - https://medinform.jmir.org/2021/3/e18607
UR  - http://dx.doi.org/10.2196/18607
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33656442
ID  - info:doi/10.2196/18607
ER  - 

TY  - JOUR
AU  - Militello, Lisa
AU  - Sezgin, Emre
AU  - Huang, Yungui
AU  - Lin, Simon
PY  - 2021/3/1
TI  - Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study
JO  - JMIR Form Res
SP  - e18240
VL  - 5
IS  - 3
KW  - perinatal care
KW  - infant mortality
KW  - health education
KW  - mobile health
KW  - feasibility studies
KW  - family
KW  - mobile phone
KW  - webcasts as topic
KW  - user-computer interface
N2  - Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children?s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention?Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants? perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. 
UR  - https://formative.jmir.org/2021/3/e18240
UR  - http://dx.doi.org/10.2196/18240
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33646136
ID  - info:doi/10.2196/18240
ER  - 

TY  - JOUR
AU  - Morris, Sara
AU  - Geraghty, Sadie
AU  - Sundin, Deborah
PY  - 2021/2/23
TI  - Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e23514
VL  - 10
IS  - 2
KW  - breech presentation
KW  - midwifery
KW  - methodology
KW  - Delphi technique
N2  - Background: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women?s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals? knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID): DERR1-10.2196/23514 
UR  - https://www.researchprotocols.org/2021/2/e23514
UR  - http://dx.doi.org/10.2196/23514
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33620329
ID  - info:doi/10.2196/23514
ER  - 

TY  - JOUR
AU  - Krishnamurti, Tamar
AU  - Davis, L. Alexander
AU  - Quinn, Beth
AU  - Castillo, F. Anabel
AU  - Martin, L. Kelly
AU  - Simhan, N. Hyagriv
PY  - 2021/2/19
TI  - Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study
JO  - J Med Internet Res
SP  - e22790
VL  - 23
IS  - 2
KW  - COVID-19
KW  - social isolation, sheltering-in-place
KW  - intimate partner violence
KW  - domestic violence
KW  - pregnancy
KW  - telemedicine
KW  - telehealth
N2  - Background: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. Objective: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. Methods: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. Results: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. Conclusions: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider. 
UR  - http://www.jmir.org/2021/2/e22790/
UR  - http://dx.doi.org/10.2196/22790
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33605898
ID  - info:doi/10.2196/22790
ER  - 

TY  - JOUR
AU  - Donelle, Lorie
AU  - Hall, Jodi
AU  - Hiebert, Bradley
AU  - Jackson, Kimberley
AU  - Stoyanovich, Ewelina
AU  - LaChance, Jessica
AU  - Facca, Danica
PY  - 2021/2/17
TI  - Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study
JO  - JMIR Pediatr Parent
SP  - e25388
VL  - 4
IS  - 1
KW  - parenting
KW  - digital health
KW  - technology
KW  - health literacy
KW  - information seeking
N2  - Background: The transition to parenting?that is, the journey from preconception through pregnancy and postpartum periods?is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents? experiences with and uses of digital technology during 4 stages?prenatal, pregnancy, labor, and postpartum?of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents? type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: ?Is this normal; is this happening to you?!?, ?Am I having a heart attack; what is this??, and ?Anyone can put anything on Wikipedia?: Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers? perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. 
UR  - https://pediatrics.jmir.org/2021/1/e25388
UR  - http://dx.doi.org/10.2196/25388
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33595440
ID  - info:doi/10.2196/25388
ER  - 

TY  - JOUR
AU  - Grimes, Lee Hannah
AU  - Uppal, Ramnik
PY  - 2021/2/17
TI  - Remote Examination and Screening for Domestic Abuse. Comment on ?Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges?
JO  - J Med Internet Res
SP  - e23295
VL  - 23
IS  - 2
KW  - spouse abuse
KW  - domestic abuse
KW  - apps
KW  - patient information
KW  - antenatal care
KW  - COVID-19
UR  - https://www.jmir.org/2021/2/e23295
UR  - http://dx.doi.org/10.2196/23295
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33595438
ID  - info:doi/10.2196/23295
ER  - 

TY  - JOUR
AU  - Morrow, L. Ardythe
AU  - Staat, A. Mary
AU  - DeFranco, A. Emily
AU  - McNeal, M. Monica
AU  - Cline, R. Allison
AU  - Conrey, C. Shannon
AU  - Schlaudecker, P. Elizabeth
AU  - Piasecki, M. Alexandra
AU  - Burke, M. Rachel
AU  - Niu, Liang
AU  - Hall, J. Aron
AU  - Bowen, D. Michael
AU  - Gerber, I. Susan
AU  - Langley, E. Gayle
AU  - Thornburg, J. Natalie
AU  - Campbell, P. Angela
AU  - Vinjé, Jan
AU  - Parashar, D. Umesh
AU  - Payne, C. Daniel
PY  - 2021/2/12
TI  - Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis in US Mothers and Children Aged 0-2: PREVAIL Cohort Study
JO  - JMIR Res Protoc
SP  - e22222
VL  - 10
IS  - 2
KW  - birth cohort
KW  - RSV
KW  - influenza
KW  - rotavirus
KW  - norovirus
KW  - vaccines
KW  - vaccine effectiveness
KW  - immunology
KW  - pediatrics
N2  - Background: Acute gastroenteritis (AGE) and acute respiratory infections (ARIs) cause significant pediatric morbidity and mortality. Developing childhood vaccines against major enteric and respiratory pathogens should be guided by the natural history of infection and acquired immunity. The United States currently lacks contemporary birth cohort data to guide vaccine development. Objective: The PREVAIL (Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal) Cohort study was undertaken to define the natural history of infection and immune response to major pathogens causing AGE and ARI in US children. Methods: Mothers in Cincinnati, Ohio, were enrolled in their third trimester of pregnancy, with intensive child follow-up to 2 years. Blood samples were obtained from children at birth (cord), 6 weeks, and 6, 12, 18, and 24 months. Whole stool specimens and midturbinate nasal swabs were collected weekly and tested by multipathogen molecular assays. Saliva, meconium, maternal blood, and milk samples were also collected. AGE (?3 loose or watery stools or ?1 vomiting episode within 24 hours) and ARI (cough or fever) cases were documented by weekly cell phone surveys to mothers via automated SMS text messaging and review of medical records. Immunization records were obtained from registries and providers. follow-up ended in October 2020. Pathogen-specific infections are defined by a PCR-positive sample or rise in serum antibody. Results: Of the 245 enrolled mother?child pairs, 51.8% (n=127) were White, 43.3% (n=106) Black, 55.9% (n=137) publicly insured, and 86.5% (n=212) initiated breastfeeding. Blood collection was 100.0% for mothers (n=245) and 85.7% for umbilical cord (n=210). A total of 194/245 (79.2%) mother?child pairs were compliant based on participation in at least 70% (?71/102 study weeks) of child-weeks and providing 70% or more of weekly samples during that time, or blood samples at 18 or 24 months. Compliant participants (n=194) had 71.0% median nasal swab collection (IQR 30.0%-90.5%), with 98.5% (191/194) providing either an 18- or 24-month blood sample; median response to weekly SMS text message surveys was 95.1% (IQR 76.5%-100%). Compliant mothers reported 2.0 AGE and 4.5 ARI cases per child-year, of which 25.5% (160/627) and 38.06% (486/1277) of cases, respectively, were medically attended; 0.5% of AGE (3/627) and 0.55% of ARI (7/1277) cases were hospitalized. Conclusions: The PREVAIL Cohort demonstrates intensive follow-up to document the natural history of enteric and respiratory infections and immunity in children 0-2 years of age in the United States and will contribute unique data to guide vaccine recommendations. Testing for pathogens and antibodies is ongoing. International Registered Report Identifier (IRRID): RR1-10.2196/22222 
UR  - http://www.researchprotocols.org/2021/2/e22222/
UR  - http://dx.doi.org/10.2196/22222
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33576746
ID  - info:doi/10.2196/22222
ER  - 

TY  - JOUR
AU  - Lawton, Beverley
AU  - Storey, Francesca
AU  - Sibanda, Nokuthaba
AU  - Bennett, Matthew
AU  - Lambert, Charles
AU  - Geller, Stacie
AU  - Edmonds, Liza
AU  - Cram, Fiona
PY  - 2021/1/29
TI  - He Korowai Manaaki (Pregnancy Wraparound Care): Protocol for a Cluster Randomized Clinical Trial
JO  - JMIR Res Protoc
SP  - e18154
VL  - 10
IS  - 1
KW  - maternity
KW  - inequity
KW  - Indigenous health
KW  - M?ori
KW  - pregnancy
KW  - Kaupapa M?ori
KW  - socioeconomic
KW  - primary health care
KW  - methodology
N2  - Background: Maternal and infant health inequities between M?ori (the Indigenous peoples of Aotearoa New Zealand) and New Zealand European women are well documented and cannot be explained solely by socioeconomic status. A research center-iwi (tribal group) partnership aims to address these disparities and improve maternal and infant health outcomes by implementing an augmented maternity care pathway (He Korowai Manaaki) to improve access to services and evidence-informed care. Objective: The objective of this study is to test whether an augmented maternity care pathway improves M?ori infant health outcomes. Methods: This is a Kaupapa M?ori (by, with, and for M?ori) cluster randomized clinical trial involving 8 primary care practices allocated to either an intervention arm or control arm. The intervention arm comprises an augmented maternity care pathway (He Korowai Manaaki) offering clinical care through additional paid health care appointments and improved access to social support (eg, housing, transport). The control arm is usual care. The primary outcome is increased timely vaccination for M?ori infants, defined as all age-appropriate vaccinations completed by 6 months of age. Results: Recruitment commenced in November 2018 and was completed in June 2020, with 251 enrolled women recruited in intervention primary care practices before 20 weeks of pregnancy. Publication of results is anticipated in late 2023. Conclusions: The results will inform primary health care policy including whether the provision of augmented maternal care pathways reduces disparities in the structural determinants of health. If effective, He Korowai Manaaki will strengthen the health and well-being of pregnant M?ori women and their babies and improve their health outcomes, laying a strong foundation for lifelong health and well-being. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001155189; https://tinyurl.com/yypbef8q International Registered Report Identifier (IRRID): DERR1-10.2196/18154 
UR  - http://www.researchprotocols.org/2021/1/e18154/
UR  - http://dx.doi.org/10.2196/18154
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33512321
ID  - info:doi/10.2196/18154
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  - Wu, Qiong
AU  - Huang, Yiwen
AU  - Liao, Zijun
AU  - van Velthoven, Helena Michelle
AU  - Wang, Wei
AU  - Zhang, Yanfeng
PY  - 2020/12/3
TI  - Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e23273
VL  - 22
IS  - 12
KW  - breastfeeding
KW  - exclusive breastfeeding
KW  - WeChat
KW  - mHealth
KW  - randomized controlled trial
N2  - Background: The benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors. Objective: This study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices. Methods: This 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum. Results: At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0%; control: 96/152, 63.2%) and 4-5 months postpartum(intervention: 50/108, 46.3%; control: 46/109, 42.2%). Conclusions: This study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7676-2 
UR  - https://www.jmir.org/2020/12/e23273
UR  - http://dx.doi.org/10.2196/23273
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33270026
ID  - info:doi/10.2196/23273
ER  - 

TY  - JOUR
AU  - Kling, MR Samantha
AU  - Harris, A. Holly
AU  - Marini, Michele
AU  - Cook, Adam
AU  - Hess, B. Lindsey
AU  - Lutcher, Shawnee
AU  - Mowery, Jacob
AU  - Bell, Scott
AU  - Hassink, Sandra
AU  - Hayward, B. Shannon
AU  - Johnson, Greg
AU  - Franceschelli Hosterman, Jennifer
AU  - Paul, M. Ian
AU  - Seiler, Christopher
AU  - Sword, Shirley
AU  - Savage, S. Jennifer
AU  - Bailey-Davis, Lisa
PY  - 2020/11/24
TI  - Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trial
JO  - JMIR Pediatr Parent
SP  - e22121
VL  - 3
IS  - 2
KW  - early obesity prevention
KW  - responsive parenting
KW  - health information technology
KW  - coordination of care
KW  - clinical care
KW  - pragmatic intervention
KW  - data sharing
N2  - Background: Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. Objective: This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. Methods: Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. Results: Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad). Conclusions: Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies. Trial Registration: ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908 International Registered Report Identifier (IRRID): RR2-10.1186/s12887-018-1263-z 
UR  - http://pediatrics.jmir.org/2020/2/e22121/
UR  - http://dx.doi.org/10.2196/22121
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33231559
ID  - info:doi/10.2196/22121
ER  - 

TY  - JOUR
AU  - Su, Yanfang
AU  - Heitner, Jesse
AU  - Yuan, Changzheng
AU  - Si, Yafei
AU  - Wang, Dan
AU  - Zhou, Zhiying
AU  - Zhou, Zhongliang
PY  - 2020/11/3
TI  - Effect of a Text Messaging?Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e19953
VL  - 8
IS  - 11
KW  - cesarean section
KW  - short message service
KW  - SMS text messaging
KW  - quasirandomized controlled trial
KW  - mobile health
N2  - Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China?s cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China?s 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi?an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother?s birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few ?basic? messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman?s gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women?s likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 
UR  - https://mhealth.jmir.org/2020/11/e19953
UR  - http://dx.doi.org/10.2196/19953
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33141099
ID  - info:doi/10.2196/19953
ER  - 

TY  - JOUR
AU  - van der Windt, Melissa
AU  - van der Kleij, Maria Rianne
AU  - Snoek, Marianne Katinka
AU  - Willemsen, Paul Sten
AU  - Dykgraaf, Maria Ramon Henny
AU  - Laven, Elisabeth Joop Stephanus
AU  - Schoenmakers, Sam
AU  - Steegers-Theunissen, Maria Régine Patricia
PY  - 2020/9/30
TI  - Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study
JO  - J Med Internet Res
SP  - e19378
VL  - 22
IS  - 9
KW  - eHealth
KW  - periconception period
KW  - lifestyle intervention
N2  - Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (?blended care?) are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service ?Healthy Pregnancy? with the eHealth platform ?Smarter Pregnancy? (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (?12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ?30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. 
UR  - http://www.jmir.org/2020/9/e19378/
UR  - http://dx.doi.org/10.2196/19378
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32996885
ID  - info:doi/10.2196/19378
ER  - 

TY  - JOUR
AU  - Fatori, Daniel
AU  - Argeu, Adriana
AU  - Brentani, Helena
AU  - Chiesa, Anna
AU  - Fracolli, Lislaine
AU  - Matijasevich, Alicia
AU  - Miguel, C. Euripedes
AU  - Polanczyk, Guilherme
PY  - 2020/7/28
TI  - Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e13686
VL  - 8
IS  - 7
KW  - mHealth
KW  - early childhood development
KW  - maternal care
KW  - randomized clinical trial
KW  - daily diary
KW  - ambulatory assessment
N2  - Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 
UR  - https://mhealth.jmir.org/2020/7/e13686
UR  - http://dx.doi.org/10.2196/13686
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32720906
ID  - info:doi/10.2196/13686
ER  - 

TY  - JOUR
AU  - Saarikko, Johanna
AU  - Niela-Vilen, Hannakaisa
AU  - Ekholm, Eeva
AU  - Hamari, Lotta
AU  - Azimi, Iman
AU  - Liljeberg, Pasi
AU  - Rahmani, M. Amir
AU  - Löyttyniemi, Eliisa
AU  - Axelin, Anna
PY  - 2020/7/24
TI  - Continuous 7-Month Internet of Things?Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study
JO  - JMIR Form Res
SP  - e12417
VL  - 4
IS  - 7
KW  - prenatal care
KW  - postnatal care
KW  - wearable electronics
KW  - biosensing
KW  - cloud computing
KW  - mHealth
KW  - physical activity
KW  - sleep
KW  - heart rate
N2  - Background: Monitoring during pregnancy is vital to ensure the mother?s and infant?s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. Objective: This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)?based monitoring system. Methods: This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. Results: Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI ?0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. Conclusions: The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up. 
UR  - http://formative.jmir.org/2020/7/e12417/
UR  - http://dx.doi.org/10.2196/12417
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32706696
ID  - info:doi/10.2196/12417
ER  - 

TY  - JOUR
AU  - Wu, Huailiang
AU  - Sun, Weiwei
AU  - Huang, Xinyu
AU  - Yu, Shinning
AU  - Wang, Hao
AU  - Bi, Xiaoyu
AU  - Sheng, Jie
AU  - Chen, Sihan
AU  - Akinwunmi, Babatunde
AU  - Zhang, P. Casper J.
AU  - Ming, Wai-Kit
PY  - 2020/7/22
TI  - Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges
JO  - J Med Internet Res
SP  - e19916
VL  - 22
IS  - 7
KW  - coronavirus disease
KW  - COVID-19
KW  - SARS-CoV-2
KW  - online prenatal education
KW  - pregnancy
KW  - online education
KW  - antenatal
KW  - telehealth
KW  - convenience
KW  - inequality
UR  - http://www.jmir.org/2020/7/e19916/
UR  - http://dx.doi.org/10.2196/19916
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32658860
ID  - info:doi/10.2196/19916
ER  - 

TY  - JOUR
AU  - Alam, Mafruha
AU  - Banwell, Cathy
AU  - Lokuge, Kamalini
PY  - 2020/7/20
TI  - The Effect of Women?s Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior  in Bangladesh: Retrospective Cross-Sectional Study
JO  - JMIR Mhealth Uhealth
SP  - e17665
VL  - 8
IS  - 7
KW  - mHealth
KW  - inequality
KW  - access
KW  - pregnancy
N2  - Background: Text or voice messages have been used as a popular method for improving women?s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women?s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. Objective: This study aims to evaluate the effect of women?s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. Methods: In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women?s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. Results: In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women?s differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged?25 years). Secondary education was statistically significantly associated with women?s ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women?s satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. Conclusions: The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households. 
UR  - https://mhealth.jmir.org/2020/7/e17665
UR  - http://dx.doi.org/10.2196/17665
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32706694
ID  - info:doi/10.2196/17665
ER  - 

TY  - JOUR
AU  - Lebrun, Victoria
AU  - Dulli, Lisa
AU  - Alami, Omar Sayed
AU  - Sidiqi, Arzoo
AU  - Sultani, Shah Ahmad
AU  - Rastagar, Haroon Sayed
AU  - Halimzai, Iftikhar
AU  - Ahmadzai, Sharif
AU  - Todd, S. Catherine
PY  - 2020/7/20
TI  - Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study
JO  - JMIR Mhealth Uhealth
SP  - e17535
VL  - 8
IS  - 7
KW  - Afghanistan
KW  - mobile apps
KW  - pregnant women
KW  - maternal health
KW  - newborn health
KW  - social and behavior change
KW  - mHealth
KW  - voice message
KW  - SMS
N2  - Background: Mobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn?s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh. Objective: The aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up. Methods: We conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test. Results: Overall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of participants with correct knowledge significantly increased for all but one MNCH measure at follow up. Conclusions: This assessment indicates that the pilot MAMA program is feasible and acceptable in the Afghan context. Further research should be conducted to determine whether program participation leads to improved MNCH knowledge, health practices, and health service utilization in this fragile setting prior to larger scale up. 
UR  - https://mhealth.jmir.org/2020/7/e17535
UR  - http://dx.doi.org/10.2196/17535
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32706690
ID  - info:doi/10.2196/17535
ER  - 

TY  - JOUR
AU  - Benski, Caroline Anne
AU  - Schmidt, C. Nicole
AU  - Viviano, Manuela
AU  - Stancanelli, Giovanna
AU  - Soaroby, Adelia
AU  - Reich, R. Michael
PY  - 2020/7/8
TI  - Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study
JO  - JMIR Mhealth Uhealth
SP  - e18543
VL  - 8
IS  - 7
KW  - mobile health
KW  - maternal health
KW  - antenatal care
KW  - quality of care
KW  - mobile phone
N2  - Background: Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective: This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods: We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results: Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P<.001). In 2019, fewer women attended their first ANC visit in the third trimester (57/277, 20.6%) than in 2015 (147/343, 42.9%). There were statistically significant associations between the ANC visit durations and the risk factors, including age (>35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school?level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions: This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time. 
UR  - https://mhealth.jmir.org/2020/7/e18543
UR  - http://dx.doi.org/10.2196/18543
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32673263
ID  - info:doi/10.2196/18543
ER  - 

TY  - JOUR
AU  - Cawley, Caroline
AU  - Buckenmeyer, Hannelore
AU  - Jellison, Trina
AU  - Rinaldi, B. Joseph
AU  - Vartanian, B. Keri
PY  - 2020/7/6
TI  - Effect of a Health System?Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study
JO  - JMIR Mhealth Uhealth
SP  - e17183
VL  - 8
IS  - 7
KW  - mobile health
KW  - perinatal health
KW  - health behaviors
N2  - Background: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective: The primary objective of this study is to assess whether the use of a health system?sponsored mobile app?Circle by Providence?aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods: This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results: A total of 567 participants were enrolled in the study?167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of ?purple crying.? Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. 
UR  - https://mhealth.jmir.org/2020/7/e17183
UR  - http://dx.doi.org/10.2196/17183
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32628123
ID  - info:doi/10.2196/17183
ER  - 

TY  - JOUR
AU  - Coleman, Jesse
AU  - Eriksen, Jaran
AU  - Black, Vivian
AU  - Thorson, Anna
AU  - Hatcher, Abigail
PY  - 2020/6/29
TI  - The Mobile Alliance for Maternal Action Text Message?Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study
JO  - JMIR Hum Factors
SP  - e14078
VL  - 7
IS  - 2
KW  - maternal health
KW  - text messaging
KW  - focus groups
KW  - South Africa
KW  - mHealth
KW  - reproductive health
KW  - limited resource settings
KW  - public health
KW  - prenatal care
KW  - postnatal care
N2  - Background: Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program. Objective: The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback. Methods: Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback. Results: The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family. Conclusions: These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system. 
UR  - http://humanfactors.jmir.org/2020/2/e14078/
UR  - http://dx.doi.org/10.2196/14078
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32459628
ID  - info:doi/10.2196/14078
ER  - 

TY  - JOUR
AU  - Almohanna, Ali Alaa
AU  - Win, Than Khin
AU  - Meedya, Shahla
PY  - 2020/5/29
TI  - Effectiveness of Internet-Based Electronic Technology Interventions on Breastfeeding Outcomes: Systematic Review
JO  - J Med Internet Res
SP  - e17361
VL  - 22
IS  - 5
KW  - breastfeeding
KW  - mobile app
KW  - mobile phone
KW  - mHealth
KW  - internet
KW  - computers
KW  - systematic review
N2  - Background: Supporting women to initiate and continue breastfeeding is a global challenge. A range of breastfeeding interventions employing electronic technologies (e-technologies) are being developed, which offer different delivery modes and features over the internet; however, the impact of internet-based e-technologies on breastfeeding outcomes remains unclear. Objective: This study aimed to identify the characteristics of current internet-based breastfeeding interventions employing e-technologies and investigate the effects of internet-based e-technologies on breastfeeding outcomes. Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following databases: Scopus, Web of Science, the Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, the Association for Computing Machinery, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore. Results: This systematic review included 16 studies published between 2007 and 2018, with 4018 women in 8 countries. The characteristics of the interventions were grouped based on (1) mode of delivery (web-based, mobile phone apps, and computer kiosk), (2) purpose of the interventions (education and support), and (3) key strategies (monitoring and breastfeeding tracking, personalization, online discussion forum, web-based consultation, and breastfeeding station locators). Combining educational activities with web-based personalized support through discussion forums appeared to be the most effective way to improve breastfeeding outcomes and long-term exclusive breastfeeding rates. Monitoring and breastfeeding trackers appeared to be the least effective ways. Conclusions: This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women. Future internet-based breastfeeding interventions employing e-technologies might consider improving interaction with mothers and personalizing the content of the proposed interventions. 
UR  - http://www.jmir.org/2020/5/e17361/
UR  - http://dx.doi.org/10.2196/17361
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32469315
ID  - info:doi/10.2196/17361
ER  - 

TY  - JOUR
AU  - Zhang, Donglan
AU  - Jin, Lan
AU  - Liang, Di
AU  - Geng, Ruijin
AU  - Liu, Yun
AU  - Ling, Yu
AU  - Jiang, Fan
AU  - Zhang, Yunting
PY  - 2020/5/28
TI  - Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study
JO  - JMIR Form Res
SP  - e17179
VL  - 4
IS  - 5
KW  - mobile health
KW  - interview
KW  - health belief model
KW  - early child development
N2  - Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone?aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. 
UR  - http://formative.jmir.org/2020/5/e17179/
UR  - http://dx.doi.org/10.2196/17179
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32463374
ID  - info:doi/10.2196/17179
ER  - 

TY  - JOUR
AU  - Cheng, Heilok
AU  - Tutt, Alison
AU  - Llewellyn, Catherine
AU  - Size, Donna
AU  - Jones, Jennifer
AU  - Taki, Sarah
AU  - Rossiter, Chris
AU  - Denney-Wilson, Elizabeth
PY  - 2020/5/27
TI  - Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation
JO  - JMIR Mhealth Uhealth
SP  - e17300
VL  - 8
IS  - 5
KW  - breast feeding
KW  - bottle feeding
KW  - infant food
KW  - readability
KW  - consumer health information
KW  - breastfeeding
KW  - mobile apps
KW  - smartphones
N2  - Background: Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective: This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods: The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results: A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps? engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions: The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council?s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources. 
UR  - http://mhealth.jmir.org/2020/5/e17300/
UR  - http://dx.doi.org/10.2196/17300
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32459187
ID  - info:doi/10.2196/17300
ER  - 

TY  - JOUR
AU  - Laureij, T. Lyzette
AU  - Breunis, J. Leonieke
AU  - Steegers-Theunissen, M. Regine P.
AU  - Rosman, N. Ageeth
PY  - 2020/5/26
TI  - Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study
JO  - JMIR Form Res
SP  - e16202
VL  - 4
IS  - 5
KW  - newborn
KW  - focus groups
KW  - postpartum period
KW  - postnatal care
KW  - eHealth
KW  - pregnancy
KW  - obstetrics
KW  - qualitative research
N2  - Background: During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective: We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods: We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results: In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators?a member of a stakeholder party and a manager of a maternity care organization?participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions: Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option. 
UR  - http://formative.jmir.org/2020/5/e16202/
UR  - http://dx.doi.org/10.2196/16202
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32452805
ID  - info:doi/10.2196/16202
ER  - 

TY  - JOUR
AU  - Demirci, R. Jill
AU  - Suffoletto, Brian
AU  - Doman, Jack
AU  - Glasser, Melissa
AU  - Chang, C. Judy
AU  - Sereika, M. Susan
AU  - Bogen, L. Debra
PY  - 2020/4/29
TI  - The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e17328
VL  - 8
IS  - 4
KW  - breast feeding
KW  - perceived insufficient milk
KW  - text messaging
KW  - short message service
KW  - cell phone
KW  - mobile phone
KW  - telemedicine
KW  - mHealth
KW  - randomized controlled trial
N2  - Background: Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective: This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)?the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods: We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message?based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging?based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results: Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants? pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions: Prenatal and postpartum evidence?based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration: ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969 
UR  - https://mhealth.jmir.org/2020/4/e17328
UR  - http://dx.doi.org/10.2196/17328
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32347815
ID  - info:doi/10.2196/17328
ER  - 

TY  - JOUR
AU  - Hussain-Shamsy, Neesha
AU  - Shah, Amika
AU  - Vigod, N. Simone
AU  - Zaheer, Juveria
AU  - Seto, Emily
PY  - 2020/4/13
TI  - Mobile Health for Perinatal Depression and Anxiety: Scoping Review
JO  - J Med Internet Res
SP  - e17011
VL  - 22
IS  - 4
KW  - mental health
KW  - depression
KW  - anxiety
KW  - pregnancy
KW  - postpartum
KW  - smartphone
KW  - mobile phone
KW  - text message
KW  - mHealth
N2  - Background: The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. Objective: This study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. Methods: Using a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. Results: A total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. Conclusions: Future work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth. 
UR  - http://www.jmir.org/2020/4/e17011/
UR  - http://dx.doi.org/10.2196/17011
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32281939
ID  - info:doi/10.2196/17011
ER  - 

TY  - JOUR
AU  - Skelton, Kara
AU  - Evans, Retta
AU  - LaChenaye, Jenna
PY  - 2020/3/24
TI  - Hidden Communities of Practice in Social Media Groups: Mixed Methods Study
JO  - JMIR Pediatr Parent
SP  - e14355
VL  - 3
IS  - 1
KW  - online social support
KW  - breastfeeding
KW  - social media
KW  - social support system
N2  - Background: Although most US mothers initiate breastfeeding, suboptimal breastfeeding rates still exist. Although breastfeeding is a complex process, social support has been linked with increases in positive breastfeeding outcomes. Recent technological advances, including the development of social networking sites, provide mothers with convenient access to a unique array of audiences from which to seek advice about parenting, including breastfeeding. However, little is known about how the use of the sites?specifically groups centered around breastfeeding?influences breastfeeding knowledge, attitudes, or behaviors. Objective: This mixed methods study aimed to explore utilization of an existing probreastfeeding Facebook group and how utilization influences breastfeeding-related knowledge, attitudes, and behaviors. Methods: Participants were recruited online through Facebook wall posts from within the existing group. Mothers aged between 18 and 50 years who were pregnant and intended to breastfeed, were currently breastfeeding, or had recently weaned their infant in the past 3 years were eligible to participate. Participants engaged in online focus group discussions (n=21) and individual interviews (n=12). Inductive content analysis of qualitative data led to the conceptualization and contextualization of a breastfeeding community of practice (COP). Using qualitative results, a quantitative survey was then developed to assess the prevalence of qualities of a COP as well as how COP usage influenced breastfeeding-related attitudes and knowledge. A total of 314 mothers completed the online survey. Results: Qualitative findings showed an overall sense of community, with subthemes of group trust, interaction, and the promotion of breastfeeding. A majority (287/314, 91.5%) of mothers initiated breastfeeding, with 69.0% (216/314) of mothers reporting exclusive breastfeeding their infant at 6 months. Approximately 98.5% (309/314) of mothers reported that the Facebook group captured and stored knowledge; therefore, information could be easily accessed and applied. In addition, 96.2% (302/317) of mothers reported that the Facebook group motivated them to share breastfeeding-related knowledge. Conclusions: The results suggest that this existing probreastfeeding Facebook group exhibits characteristics of an online COP, which was organically formed. Utilization of the Facebook group, in the context of an online COP, could be beneficial in impacting breastfeeding-related knowledge, attitudes, and behaviors. However, further examination and exploration of breastfeeding COPs, including using this type of model as a method of lactation support or as a telemedicine framework, is a clear need. 
UR  - http://pediatrics.jmir.org/2020/1/e14355/
UR  - http://dx.doi.org/10.2196/14355
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32207693
ID  - info:doi/10.2196/14355
ER  - 

TY  - JOUR
AU  - Heller, M. Hanna
AU  - Hoogendoorn, W. Adriaan
AU  - Honig, Adriaan
AU  - Broekman, P. Birit F.
AU  - van Straten, Annemieke
PY  - 2020/3/23
TI  - The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e15172
VL  - 22
IS  - 3
KW  - pregnancy
KW  - depression
KW  - anxiety
KW  - internet
KW  - pregnancy outcome
KW  - treatment
N2  - Background: Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. Objective: This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. Methods: This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). Results: Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (?21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. Conclusions: Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. Trial Registration: Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek 
UR  - http://www.jmir.org/2020/3/e15172/
UR  - http://dx.doi.org/10.2196/15172
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32202505
ID  - info:doi/10.2196/15172
ER  - 

TY  - JOUR
AU  - Blackwell, M. Tenya
AU  - Dill, J. LeConte
AU  - Hoepner, A. Lori
AU  - Geer, A. Laura
PY  - 2020/2/13
TI  - Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage
JO  - JMIR Mhealth Uhealth
SP  - e14737
VL  - 8
IS  - 2
KW  - Text4baby
KW  - mHealth
KW  - pregnancy
KW  - text messaging
KW  - health information
KW  - prenatal health
KW  - disparities
N2  - Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants? knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants? knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks? exposure to the text message?based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants? perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. 
UR  - http://mhealth.jmir.org/2020/2/e14737/
UR  - http://dx.doi.org/10.2196/14737
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32053117
ID  - info:doi/10.2196/14737
ER  - 

TY  - JOUR
AU  - Parga-Belinkie, Joanna
AU  - Merchant, M. Raina
PY  - 2019/12/20
TI  - Voices in Evidence-Based Newborn Care: A How-to-Guide on Developing a Parent-Facing Podcast
JO  - JMIR Pediatr Parent
SP  - e16335
VL  - 2
IS  - 2
KW  - neonatology
KW  - social media
KW  - medical education
KW  - patient education
UR  - http://pediatrics.jmir.org/2019/2/e16335/
UR  - http://dx.doi.org/10.2196/16335
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31859674
ID  - info:doi/10.2196/16335
ER  - 

TY  - JOUR
AU  - Zhao, Jing
AU  - Li, Mu
AU  - Freeman, Becky
PY  - 2019/11/29
TI  - A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps
JO  - JMIR Mhealth Uhealth
SP  - e14219
VL  - 7
IS  - 11
KW  - infant formula
KW  - food policy
KW  - health promotion
KW  - marketing
KW  - mobile app
KW  - parenting
KW  - breastfeeding
KW  - advertisement
N2  - Background: China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing. Objective: This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding. Methods: We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure. Results: The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure. Conclusions: The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors. 
UR  - http://mhealth.jmir.org/2019/11/e14219/
UR  - http://dx.doi.org/10.2196/14219
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31782743
ID  - info:doi/10.2196/14219
ER  - 

TY  - JOUR
AU  - Waring, E. Molly
AU  - Libby, A. Brooke
AU  - Moore Simas, A. Tiffany
AU  - Bracken, L. Madison
AU  - Bibeau, L. Jessica
AU  - Herrera, Valeria
AU  - Wang, Justin
AU  - Pagoto, L. Sherry
PY  - 2019/11/28
TI  - Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial
JO  - JMIR Res Protoc
SP  - e15530
VL  - 8
IS  - 11
KW  - postpartum period
KW  - weight loss
KW  - social media
KW  - pilot study
N2  - Background: Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. Objective: The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. Methods: Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. Results: Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. Conclusions: Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. International Registered Report Identifier (IRRID): DERR1-10.2196/15530 
UR  - http://www.researchprotocols.org/2019/11/e15530/
UR  - http://dx.doi.org/10.2196/15530
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31778116
ID  - info:doi/10.2196/15530
ER  - 

TY  - JOUR
AU  - Isler, Jasmin
AU  - Sawadogo, Hélène N.
AU  - Harling, Guy
AU  - Bärnighausen, Till
AU  - Adam, Maya
AU  - Kagoné, Moubassira
AU  - Sié, Ali
AU  - Greuel, Merlin
AU  - McMahon, A. Shannon
PY  - 2019/11/11
TI  - Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study
JO  - JMIR Mhealth Uhealth
SP  - e13604
VL  - 7
IS  - 11
KW  - mHealth
KW  - Burkina Faso
KW  - mothers
KW  - Community Health Workers
KW  - pregnancy
KW  - diet
KW  - dgital health
N2  - Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video?s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions. 
UR  - http://mhealth.jmir.org/2019/11/e13604/
UR  - http://dx.doi.org/10.2196/13604
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31710302
ID  - info:doi/10.2196/13604
ER  - 

TY  - JOUR
AU  - Oostingh, C. Elsje
AU  - Ophuis, H. Robbin
AU  - Koster, PH Maria
AU  - Polinder, Suzanne
AU  - Lingsma, F. Hester
AU  - Laven, SE Joop
AU  - Steegers-Theunissen, PM Régine
PY  - 2019/10/23
TI  - Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis
JO  - JMIR Mhealth Uhealth
SP  - e13935
VL  - 7
IS  - 10
KW  - preconception
KW  - subfertility
KW  - IVF treatment
KW  - pregnancy
KW  - cost-effectiveness
N2  - Background: The health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment. Objective: This study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle. Methods: This model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters. Results: Based on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved ?270,000 compared to usual care after two IVF cycles, with an ICER of ??3050 (95% CI ?3960 to ?540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51% after two IVF cycles for cost saving. Conclusions: The mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates. 
UR  - http://mhealth.jmir.org/2019/10/e13935/
UR  - http://dx.doi.org/10.2196/13935
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31647476
ID  - info:doi/10.2196/13935
ER  - 

TY  - JOUR
AU  - Lee, H. Harold
AU  - Hsieh, Patrick Yuli
AU  - Murphy, Joe
AU  - Tidey, W. Jennifer
AU  - Savitz, A. David
PY  - 2019/10/18
TI  - Health Research Using Facebook to Identify and Recruit Pregnant Women Who Use Electronic Cigarettes: Internet-Based Nonrandomized Pilot Study
JO  - JMIR Res Protoc
SP  - e12444
VL  - 8
IS  - 10
KW  - e-cigarette
KW  - pregnancy
KW  - social media
N2  - Background: Participant recruitment is often a challenge, particularly enrolling individuals with relatively rare characteristics. The wide reach of social media may provide a mechanism to overcome these challenges. Objective: This paper aimed to provide information to researchers who seek to recruit participants from rare populations using social media for studies with demanding protocols. We aimed to describe a pilot study protocol that identified and enrolled pregnant women (second or third trimester) who were exclusive users of electronic cigarettes (e-cigarettes). We have described the recruitment methods, time, and cost; examined advertisement types that were more or less successful; discussed participant retention and relationship management; and described the process of collecting biological data. Methods: In an open-access, nonrandomized pilot study, we placed Facebook advertisements that were selectively targeting women who were likely to be pregnant and interested in e-cigarettes or vaping. The advertisements invited individuals to complete a fully automated eligibility screener based on Qualtrics. Eligible participants were asked to (1) complete a Web-based survey that collected detailed information on the use of e-cigarettes, including the exact type of device and electronic liquid, (2) report the frequency and intensity of e-cigarette use for 3 months before pregnancy and during each trimester, and (3) provide a saliva specimen for a nicotine biomarker assay. We collected a photograph of each participant?s e-cigarette device, 8 weeks after the mother?s due date, to allow corroboration of the self-report and the baby?s birth weight and gestational age from the participant?s physician. Results: Participants were recruited between August 19 and October 26, 2017. We enrolled 20 participants in 2 months at a cost of US $3421.28. Baseline data were collected for all 20 participants. Of the 20 women enrolled, 16 provided a saliva sample, 4 provided a photo of the e-cigarette device, and 10 provided physician contact information. Of the 10 physicians contacted by mail, 6 responded with information on the participants and their babies. Conclusions: Study findings suggest that Facebook?s targeting criteria should focus on e-cigarette users to maximize advertisement exposure of potentially eligible women. In addition, saliva sample collection was feasible among pregnant women (second or third trimester) who were exclusive e-cigarette users, but obtaining photographs and physician reports was problematic and called for further refinement. These lessons are likely useful to others who are seeking to use social media to recruit participants from rare populations into studies with demanding protocols. 
UR  - https://www.researchprotocols.org/2019/10/e12444
UR  - http://dx.doi.org/10.2196/12444
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31628785
ID  - info:doi/10.2196/12444
ER  - 

TY  - JOUR
AU  - Abbasgholizadeh Rahimi, Samira
AU  - Archambault, M. Patrick
AU  - Ravitsky, Vardit
AU  - Lemoine, Marie-Eve
AU  - Langlois, Sylvie
AU  - Forest, Jean-Claude
AU  - Giguère, C. Anik M.
AU  - Rousseau, François
AU  - Dolan, G. James
AU  - Légaré, France
PY  - 2019/10/8
TI  - An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e13321
VL  - 8
IS  - 10
KW  - shared decision making
KW  - multiple criteria decision analysis
KW  - analytic hierarchy process
KW  - decision aid
KW  - prenatal screening
KW  - mobile app
N2  - Background: Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. Objective: In this mixed methods study, we aim to (1) assess women?s needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. Methods: In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants? attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. Results: Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. Conclusions: This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. International Registered Report Identifier (IRRID): DERR1-10.2196/13321 
UR  - https://www.researchprotocols.org/2019/10/e13321
UR  - http://dx.doi.org/10.2196/13321
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31596249
ID  - info:doi/10.2196/13321
ER  - 

TY  - JOUR
AU  - Kamke, Kristyn
AU  - Grenen, Emily
AU  - Robinson, Cendrine
AU  - El-Toukhy, Sherine
PY  - 2019/10/7
TI  - Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study
JO  - JMIR Mhealth Uhealth
SP  - e14699
VL  - 7
IS  - 10
KW  - smoking cessation
KW  - pregnancy
KW  - women's health
KW  - mHealth
KW  - text messaging intervention
N2  - Background: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor?s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized. 
UR  - https://mhealth.jmir.org/2019/10/e14699
UR  - http://dx.doi.org/10.2196/14699
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31593542
ID  - info:doi/10.2196/14699
ER  - 

TY  - JOUR
AU  - Tang, Kymeng
AU  - Gerling, Kathrin
AU  - Chen, Wei
AU  - Geurts, Luc
PY  - 2019/9/27
TI  - Information and Communication Systems to Tackle Barriers to Breastfeeding: Systematic Search and Review
JO  - J Med Internet Res
SP  - e13947
VL  - 21
IS  - 9
KW  - breastfeeding
KW  - technology
KW  - review
N2  - Background: Breastfeeding has many benefits for newborns, mothers, and the wider society. The World Health Organization recommends mothers to feed newborns exclusively with breastmilk for the first 6 months after birth, but breastfeeding rates in many countries fail to align with the recommendations because of various barriers. Breastfeeding success is associated with a number of determinants, such as self-efficacy, intention to breastfeed, and attitudes toward breastfeeding. Information and communication technology (ICT) has been leveraged to support breastfeeding by means of improving knowledge or providing practical supports in different maternal stages. Previous reviews have examined and summarized the effectiveness and credibility of interventions; however, no review has been done from a human-computer interaction perspective that is concerned with novel interaction techniques and the perspective of end users. Objective: The objective of this review was to provide a comprehensive overview of existing digital interventions that support breastfeeding by investigating systems? objective, technology design, validation process, and quality attributes, both in terms of clinical parameters as well as usability and user experience. Methods: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following libraries: PubMed, Science Direct, Association for Computing Machinery Digital Library (ACM Digital Library), and Institute of Electrical and Electronics Engineers Xplore (IEEE Xplore). Results: A total of 35 papers discussing 30 interventions were included. The main goals of these interventions were organized into 4 categories: breastfeeding education (n=12), breastfeeding promotion (n=8), communication support (n=6), and daily practical support (n=4). Of the interventions, 13 target mothers in the postnatal period. Most interventions come in forms of client communication systems (n=18), which frequently leverage Web technologies, text message, and mobile apps to provide breastfeeding support. Systems predominantly focus on mothers; validation strategies were rather heterogeneous, with 12 user studies concerning usability and user experience and 18 clinical validation studies focusing on the effects of the interventions on breastfeeding determinants; 5 papers did not report results. Generally, straightforward systems (eg, communication tools or Web-based solutions) seem to be more effective than complex interventions (eg, games). Conclusions: Existing information and communication systems offer effective means of improving breastfeeding outcomes, but they do not address all relevant periods in parenthood (eg, the antenatal period) and often do not involve important stakeholders, such as partners. There is an opportunity to leverage more complex technical systems to open up avenues for the broader design of ICT to support breastfeeding; however, considering evaluation outcomes of existing support systems of higher complexity, such systems need to be designed with care. 
UR  - https://www.jmir.org/2019/9/e13947/
UR  - http://dx.doi.org/10.2196/13947
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31573903
ID  - info:doi/10.2196/13947
ER  - 

TY  - JOUR
AU  - Ukoha, P. Erinma
AU  - Feinglass, Joe
AU  - Yee, M. Lynn
PY  - 2019/09/23
TI  - Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study
JO  - J Med Internet Res
SP  - e14445
VL  - 21
IS  - 9
KW  - patient portals
KW  - socioeconomic factors
KW  - pregnancy
KW  - cohort studies
N2  - Background: Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. Objective: This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients? demographics or clinical characteristics exist. Methods: This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (?1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients? characteristics. Results: Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23). Conclusions: Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care. 
UR  - https://www.jmir.org/2019/9/e14445
UR  - http://dx.doi.org/10.2196/14445
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31586367
ID  - info:doi/10.2196/14445
ER  - 

TY  - JOUR
AU  - Poudyal, Anubhuti
AU  - van Heerden, Alastair
AU  - Hagaman, Ashley
AU  - Maharjan, Man Sujen
AU  - Byanjankar, Prabin
AU  - Subba, Prasansa
AU  - Kohrt, A. Brandon
PY  - 2019/09/11
TI  - Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal
JO  - JMIR Res Protoc
SP  - e14734
VL  - 8
IS  - 8
KW  - developing countries
KW  - feasibility studies
KW  - mobile health
KW  - mother-child interaction
KW  - postpartum depression
KW  - psychotherapy
N2  - Background: There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. Objective: This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. Methods: This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. Results: To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. Conclusions: Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/14734 
UR  - http://www.researchprotocols.org/2019/8/e14734/
UR  - http://dx.doi.org/10.2196/14734
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31512581
ID  - info:doi/10.2196/14734
ER  - 

TY  - JOUR
AU  - Kapinos, Kandice
AU  - Kotzias, Virginia
AU  - Bogen, Debra
AU  - Ray, Kristin
AU  - Demirci, Jill
AU  - Rigas, Ann Mary
AU  - Uscher-Pines, Lori
PY  - 2019/09/03
TI  - The Use of and Experiences With Telelactation Among Rural Breastfeeding Mothers: Secondary Analysis of a Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e13967
VL  - 21
IS  - 9
KW  - telehealth
KW  - telemedicine
KW  - breastfeeding
KW  - lactation
KW  - lactation support
KW  - rural health
N2  - Background: Telelactation services connect breastfeeding mothers to remotely located lactation consultants through audio-visual technology and can increase access to professional breastfeeding support in rural areas. Objective: The objective of this study was to identify maternal characteristics associated with the demand for and use of telelactation and to describe visit characteristics. Methods: We conducted a descriptive study within the context of a randomized controlled trial. Participant survey data and vendor electronic medical record data were used to assess video call characteristics like timing, duration, topics discussed, and participant satisfaction. Recruitment occurred from 2016-2018 at a rural critical access hospital in Pennsylvania. The 102 women enrolled in the study were given access to unlimited, on-demand video calls with lactation consultants through a mobile phone app and were tracked for 12 weeks following their postpartum hospitalization. Results: A total of 94 participants out of 102 recruits (92%) participated in the final, 12-week survey assessment were included in the analysis. Of those, 47 (50%) participants reported participating in one or more video calls, and 31 (33%) completed one or more calls that included a substantive discussion of a breastfeeding challenge. Participants who used telelactation (21/31, 68%; P=.02) were more likely to be working at 12 weeks postpartum compared to others (26/63, 41%), were less likely (12/31, 39%; P=.02) to have prior breastfeeding experience on average compared to nonusers (41/63, 65%), and were less likely to have breastfed exclusively (16/31, 52%; P<.001) prior to hospital discharge compared to mothers who didn?t use telelactation services (51/63, 81%). Most video calls (58/83, 70%) occurred during the infant?s first month of life and 41% (34/83) occurred outside of business hours. The most common challenges discussed included: breast pain, soreness, and infection (25/83, 30%), use of nipple shields (21/83, 25%), and latch or positioning (17/83, 24%). Most telelactation users (43/47, 91%) expressed satisfaction with the help received. Conclusions: Telelactation is an innovation in the delivery of professional breastfeeding support. This research documents both demand for and positive experiences with telelactation in an underserved population. Trial Registration: ClinicalTrials.gov NCT02870413; https://clinicaltrials.gov/ct2/show/NCT02870413 
UR  - https://www.jmir.org/2019/9/e13967/
UR  - http://dx.doi.org/10.2196/13967
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31482848
ID  - info:doi/10.2196/13967
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Ng, Debby Esperanza
PY  - 2019/08/29
TI  - Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study
JO  - J Med Internet Res
SP  - e12915
VL  - 21
IS  - 8
KW  - depression
KW  - mothers
KW  - postpartum
KW  - qualitative
KW  - social support
KW  - telecommunication
KW  - digital health
KW  - peer support
KW  - peer-to-peer support
KW  - online support groups
KW  - internet
N2  - Background: Social support is known to reduce risks of postnatal depression (PND) and improve maternal emotional well-being. However, the Asian cultural context is often neglected when appraising maternal needs and mothers? preferences for social support. While many preventive efforts have experimented with technology, professionals, and paraprofessionals in providing social support to mothers in need, most studies determined the effectiveness of their interventions through quantitative measurements of maternal outcomes. Experiences and feedback from both participants and administrators are rarely discussed, especially in an Asian setting. Objective: The goal of the research was to evaluate the postnatal experiences of Asian mothers at risk of PND and the perceptions of peer volunteers regarding a technology-based peer-support intervention program (PIP). Methods: A qualitative semistructured interview was conducted with 20 Asian mothers at risk of depression (10 from the control group and 10 from the intervention group) and 19 peer volunteers from a randomized controlled trial. The PIP included weekly correspondence between peer volunteers and mothers through any telecommunication means over 4 weeks. All interviews were approximately 30 to 60 minutes long, audiotaped, transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Standards of Reporting Trials checklist. Results: Two overarching themes comprising five subthemes were generated: postnatal experience (a bouncy ride, a way forward) and evaluation of the PIP (valuable, flexible, and supportive program; building blocks of a good relationship; and lessons learned and the road ahead). Mothers from both the control and interventions groups were generally satisfied with hospital care and the support received from family. They also shared similar breastfeeding challenges and needs for more informed decisions and follow-up support from the hospital. However, mothers who received the PIP tended to have more positive outlooks of their birth experiences. Overall, peer volunteers and mothers involved in the PIP found the PIP useful and expressed satisfaction with the program?s flexibility. They also shared their personal takeaways, the qualities of their friendships, and the need for extended correspondence time and recommended outreach to non?at-risk mothers. Conclusions: The positive endorsement of the PIP by peer volunteers and mothers suggests the success of the PIP in maintaining positive maternal emotional well-being during the postpartum period. With the help of technology, hospitals can easily provide additional peer support to at-risk mothers in addition to existing standard care offered to these mothers. Trial Registration: ISRCTN Registry ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9416 
UR  - http://www.jmir.org/2019/8/e12915/
UR  - http://dx.doi.org/10.2196/12915
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31469080
ID  - info:doi/10.2196/12915
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Chee, Ing Cornelia Yin
AU  - Ng, Debby Esperanza
AU  - Lau, Ying
AU  - Dennis, Cindy-Lee
AU  - Chan, Huak Yiong
PY  - 2019/08/29
TI  - Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e12410
VL  - 21
IS  - 8
KW  - anxiety
KW  - loneliness
KW  - postpartum depression
KW  - social support
KW  - technology
KW  - digital health
KW  - peer support
KW  - peer-to-peer support
KW  - online support groups
KW  - internet
N2  - Background: The frenzy of postbirth events often takes a toll on mothers? mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being. Objective: This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period. Methods: A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week?long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period. Results: There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=?2.11; 95% CI ?4.0 to ?0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group. Conclusions: The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices. Trial Registration: ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9416 
UR  - http://www.jmir.org/2019/8/e12410/
UR  - http://dx.doi.org/10.2196/12410
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31469084
ID  - info:doi/10.2196/12410
ER  - 

TY  - JOUR
AU  - Boyle, Anne Jacqueline
AU  - Willey, Suzanne
AU  - Blackmore, Rebecca
AU  - East, Christine
AU  - McBride, Jacqueline
AU  - Gray, Kylie
AU  - Melvin, Glenn
AU  - Fradkin, Rebecca
AU  - Ball, Natahl
AU  - Highet, Nicole
AU  - Gibson-Helm, Melanie
PY  - 2019/08/19
TI  - Improving Mental Health in Pregnancy for Refugee Women: Protocol for the Implementation and Evaluation of a Screening Program in Melbourne, Australia
JO  - JMIR Res Protoc
SP  - e13271
VL  - 8
IS  - 8
KW  - mental health
KW  - refugees
KW  - transients and migrants
KW  - pregnancy
KW  - prenatal care
KW  - mass screening
N2  - Background: Identifying mental health disorders in migrant and refugee women during pregnancy provides an opportunity for interventions that may benefit women and their families. Evidence suggests that perinatal mental health disorders impact mother-infant attachment at critical times, which can affect child development. Postnatal depression resulting in suicide is one of the leading causes of maternal mortality postpartum. Routine screening of perinatal mental health is recommended to improve the identification of depression and anxiety and to facilitate early management. However, screening is poorly implemented into routine practice. This study is the first to investigate routine screening for perinatal mental health in a maternity setting designed for refugee women. This study will determine whether symptoms of depression and anxiety are more likely to be detected by the screening program compared with routine care and will evaluate the screening program?s feasibility and acceptability to women and health care providers (HCPs). Objective: The objectives of this study are (1) to assess if refugee women are more likely to screen risk-positive for depression and anxiety than nonrefugee women, using the Edinburgh Postnatal Depression Scale (EPDS); (2) to assess if screening in pregnancy using the EPDS enables better detection of symptoms of depression and anxiety in refugee women than current routine care; (3) to determine if a screening program for perinatal mental health in a maternity setting designed for refugee women is acceptable to women; and (4) to evaluate the feasibility and acceptability of the perinatal mental health screening program from the perspective of HCPs (including the barriers and enablers to implementation). Methods: This study uses an internationally recommended screening measure, the EPDS, and a locally developed psychosocial questionnaire, both administered in early pregnancy and again in the third trimester. These measures have been translated into the most common languages used by the women attending the clinic and are administered via an electronic platform (iCOPE). This platform automatically calculates the EPDS score and generates reports for the HCP and woman. A total of 119 refugee women and 155 nonrefugee women have been recruited to evaluate the screening program?s ability to detect depression and anxiety symptoms and will be compared with 34 refugee women receiving routine care. A subsample of women will participate in a qualitative assessment of the screening program?s acceptability and feasibility. Health service staff have been recruited to evaluate the integration of screening into maternity care. Results: The recruitment is complete, and data collection and analysis are underway. Conclusions: It is anticipated that screening will increase the identification and management of depression and anxiety symptoms in pregnancy. New information will be generated on how to implement such a program in feasible and acceptable ways that will improve health outcomes for refugee women. International Registered Report Identifier (IRRID): DERR1-10.2196/13271 
UR  - http://www.researchprotocols.org/2019/8/e13271/
UR  - http://dx.doi.org/10.2196/13271
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31429411
ID  - info:doi/10.2196/13271
ER  - 

TY  - JOUR
AU  - Otte, A. Renée
AU  - van Beukering, E. Alice J.
AU  - Boelens-Brockhuis, Lili-Marjan
PY  - 2019/07/24
TI  - Tracker-Based Personal Advice to Support the Baby?s Healthy Development in a Novel Parenting App: Data-Driven Innovation
JO  - JMIR Mhealth Uhealth
SP  - e12666
VL  - 7
IS  - 7
KW  - data analytics
KW  - data-driven science
KW  - mHealth
KW  - mobile apps
KW  - infant development
KW  - infant health
KW  - parenting
N2  - Background: The current generation of millennial parents prefers digital communications and makes use of apps on a daily basis to find information about child-rearing topics. Given this, an increasing amount of parenting apps have become available. These apps also allow parents to track their baby?s development with increasing completeness and precision. The large amounts of data collected in this process provide ample opportunity for data-driven innovation (DDI). Subsequently, apps are increasingly personalized by offering information that is based on the data tracked in the app. In line with this, Philips Avent has developed the uGrow app, a medical-grade app dedicated to new parents for tracking their baby?s development. Through so-called insights, the uGrow app seeks to provide a data-driven solution by offering parents personal advice that is sourced from user-tracked behavioral and contextual data. Objective: The aim of this study was twofold. First, it aimed to give a description of the development process of the insights for the uGrow app. Second, it aimed to present results from a study about parents? experiences with the insights. Methods: The development process comprised 3 phases: a formative phase, development phase, and summative phase. In the formative phase, 3 substudies were executed in series to understand and identify parents? and health care professionals? (HCPs) needs for insights, using qualitative and quantitative methods. After the formative phase, insights were created during the development phase. Subsequently, in the summative phase, these insights were validated against parents? experience using a quantitative approach. Results: As part of the formative phase, parents indicated having a need for smart information based on a data analysis of the data they track in an app. HCPs supported the general concept of insights for the uGrow app, although specific types of insights were considered irrelevant or even risky. After implementing a preliminary set of insights in a prototype version of the uGrow app and testing it with parents, the majority of parents (87%) reported being satisfied with the insights. From these outcomes, a total of 89 insights were implemented in a final version of the uGrow app. In the summative phase, the majority of parents reported experiencing these insights as reassuring and useful (94%), as adding enjoyment (85%), and as motivating for continuing tracking for a longer period of time (77%). Conclusions: Parents experienced the insights in the uGrow app as useful and reassuring and as adding enjoyment to their use of the uGrow app and tracking their baby?s development. The insights development process we followed showed how the quality of insights can be guaranteed by ensuring that insights are relevant, appropriate, and evidence based. In this way, insights are an example of meaningful DDI. 
UR  - https://mhealth.jmir.org/2019/7/e12666/
UR  - http://dx.doi.org/10.2196/12666
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31342901
ID  - info:doi/10.2196/12666
ER  - 

TY  - JOUR
AU  - Dufour, Sinéad
AU  - Fedorkow, Donna
AU  - Kun, Jessica
AU  - Deng, Xiaoxuan Shirley
AU  - Fang, Qiyin
PY  - 2019/07/11
TI  - Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study
JO  - JMIR Mhealth Uhealth
SP  - e12587
VL  - 7
IS  - 7
KW  - postpartum
KW  - pelvic floor
KW  - mobile health
KW  - feasibility study
KW  - wireless technology
KW  - wearable technology
KW  - computer games
KW  - biofeedback
N2  - Background: The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective: The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods: A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne?s interpretive description approach. Results: A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions: Our pilot study demonstrated the potential for mHealth solution?enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration: ClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954 
UR  - http://mhealth.jmir.org/2019/7/e12587/
UR  - http://dx.doi.org/10.2196/12587
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31298221
ID  - info:doi/10.2196/12587
ER  - 

TY  - JOUR
AU  - Moon, Y. Rachel
AU  - Mathews, Anita
AU  - Oden, Rosalind
AU  - Carlin, Rebecca
PY  - 2019/07/09
TI  - Mothers? Perceptions of the Internet and Social Media as Sources of Parenting and Health Information: Qualitative Study
JO  - J Med Internet Res
SP  - e14289
VL  - 21
IS  - 7
KW  - internet
KW  - parenting
KW  - social media
KW  - focus groups
N2  - Background: Traditionally, guidance and support to new parents have come from family, friends, and health care providers. However, the internet and social media are growing sources of guidance and support for parents. Little is known about how the internet and social media are used by parents of young infants and specifically about parental perceptions of the internet and social media as sources of parenting and infant health information. Objective: The aim of this study was to explore, using qualitative methods, parental perceptions of the advantages and disadvantages of the internet and social media as sources of parenting and health information regarding their infant. Methods: A total of 28 mothers participated in focus groups or individual interviews. Probing questions concerning parenting and health information sources were asked. Themes were developed in an iterative manner from coded data. Results: The central themes were (1) reasons that mothers turn to the internet for parenting and health information, (2) cautionary advice about the internet, and (3) reasons that mothers turn to social media for parenting and health information. Mothers appreciated the ability to gather unlimited information and multiple opinions quickly and anonymously, but recognized the need to use reputable sources of information. Mothers also appreciated the immediacy of affirmation, support, and tailored information available through social media. Conclusions: The internet and social media are rapidly becoming important and trusted sources of parenting and health information that mothers turn to when making infant care decisions. 
UR  - https://www.jmir.org/2019/7/e14289/
UR  - http://dx.doi.org/10.2196/14289
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31290403
ID  - info:doi/10.2196/14289
ER  - 

TY  - JOUR
AU  - White, Becky
AU  - Giglia, C. Roslyn
AU  - White, A. James
AU  - Dhaliwal, Satvinder
AU  - Burns, K. Sharyn
AU  - Scott, A. Jane
PY  - 2019/06/20
TI  - Gamifying Breastfeeding for Fathers: Process Evaluation of the Milk Man Mobile App
JO  - JMIR Pediatr Parent
SP  - e12157
VL  - 2
IS  - 1
KW  - mHealth
KW  - app
KW  - breastfeeding
KW  - fathers
KW  - gamification
KW  - socially connected
KW  - push notifications
N2  - Background: Mobile technology offers unique opportunities to reach people with health promotion interventions. Breastfeeding is an important public health issue, and fathers are a key support. Milk Man is a father-focused breastfeeding app that sought to engage fathers with information and conversation about breastfeeding, with the goal to impact positively on breastfeeding duration. Objective: The study aimed to describe the process evaluation of the Milk Man app that was trialed in the Parent Infant Feeding Initiative randomized controlled trial. Methods: The app used an information library, gamification, push notifications, and social connectivity via a Web-based conversation forum, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks of gestation to 6 months postpartum. Process evaluation data were collected from a self-completed questionnaire administered via a Web-based link sent to participants at 6 weeks postpartum, and app analytics data were collected directly from the app. Quantitative data from both sources and qualitative responses to open-ended questions were used to triangulate findings to investigate patterns of usage and the effectiveness of each app engagement strategy to motivate and engage users. Results: A total of 80.3% (586/730) of participants, who were randomized to receive the app, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the 2 main motivators to app use. Fathers used the app most while their partners were still pregnant and in the weeks immediately after the birth of their baby. Perspectives on the gamification strategy were varied. However, at 6 weeks postpartum, approximately one-third of fathers still using the app said that the gamification elements were encouraging the app use. The ease of use of the app and the design were important elements that were rated positively. The conversation forum emerged as the hub of app activity; all but 1 of the most accessed library articles and external organization links had been prompted as part of a conversation starter. Fathers posted comments in the conversation forum 1126 times (average of 2.21 per user) and voted in polls 3096 times (average of 6 per user). Conclusions: These results demonstrate that the Milk Man app was an acceptable source of breastfeeding information and support that fathers and fathers-to-be are prepared to use throughout the perinatal period. The app showed encouraging results with facilitating conversation between partners. The conversation forum was clearly central to the success of the app, and fathers provided suggestions for improvement. Gamification results were varied, yet it was a key motivator for some users. These results provide valuable insight into the acceptability of the engagement strategies, including motivations for use and user perspectives on the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?ACTRN=12614000605695  
UR  - http://pediatrics.jmir.org/2019/1/e12157/
UR  - http://dx.doi.org/10.2196/12157
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518324
ID  - info:doi/10.2196/12157
ER  - 

TY  - JOUR
AU  - Haragan, F. Adriane
AU  - Zuwiala, A. Carly
AU  - Himes, P. Katherine
PY  - 2019/6/7
TI  - Online Information About Periviable Birth: Quality Assessment
JO  - JMIR Pediatr Parent
SP  - e12524
VL  - 2
IS  - 1
KW  - periviable birth
KW  - patient education
KW  - patient counseling
KW  - Internet resources
N2  - Background: Over 20,000 parents in the United States face the challenge of participating in decisions about whether to use life support for their infants born on the cusp of viability every year. Clinicians must help families grasp complex medical information about their baby?s immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision want supplemental information and frequently seek medical information on the Internet. Empirical evidence about the quality of websites is lacking. Objective: We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. Methods: We read a counseling script to 20 pregnant participants that included information typically provided by perinatal and neonatal providers when periviable birth is imminent. The women were then asked to list terms they would use to search the Internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a Google search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address key components of counseling around periviable birth as outlined by professional organizations. DISCERN scores were classified as low quality if scores were 2, fair quality if scores were 3, and high quality if scores were 4 or higher. Scores of 6 or higher on the ECT were considered high quality. Interreviewer agreement was assessed by calculated kappa statistic. Results: A total of 97 websites were reviewed. Over half (57/97, 59%) were for-profit sites, news stories, or personal blogs; 28% (27/97) were government or medical sites; and 13% (13/97) were nonprofit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented as well as data regarding treatment choices. Only 7% (7/97) of the websites were high quality as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18% of websites (17/97) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong, with kappa ranging from .72 to .91. Conclusions: Most information about periviable birth found on the Internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort care or how treatment decisions impact quality of life. 
UR  - http://pediatrics.jmir.org/2019/1/e12524/
UR  - http://dx.doi.org/10.2196/12524
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518325
ID  - info:doi/10.2196/12524
ER  - 

TY  - JOUR
AU  - Duffecy, Jennifer
AU  - Grekin, Rebecca
AU  - Hinkel, Hannah
AU  - Gallivan, Nicholas
AU  - Nelson, Graham
AU  - O'Hara, W. Michael
PY  - 2019/05/28
TI  - A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial
JO  - JMIR Ment Health
SP  - e10778
VL  - 6
IS  - 5
KW  - postpartum depression
KW  - cognitive behavioral therapy
KW  - internet
KW  - social support
N2  - Background: Postpartum depression (PPD) has a 20% 3-month prevalence rate. The consequences of PPD are significant for the mother, infant, and the family. There is a need for preventive interventions for PPD, which are effective and accessible; however, many barriers exist for women who attempt to access perinatal depression prevention programs. Internet interventions for the treatment and prevention of depression are widely accepted as efficacious and may overcome some of the issues pertaining to access to treatment barriers perinatal women face. However, internet interventions offered without any human support tend to have low adherence but positive outcomes for those who do complete treatment. Internet support groups often have high levels of adherence but minimal data supporting efficacy as a treatment for depression. Taken together, these findings suggest that combining the treatment components of individual interventions with the support provided by an internet support group might create an intervention with the scalability and cost-effectiveness of an individual intervention and the better outcomes typically found in supported interventions. Objectives: This study aimed to describe the development of a cognitive behavioral therapy (CBT) internet intervention with peer support to prevent PPD and examine preliminary depression and site usage outcomes. Methods: User-centered design groups were used to develop the internet intervention. Once the intervention was developed, women who were 20 to 28 weeks pregnant with symptoms of depression (Patient Health Questionnaire-8 scores of 5-14) but who had no major depression diagnosis were enrolled in a randomized controlled trial (RCT) to compare 8 weeks of a CBT-based internet intervention with peer support to an individual internet intervention designed to prevent PPD. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), and then 4 weeks and 6 weeks postpartum. Results: A total of 25 women were randomized. Of these, 24 women completed the RCT. Patient Health Questionnaire-9 scores at 6 weeks postpartum remained below the clinical threshold for referral for treatment in both groups, with depression measures showing a decrease in symptoms from baseline to postpartum. At 6 weeks postpartum, only 4% (1/24) met the criteria for PPD. There was no difference between groups in adherence to the intervention, with an average of 14.55 log-ins over the course of treatment. Conclusions: Results suggest women were responsive to both peer support and individual internet interventions to prevent PPD and that peer support may be a useful feature to keep participants adherent. Trial Registration: ClinicalTrials.gov NCT02121015; https://clinicaltrials.gov/ct2/show/NCT02121015 (archived by WebCite at http://www.webcitation.org/765a7qBKy) 
UR  - http://mental.jmir.org/2019/5/e10778/
UR  - http://dx.doi.org/10.2196/10778
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31140443
ID  - info:doi/10.2196/10778
ER  - 

TY  - JOUR
AU  - Chan, Ling Ko
AU  - Leung, Cheong Wing
AU  - Tiwari, Agnes
AU  - Or, Lun Ka
AU  - Ip, Patrick
PY  - 2019/05/14
TI  - Using Smartphone-Based Psychoeducation to Reduce Postnatal Depression Among First-Time Mothers: Randomized Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e12794
VL  - 7
IS  - 5
KW  - smartphone technology
KW  - postnatal depression
KW  - psychoeducation
KW  - randomized controlled trial
N2  - Background: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. Objective: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. Methods: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as ?intervention? or ?control? by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. Results: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was ?0.65 (95% CI ?1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. Conclusions: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. Trial Registration: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384 
UR  - http://mhealth.jmir.org/2019/5/e12794/
UR  - http://dx.doi.org/10.2196/12794
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31094354
ID  - info:doi/10.2196/12794
ER  - 

TY  - JOUR
AU  - Sidhu, Suhail
AU  - Ma, Kaoer
AU  - Sadovnikova, Anna
PY  - 2019/05/01
TI  - Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory
JO  - JMIR Pediatr Parent
SP  - e12364
VL  - 2
IS  - 1
KW  - milk production
KW  - milk supply
KW  - human lactation
KW  - breastfeeding
KW  - breastfeeding app
KW  - smartphone app
KW  - Social Cognitive Theory
KW  - breastfeeding self-efficacy
N2  - Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. 
UR  - http://pediatrics.jmir.org/2019/1/e12364/
UR  - http://dx.doi.org/10.2196/12364
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518317
ID  - info:doi/10.2196/12364
ER  - 

TY  - JOUR
AU  - Marko, I. Kathryn
AU  - Ganju, Nihar
AU  - Krapf, M. Jill
AU  - Gaba, D. Nancy
AU  - Brown, A. James
AU  - Benham, J. Joshua
AU  - Oh, Julia
AU  - Richards, M. Lorna
AU  - Meltzer, C. Andrew
PY  - 2019/05/01
TI  - A Mobile Prenatal Care App to Reduce In-Person Visits: Prospective Controlled Trial
JO  - JMIR Mhealth Uhealth
SP  - e10520
VL  - 7
IS  - 5
KW  - prenatal care
KW  - mobile applications
KW  - patient monitoring
KW  - patient safety
KW  - patient satisfaction
KW  - technological innovations
KW  - controlled clinical trial
KW  - mobile health
N2  - Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. Trial Registration: ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517) 
UR  - https://mhealth.jmir.org/2019/5/e10520/
UR  - http://dx.doi.org/10.2196/10520
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31042154
ID  - info:doi/10.2196/10520
ER  - 

TY  - JOUR
AU  - Green, P. Eric
AU  - Pearson, Nicholas
AU  - Rajasekharan, Sathyanath
AU  - Rauws, Michiel
AU  - Joerin, Angela
AU  - Kwobah, Edith
AU  - Musyimi, Christine
AU  - Bhat, Chaya
AU  - Jones, M. Rachel
AU  - Lai, Yihuan
PY  - 2019/04/29
TI  - Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study
JO  - JMIR Res Protoc
SP  - e11800
VL  - 8
IS  - 4
KW  - telemedicine
KW  - mental health
KW  - depression
KW  - artificial intelligence
KW  - Kenya
KW  - text messaging
KW  - chatbot
KW  - conversational agent
N2  - Background: Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: The objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. Methods: We will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment. Results: Our team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019. Conclusions: The main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population. International Registered Report Identifier (IRRID): DERR1-10.2196/11800 
UR  - http://www.researchprotocols.org/2019/4/e11800/
UR  - http://dx.doi.org/10.2196/11800
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31033448
ID  - info:doi/10.2196/11800
ER  - 

TY  - JOUR
AU  - Richardson, Brianna
AU  - Dol, Justine
AU  - Rutledge, Kallen
AU  - Monaghan, Joelle
AU  - Orovec, Adele
AU  - Howie, Katie
AU  - Boates, Talia
AU  - Smit, Michael
AU  - Campbell-Yeo, Marsha
PY  - 2019/04/15
TI  - Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review
JO  - JMIR Mhealth Uhealth
SP  - e11620
VL  - 7
IS  - 4
KW  - parenting
KW  - intensive care units, neonatal
KW  - review
KW  - mobile health
KW  - mHealth
KW  - mobile apps
KW  - eHealth
KW  - education, nonprofessional
KW  - infant, premature
N2  - Background: Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents. Objective: This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility. Methods: We systematically searched the Apple App Store and Google Play using 49 key terms (eg, ?preterm infant?) from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app?s content usability; and Trust it or Trash It to measure credibility. Results: The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer?s expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures. Conclusions: This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility. 
UR  - http://mhealth.jmir.org/2019/4/e11620/
UR  - http://dx.doi.org/10.2196/11620
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30985282
ID  - info:doi/10.2196/11620
ER  - 

TY  - JOUR
AU  - Lanssens, Dorien
AU  - Vandenberk, Thijs
AU  - Lodewijckx, Joy
AU  - Peeters, Tessa
AU  - Storms, Valerie
AU  - Thijs, M. Inge
AU  - Grieten, Lars
AU  - Gyselaers, Wilfried
PY  - 2019/04/15
TI  - Midwives?, Obstetricians?, and Recently Delivered Mothers? Perceptions of Remote Monitoring for Prenatal Care: Retrospective Survey
JO  - J Med Internet Res
SP  - e10887
VL  - 21
IS  - 4
KW  - remote monitoring
KW  - gestational hypertensive diseases
KW  - questionnaires
KW  - monitoring, ambulatory
KW  - hypertension, pregnancy-induced
KW  - surveys and questionnaires
N2  - Background: The Pregnancy Remote Monitoring (PREMOM) study enrolled pregnant women at increased risk of developing hypertensive disorders of pregnancy and investigated the effect of remote monitoring in addition to their prenatal follow-up. Objective: The objective of this study was to investigate the perceptions and experiences of remote monitoring among mothers, midwives, and obstetricians who participated in the PREMOM study. Methods: We developed specific questionnaires for the mothers, midwives, and obstetricians addressing 5 domains: (1) prior knowledge and experience of remote monitoring, (2) reactions to abnormal values, (3) privacy, (4) quality and patient safety, and (5) financial aspects. We also questioned the health care providers about which issues they considered important when implementing remote monitoring. We used a 5-point Likert scale to provide objective scores. It was possible to add free-text feedback at every question. Results: A total of 91 participants completed the questionnaires. The mothers, midwives, and obstetricians reported positive experiences and perceptions of remote monitoring, although most of them had no or little prior experience with this technology. They supported a further rollout of remote monitoring in Belgium. Nearly three-quarters of the mothers (34/47, 72%) did not report any problems with taking the measurements at the required times. Almost half of the mothers (19/47, 40%) wanted to be contacted within 3 to 12 hours after abnormal measurement values, preferably by telephone. Conclusions: Although most of midwives and obstetricians had no or very little experience with remote monitoring before enrolling in the PREMOM study, they reported, based on their one-year experience, that remote monitoring was an important component in the follow-up of high-risk pregnancies and would recommend it to their colleagues and pregnant patients. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/ct2/show/NCT03246737 (Archived by WebCite at http://www.webcitation.org/76KVnHSYY) 
UR  - https://www.jmir.org/2019/4/e10887/
UR  - http://dx.doi.org/10.2196/10887
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30985286
ID  - info:doi/10.2196/10887
ER  - 

TY  - JOUR
AU  - Gootjes, V. Dionne
AU  - van Dijk, R. Matthijs
AU  - Koster, PH Maria
AU  - Willemsen, P. Sten
AU  - Steegers, AP Eric
AU  - Steegers-Theunissen, PM Régine
PY  - 2019/04/11
TI  - Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands
JO  - JMIR Mhealth Uhealth
SP  - e11664
VL  - 7
IS  - 4
KW  - pregnancy
KW  - telemedicine
KW  - lifestyle
KW  - nutritional status
KW  - preconception care
N2  - Background: In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. Objective: This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. Methods: We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. Results: Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). Conclusions: The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation. 
UR  - https://mhealth.jmir.org/2019/4/e11664/
UR  - http://dx.doi.org/10.2196/11664
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30973345
ID  - info:doi/10.2196/11664
ER  - 

TY  - JOUR
AU  - Litchman, L. Michelle
AU  - Tran, MJ
AU  - Dearden, E. Susan
AU  - Guo, Jia-Wen
AU  - Simonsen, E. Sara
AU  - Clark, Lauren
PY  - 2019/03/14
TI  - What Women With Disabilities Write in Personal Blogs About Pregnancy and Early Motherhood: Qualitative Analysis of Blogs
JO  - JMIR Pediatr Parent
SP  - e12355
VL  - 2
IS  - 1
KW  - disabled persons
KW  - pregnancy
KW  - blog
KW  - women?s health
KW  - parenting
KW  - mothers
KW  - spinal cord injury
KW  - autism
KW  - traumatic brain injury
N2  - Background: More than 1 in 10 women of reproductive age identify as having some type of disability. Most of these women are able to become pregnant and have similar desires for motherhood as women without disability. Women with disability, however, face greater stigma and stereotyping, additional risk factors, and may be less likely to receive adequate reproductive health care compared with their peers without disability. More and more individuals, including those with disability, are utilizing the internet to seek information and peer support. Blogs are one source of peer-to-peer social media engagement that may provide a forum for women with disability to both share and obtain peer-to-peer information and support. Nevertheless, it is not clear what content about reproductive health and pregnancy and/or motherhood is featured in personal blogs authored by women with spinal cord injury (SCI), traumatic brain injury (TBI), spina bifida, and autism. Objective: The objective of this study was twofold: (1) to examine the information being shared in blogs by women with 4 types of disabilities, namely, SCI, TBI, spina bifida, and autism, about reproductive health, disability, health care, pregnancy, and motherhood; and (2) to classify the content of reproductive health experiences addressed by bloggers to better understand what they viewed as important. Methods: Personal blogs were identified by searching Google with keywords related to disabilities, SCI, TBI, spina bifida, and autism, and a variety of keywords related to reproductive health. The first 10 pages of each database search in Google, based on the relevance of the search terms, were reviewed and all blogs in these pages were included. Blog inclusion criteria were as follows: (1) written by a woman or care partner (ie, parent or spouse) of a woman with a self-identified diagnosis of SCI, TBI, spina bifida, or autism; (2) focused on the personal experience of health and health care during the prepregnancy, prenatal, antepartum, intrapartum, and/or postpartum periods; (3) written in English; and (4) published between 2013 and 2017. A descriptive and thematic qualitative analysis of blogs and corresponding comments was facilitated with NVivo software and matrix analysis. Results: Our search strategy identified 125 blogs that met all the inclusion criteria; no blogs written by women with spina bifida were identified. We identified 4 reproductive health themes featured in the blog of women with disabilities: (1) (in)accessible motherhood, (2) (un)supportive others, (3) different, but not different, and (4) society questioning motherhood. Conclusions: This analysis of personal blogs about pregnancy and health care written by women with SCI, TBI, and autism provides a glimpse into their experiences. The challenges faced by these women and the adaptations they made to successfully navigate pregnancy and early motherhood provide insights that can be used to shape future research. 
UR  - http://pediatrics.jmir.org/2019/1/e12355/
UR  - http://dx.doi.org/10.2196/12355
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518332
ID  - info:doi/10.2196/12355
ER  - 

TY  - JOUR
AU  - Tang, Shangfeng
AU  - Ghose, Bishwajit
AU  - Hoque, Rakibul Md
AU  - Hao, Gang
AU  - Yaya, Sanni
PY  - 2019/02/28
TI  - Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study
JO  - JMIR Mhealth Uhealth
SP  - e10645
VL  - 7
IS  - 2
KW  - antenatal care
KW  - facility delivery services
KW  - postnatal care
KW  - mHealth
KW  - Bangladesh
N2  - Background: The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization. Objective: In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs). Methods: Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques. Results: More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas. Conclusions: The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care. 
UR  - http://mhealth.jmir.org/2019/2/e10645/
UR  - http://dx.doi.org/10.2196/10645
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30816850
ID  - info:doi/10.2196/10645
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Ng, Debby Esperanza
PY  - 2019/02/13
TI  - Evaluation of Mothers? Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study
JO  - J Med Internet Res
SP  - e11065
VL  - 21
IS  - 2
KW  - education
KW  - mothers
KW  - parenting
KW  - technology
N2  - Background: Transitioning into parenthood can be stressful as parents struggle to cope with new parenting responsibilities. Although perinatal care in hospitals aims to improve parental outcomes, there is a general consensus that it is suboptimal and insufficient. Therefore, many studies have designed intervention methods to supplement support for parents during this stressful period. However, studies often focus on parental outcomes as indicators of their interventions? success and effectiveness. Studies evaluating participants? experiences and feedback are limited. Objective: This study aimed to examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study. Methods: A qualitative semistructured interview was conducted with 16 mothers (6 control and 10 intervention) from a randomized controlled trial. The supportive education parenting program received by the intervention group included 2 phone-based perinatal educational sessions, a phone-based educational session after childbirth, and a 1-month postpartum access to a mobile health app. The interviews were approximately 30- to 60-min long, audiotaped and transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. Results: The 3 main themes evaluating mothers? experiences and perceptions were generated: (1) changed perspective toward parenthood, (2) journey from pregnancy to after birth, and (3) a way forward. Mothers from the intervention group mostly had good perinatal experiences with sufficient support received, which elevated their emotional well-being and increased parenting involvement. Mothers in the control group, although satisfied with the hospital care received, were more stressed and shared a need for professional advice and extra support. Apart from technical enhancements, mothers also requested extended social support during early pregnancy up to 1 year postpartum, taking into consideration Asian cultural practices. Conclusions: Mothers who received the intervention were overall satisfied with the support provided by the technology-based supportive educational parenting program. The success of the educational program in this study highlights the need to supplement standard care in hospitals with technology-based educational programs. Future research should include fathers? perceptions to attain an in-depth understanding of overall participants? experiences and needs in the future development of supportive and educational programs. 
UR  - https://www.jmir.org/2019/2/e11065/
UR  - http://dx.doi.org/10.2196/11065
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30758295
ID  - info:doi/10.2196/11065
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Ng, Mei Yvonne Peng
AU  - Ng, Debby Esperanza
AU  - Siew, Ling An
AU  - Mörelius, Evalotte
AU  - Yoong, Joanne
AU  - Gandhi, Mihir
PY  - 2019/02/13
TI  - Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e10816
VL  - 21
IS  - 2
KW  - parents
KW  - social support
N2  - Background: Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child?s development. For the family?s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period. Objective: This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples. Methods: A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura?s self-efficacy theory and Bowlby?s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables. Results: The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD ?1.32; 95% CI ?1.89 to ?0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD ?0.91; 95% CI ?1.34 to ?0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD ?0.82; 95% CI ?1.15 to ?0.49; P<.001). Conclusions: The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents? needs and create positive childbirth experiences, which may in turn encourage parents to have more children. Trial Registration: ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO). 
UR  - http://www.jmir.org/2019/2/e10816/
UR  - http://dx.doi.org/10.2196/10816
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30758289
ID  - info:doi/10.2196/10816
ER  - 

TY  - JOUR
AU  - Laws, Rachel
AU  - Walsh, D. Adam
AU  - Hesketh, D. Kylie
AU  - Downing, L. Katherine
AU  - Kuswara, Konsita
AU  - Campbell, J. Karen
PY  - 2019/01/23
TI  - Differences Between Mothers and Fathers of Young Children in Their Use of the Internet to Support Healthy Family Lifestyle Behaviors: Cross-Sectional Study
JO  - J Med Internet Res
SP  - e11454
VL  - 21
IS  - 1
KW  - child
KW  - family
KW  - healthy lifestyle
KW  - infant
KW  - internet
KW  - obesity
KW  - parents
N2  - Background: In early life, both mothers and fathers are important influences on their children?s diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers? and fathers? use and sociodemographic predictors. Objective: The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child?s health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics. Methods: We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents? own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes. Results: Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5% vs 93, 46.5%), child health (226, 77.1% vs 84, 42.4%), child feeding (136, 46.3% vs 35, 17.5%), and child play (123, 42.1% vs 28, 14.0%) and intended to use Facebook to connect with other parents (200, 74.9% vs 43, 30.5%). Despite the high use of the internet to support family health behaviors, only 15.9% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child?s weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors. Conclusions: Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child?s life. Trial Registration: ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050 
UR  - http://www.jmir.org/2019/1/e11454/
UR  - http://dx.doi.org/10.2196/11454
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30674450
ID  - info:doi/10.2196/11454
ER  - 

TY  - JOUR
AU  - Konheim-Kalkstein, L. Yasmine
AU  - Miron-Shatz, Talya
AU  - Israel, Jenny Leah
PY  - 2018/12/18
TI  - How Women Evaluate Birth Challenges: Analysis of Web-Based Birth Stories
JO  - JMIR Pediatr Parent
SP  - e12206
VL  - 1
IS  - 2
KW  - patient-centered care
KW  - decision making
KW  - parturition
KW  - women?s health
N2  - Background: Birth stories provide an intimate glimpse into women?s birth experiences in their own words. Understanding the emotions elicited in women by certain types of behaviors during labor and delivery could help those in the health care community provide better emotional care for women in labor. Objective: The aim of this study was to understand which supportive reactions and behaviors contributed to negative or positive emotions among women with regard to their labor and delivery experience. Methods: We sampled 10 women?s stories from a popular blog that described births that strayed from the plan. Overall, 90 challenging events that occurred during labor and delivery were identified. Each challenge had an emotionally positive, negative, or neutral evaluation by the woman. We classified supportive and unsupportive behaviors in response to these challenges and examined their association with the woman?s emotional appraisal of the challenges. Results: Overall, 4 types of behaviors were identified: informational inclusion, decisional inclusion (mostly by health care providers), practical support, and emotional support (mostly by partners). Supportive reactions were not associated with emotional appraisal; however, unsupportive reactions were associated with women appraising the challenge negatively (Fisher exact test, P=.02). Conclusions: Although supportive behaviors did not elicit any particular emotion, unsupportive behaviors did cause women to view challenges negatively. It is worthwhile conducting a larger scale investigation to observe what happens when patients express their needs, particularly when challenges present themselves during labor, and health care professionals strive to cater to them. 
UR  - http://pediatrics.jmir.org/2018/2/e12206/
UR  - http://dx.doi.org/10.2196/12206
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518300
ID  - info:doi/10.2196/12206
ER  - 

TY  - JOUR
AU  - Cluxton-Keller, Fallon
AU  - Williams, Melony
AU  - Buteau, Jennifer
AU  - Donnelly, L. Craig
AU  - Stolte, Patricia
AU  - Monroe-Cassel, Maggie
AU  - Bruce, L. Martha
PY  - 2018/12/10
TI  - Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial
JO  - JMIR Ment Health
SP  - e11513
VL  - 5
IS  - 4
KW  - videoconferencing
KW  - family therapy, depression
N2  - Background: The Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas. Objective: This pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation. Methods: A total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act?compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes. Results: No families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004). Conclusions: This pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our findings are very promising, but more research is needed to ultimately influence mental health practices and policies that pertain to video-delivered mental health interventions in unsupervised settings (eg, homes). 
UR  - http://mental.jmir.org/2018/4/e11513/
UR  - http://dx.doi.org/10.2196/11513
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30530456
ID  - info:doi/10.2196/11513
ER  - 

TY  - JOUR
AU  - Mo, Yushi
AU  - Gong, Wenjie
AU  - Wang, Joyce
AU  - Sheng, Xiaoqi
AU  - Xu, R. Dong
PY  - 2018/11/29
TI  - The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study
JO  - JMIR Mhealth Uhealth
SP  - e11508
VL  - 6
IS  - 11
KW  - antenatal care
KW  - antenatal depression
KW  - app
KW  - mobile phone
N2  - Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression. 
UR  - http://mhealth.jmir.org/2018/11/e11508/
UR  - http://dx.doi.org/10.2196/11508
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30497996
ID  - info:doi/10.2196/11508
ER  - 

TY  - JOUR
AU  - Doherty, Kevin
AU  - Barry, Marguerite
AU  - Marcano-Belisario, José
AU  - Arnaud, Bérenger
AU  - Morrison, Cecily
AU  - Car, Josip
AU  - Doherty, Gavin
PY  - 2018/11/27
TI  - A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study
JO  - JMIR Ment Health
SP  - e10007
VL  - 5
IS  - 4
KW  - engagement
KW  - mental health
KW  - mHealth
KW  - midwifery
KW  - perinatal depression
KW  - pregnancy
KW  - self-report
KW  - well-being
KW  - mobile phone
N2  - Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening. Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy. Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis. Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement. Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies. 
UR  - http://mental.jmir.org/2018/4/e10007/
UR  - http://dx.doi.org/10.2196/10007
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30482742
ID  - info:doi/10.2196/10007
ER  - 

TY  - JOUR
AU  - Jensen, K. Jessica
AU  - Ciolino, D. Jody
AU  - Diebold, Alicia
AU  - Segovia, Melissa
AU  - Degillio, Aria
AU  - Solano-Martinez, Jesus
AU  - Tandon, Darius S.
PY  - 2018/11/20
TI  - Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e11624
VL  - 7
IS  - 11
KW  - depression
KW  - postpartum
KW  - pregnancy
KW  - randomized controlled trial
KW  - community health
N2  - Background: Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. Objective: This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. Methods: A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ?16 years enrolled in HV programs, who are 33 or more weeks? gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. Results: We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. Conclusions: There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. Trial Registration: ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) International Registered Report Identifier (IRRID): PRR1-10.2196/11624 
UR  - http://www.researchprotocols.org/2018/11/e11624/
UR  - http://dx.doi.org/10.2196/11624
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30459138
ID  - info:doi/10.2196/11624
ER  - 

TY  - JOUR
AU  - Skelton, Renee Kara
AU  - Evans, Retta
AU  - LaChenaye, Jenna
AU  - Amsbary, Jonathan
AU  - Wingate, Martha
AU  - Talbott, Laura
PY  - 2018/11/05
TI  - Exploring Social Media Group Use Among Breastfeeding Mothers: Qualitative Analysis
JO  - JMIR Pediatr Parent
SP  - e11344
VL  - 1
IS  - 2
KW  - social media
KW  - milk
KW  - human
KW  - breastfeeding
N2  - Background: Breastfeeding is well known as the optimal source of nutrition for the first year of life. However, suboptimal exclusively breastfeeding rates in the United States are still prevalent. Given the extent of social media use and the accessibility of this type of peer-to-peer support, the role of social networking sites in enabling and supporting breastfeeding mothers needs to be further explored. Objective: This study aimed to leverage mothers? attitudes and behaviors of social media usage to understand effects on breastfeeding outcomes. Methods: Participants were recruited from 1 probreastfeeding social media group with over 6300 members throughout the United States. Online focus group discussions were conducted with 21 women; interviews were conducted with 12 mothers. Qualitative data were aggregated for thematic analysis. Results: Participants indicated that the social media group formed a community of support for breastfeeding, with normalizing breastfeeding, empowerment for breastfeeding, resource for breastfeeding, and shared experiences in breastfeeding as additional themes. Conclusions: According to participants, social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors as well as lead to longer duration of breastfeeding. The results of this study should be taken into account when designing interventions for breastfeeding mothers. 
UR  - http://pediatrics.jmir.org/2018/2/e11344/
UR  - http://dx.doi.org/10.2196/11344
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518305
ID  - info:doi/10.2196/11344
ER  - 

TY  - JOUR
AU  - Comulada, Scott W.
AU  - Swendeman, Dallas
AU  - Rezai, Roxana
AU  - Ramanathan, Nithya
PY  - 2018/11/05
TI  - Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study
JO  - JMIR Formativ Res
SP  - e11062
VL  - 2
IS  - 2
KW  - changepoint
KW  - diet quality
KW  - mobile phone
KW  - moving average
KW  - physical activity
KW  - stress
KW  - time series
N2  - Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals? daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=?.14) and diet quality (r=?.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. 
UR  - https://formative.jmir.org/2018/2/e11062/
UR  - http://dx.doi.org/10.2196/11062
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30684407
ID  - info:doi/10.2196/11062
ER  - 

TY  - JOUR
AU  - Jiang, Hong
AU  - Li, Mu
AU  - Wen, Ming Li
AU  - Baur, A. Louise
AU  - He, Gengsheng
AU  - Ma, Xiaoying
AU  - Qian, Xu
PY  - 2018/10/29
TI  - A Short Message Service Intervention for Improving Infant Feeding Practices in Shanghai, China: Planning, Implementation, and Process Evaluation
JO  - JMIR Mhealth Uhealth
SP  - e11039
VL  - 6
IS  - 10
KW  - mHealth
KW  - short message service
KW  - breastfeeding
KW  - infant feeding practices
KW  - health services
KW  - planning and development
KW  - implementation
KW  - process evaluation
N2  - Background: Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. Objective: Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. Methods: The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. Results: We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. Conclusions: This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited. 
UR  - http://mhealth.jmir.org/2018/10/e11039/
UR  - http://dx.doi.org/10.2196/11039
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30373728
ID  - info:doi/10.2196/11039
ER  - 

TY  - JOUR
AU  - Endehabtu, Berhanu
AU  - Weldeab, Adane
AU  - Were, Martin
AU  - Lester, Richard
AU  - Worku, Abebaw
AU  - Tilahun, Binyam
PY  - 2018/10/17
TI  - Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study
JO  - JMIR Pediatr Parent
SP  - e9
VL  - 1
IS  - 2
KW  - mHealth
KW  - mobile phone
KW  - pregnant women
KW  - SMS
KW  - willingness
KW  - Ethiopia
KW  - antenatal care
KW  - maternal health
N2  - Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)?based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message?based mHealth intervention. Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message?based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message?based mHealth interventions. 
UR  - http://pediatrics.jmir.org/2018/2/e9/
UR  - http://dx.doi.org/10.2196/pediatrics.9618
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518334
ID  - info:doi/10.2196/pediatrics.9618
ER  - 

TY  - JOUR
AU  - Swendeman, Dallas
AU  - Comulada, Scott Warren
AU  - Koussa, Maryann
AU  - Worthman, M. Carol
AU  - Estrin, Deborah
AU  - Rotheram-Borus, Jane Mary
AU  - Ramanathan, Nithya
PY  - 2018/9/21
TI  - Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers
JO  - JMIR Mhealth Uhealth
SP  - e176
VL  - 6
IS  - 9
KW  - self-monitoring
KW  - mHealth
KW  - diet
KW  - physical activity
KW  - stress
KW  - multi-method
KW  - mobile phones
KW  - C-reactive protein
N2  - Background: Multiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its? sequelae diseases are elevated among minority populations. Objective: To examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers. Methods: A purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein?Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions were used to assess the strength of associations between variables. Results: Almost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P<.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=?.32), C-reactive protein level (r=?.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein?Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=?.35 to ?.44, P<.05). Conclusions: Brief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support. 
UR  - http://mhealth.jmir.org/2018/9/e176/
UR  - http://dx.doi.org/10.2196/mhealth.9378
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30249576
ID  - info:doi/10.2196/mhealth.9378
ER  - 

TY  - JOUR
AU  - Silfee, J. Valerie
AU  - Lopez-Cepero, Andrea
AU  - Lemon, C. Stephenie
AU  - Estabrook, Barbara
AU  - Nguyen, Oanh
AU  - Wang, L. Monica
AU  - Rosal, C. Milagros
PY  - 2018/09/10
TI  - Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women
JO  - JMIR Formativ Res
SP  - e18
VL  - 2
IS  - 2
KW  - Facebook
KW  - health disparities
KW  - postpartum women
KW  - social media
KW  - weight loss
N2  - Background: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. Objective: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. Methods: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants? questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. Results: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. Conclusions: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention. 
UR  - http://formative.jmir.org/2018/2/e18/
UR  - http://dx.doi.org/10.2196/formative.9597
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30684423
ID  - info:doi/10.2196/formative.9597
ER  - 

TY  - JOUR
AU  - Pretorius, A. Kelly
AU  - Mackert, Michael
AU  - Wilcox, B. Gary
PY  - 2018/09/07
TI  - Sudden Infant Death Syndrome and Safe Sleep on Twitter: Analysis of Influences and Themes to Guide Health Promotion Efforts
JO  - JMIR Pediatr Parent
SP  - e10435
VL  - 1
IS  - 2
KW  - sudden infant death
KW  - sudden unexpected infant death
KW  - accidental suffocation in a sleeping environment
KW  - infant mortality
KW  - safe sleep
KW  - sleep environment
KW  - social media
KW  - Twitter
KW  - health communication
KW  - public health
N2  - Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep. Objective: The objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic. Methods: We used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter?s search API using the keywords: ?sids,? ?infant death syndrome,? ?sudden infant death syndrome,? and ?safe sleep.? This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software. Results: Multiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations. Conclusions: We identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations? presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information. 
UR  - http://pediatrics.jmir.org/2018/2/e10435/
UR  - http://dx.doi.org/10.2196/10435
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518314
ID  - info:doi/10.2196/10435
ER  - 

TY  - JOUR
AU  - Kwegyir-Afful, Emma
AU  - Verbeek, Jos
AU  - Aziato, Lydia
AU  - Seffah, D. Joseph
AU  - Räsänen, Kimmo
PY  - 2018/08/23
TI  - A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e10095
VL  - 7
IS  - 8
KW  - heavy lifting
KW  - Ghana
KW  - low birthweight
KW  - liftless intervention
KW  - low-and middle-income countries
KW  - physical activity
KW  - preterm birth
KW  - randomized controlled trial
KW  - stepped-wedge
N2  - Background: Preterm birth (PTB) is a leading cause of infant morbidity and mortality worldwide. Every year, 20 million babies are born with low birthweight (LBW), about 96% of which occur in low-income countries. Despite the associated dangers, in about 40%-50% of PTB and LBW cases, the causes remain unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana?s PTB rate is 14.5%, whereas the global average is 9.6%. The proposed liftless intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. We hypothesize that a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight. Objective: To investigate the effects of the liftless intervention on the incidence of PTB and LBW among pregnant Ghanaian women. Methods: A cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1000 pregnant participants will be recruited for a 60-week period. To be eligible, the participant should have a singleton pregnancy between 12 and 16 weeks gestation, be attending any of the 10 antenatal clinics, and be exposed to heavy lifting. All participants will receive standard antenatal care within the control phase; by random allocation, two clusters will transit into the intervention phase. The midwife-led 3-component liftless intervention consists of health education, a take-home reminder card mimicking the colors of a traffic light, and a shopping voucher. The primary outcome are gestational ages of <28, 28-32, and 33-37 weeks. The secondary outcomes are LBW (preterm LBW, term but LBW, and postterm), compliance, prevalence of low back and pelvic pain, and premature uterine contractions. Study midwives and participants will not be blinded to the treatment allocation. Results: Permission to conduct the study at all 10 antenatal clinics has been granted by the Ghana Health Service. Application for funding to begin the trial is ongoing. Findings from the main trial are expected to be published by the end of 2019. Conclusions: To the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among pregnant African women can reduce the soaring rates of PTB and LBW. The findings will increase the knowledge of the prevention of PTB and LBW worldwide. Trial Registration: Pan African Clinical Trial Register (PACTR201602001301205); http://apps.who.int/trialsearch/ Trial2.aspx?TrialID=PACTR201602001301205 (Archived by WebCite at http://www.webcitation.org/71TCYkHzu) Registered Report Identifier: RR1-10.2196/10095 
UR  - http://www.researchprotocols.org/2018/8/e10095/
UR  - http://dx.doi.org/10.2196/10095
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30139723
ID  - info:doi/10.2196/10095
ER  - 

TY  - JOUR
AU  - Mackert, Michael
AU  - Guadagno, Marie
AU  - Lazard, Allison
AU  - Donovan, Erin
AU  - Rochlen, Aaron
AU  - Garcia, Alexandra
AU  - Damásio, José Manuel
AU  - Crook, Brittani
PY  - 2018/08/09
TI  - Engaging Men in Prenatal Health via eHealth: Findings From a National Survey
JO  - JMIR Pediatr Parent
SP  - e7
VL  - 1
IS  - 2
KW  - health communication
KW  - fathering
KW  - expectant fathers
KW  - prenatal health
N2  - Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early ?teachable moment??where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States. 
UR  - http://pediatrics.jmir.org/2018/2/e7/
UR  - http://dx.doi.org/10.2196/pediatrics.9513
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31518311
ID  - info:doi/10.2196/pediatrics.9513
ER  - 

TY  - JOUR
AU  - LeFevre, Amnesty
AU  - Cabrera-Escobar, A. Maria
AU  - Mohan, Diwakar
AU  - Eriksen, Jaran
AU  - Rogers, Debbie
AU  - Neo Parsons, Annie
AU  - Barre, Iman
AU  - Jo, Youngji
AU  - Labrique, Alain
AU  - Coleman, Jesse
PY  - 2018/07/27
TI  - Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis
JO  - JMIR Mhealth Uhealth
SP  - e153
VL  - 6
IS  - 7
KW  - mHealth
KW  - cost effectiveness
KW  - cost utility analysis
KW  - digital health
N2  - Background: Limited evidence exists on the value for money of mHealth information programs in low resource settings. Objective: This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017. Methods: Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant?s first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses. Results: Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results. 
UR  - http://mhealth.jmir.org/2018/7/e153/
UR  - http://dx.doi.org/10.2196/mhealth.8185
UR  - http://www.ncbi.nlm.nih.gov/pubmed/30054263
ID  - info:doi/10.2196/mhealth.8185
ER  - 

TY  - JOUR
AU  - Baumel, Amit
AU  - Tinkelman, Amanda
AU  - Mathur, Nandita
AU  - Kane, M. John
PY  - 2018/02/13
TI  - Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study
JO  - JMIR Mhealth Uhealth
SP  - e38
VL  - 6
IS  - 2
KW  - mhealth
KW  - postpartum depression
KW  - perinatal mood disorder
KW  - peer support
KW  - online
KW  - self-help
N2  - Background: Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers? lack of time due to child care. Objective: This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD. Methods: Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU). Results: Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58). Conclusions: This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect. 
UR  - http://mhealth.jmir.org/2018/2/e38/
UR  - http://dx.doi.org/10.2196/mhealth.9482
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29439944
ID  - info:doi/10.2196/mhealth.9482
ER  - 

TY  - JOUR
AU  - Fletcher, Richard
AU  - May, Chris
AU  - Attia, John
AU  - Garfield, Franklin Craig
AU  - Skinner, Geoff
PY  - 2018/02/06
TI  - Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e37
VL  - 7
IS  - 2
KW  - perinatal
KW  - fathers
KW  - online intervention
KW  - randomized controlled trial
KW  - mental health
N2  - Background: Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers? mental health needs requires overcoming men?s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with ?hard-to-reach? fathers in a critical period of their parenting. Objective: The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period. Methods: A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers? physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies? expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments. Results: Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018. Conclusions: This study?s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII). 
UR  - http://www.researchprotocols.org/2018/2/e37/
UR  - http://dx.doi.org/10.2196/resprot.8368
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29410387
ID  - info:doi/10.2196/resprot.8368
ER  - 

TY  - JOUR
AU  - He, Honggu
AU  - Zhu, Lixia
AU  - Chan, Chi Sally Wai
AU  - Chong, Yap-Seng
AU  - Jiao, Nana
AU  - Chan, Huak Yiong
AU  - Luo, Nan
AU  - Shorey, Shefaly
PY  - 2018/01/31
TI  - The Effectiveness and Cost-Effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-Time Mothers: Randomized Controlled Trial Protocol
JO  - JMIR Res Protoc
SP  - e35
VL  - 7
IS  - 1
KW  - mothers
KW  - education
KW  - postpartum period
KW  - Internet
N2  - Background: In addition to recuperating from the physical and emotional demands of childbirth, first-time mothers are met with demands of adapting to their social roles while picking up new skills to take care of their newborn. Mothers may not feel adequately prepared for parenthood if they are situated in an unsupported environment. Postnatal psychoeducational interventions have been shown to be useful and can offer a cost-effective solution for improving maternal outcomes. Objective: The objective of this study was to examine the effectiveness and cost-effectiveness of Web-based and home-based postnatal psychoeducational programs for first-time mothers on maternal outcomes. Methods: A randomized controlled three-group pre- and posttests experimental design is proposed. This study plans to recruit 204 first-time mothers on their day of discharge from a public tertiary hospital in Singapore. Eligible first-time mothers will be randomly allocated to either a Web-based psychoeducation group, a home-based psychoeducation group, or a control group receiving standard care. The outcomes include maternal parental self-efficacy, social support, psychological well-being (anxiety and postnatal depression), and cost evaluation. Data will be collected at baseline, 1 month, 3 months, and 6 months post-delivery. Results: The recruitment (n=204) commenced in October 2016 and was completed in February 2017, with 68 mothers in each group. The 6-month follow-up data collection was completed in August 2017. Conclusions: This study may identify an effective and cost-effective Web-based postnatal psychoeducational program to improve first-time mothers? health outcomes. The provision of a widely-accessed Web-based postnatal psychoeducational program will eventually lead to more positive postnatal experiences for first-time mothers and positively influence their future birth plans. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 45202278; http://www.isrctn.com/ISRCTN45202278 (Archived by WebCite at http://www.webcitation.org/6whx0pQ2F). 
UR  - http://www.researchprotocols.org/2018/1/e35/
UR  - http://dx.doi.org/10.2196/resprot.9042
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29386175
ID  - info:doi/10.2196/resprot.9042
ER  - 

TY  - JOUR
AU  - Shorey, Shefaly
AU  - Ng, Mei Yvonne Peng
AU  - Siew, Ling An
AU  - Yoong, Joanne
AU  - Mörelius, Evalotte
PY  - 2018/01/10
TI  - Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes in Singapore: Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e4
VL  - 7
IS  - 1
KW  - parents
KW  - satisfaction
KW  - perinatal
KW  - self-efficacy
KW  - social support
N2  - Background: Supportive educational programs during the perinatal period are scarce in Singapore. There is no continuity of care available in terms of support from community care nurses in Singapore. Parents are left on their own most of the time, which results in a stressful transition to parenthood. There is a need for easily accessible technology-based educational programs that can support parents during this crucial perinatal period. Objective: The aim of this study was to describe the study protocol of a randomized controlled trial on a technology-based supportive educational parenting program. Methods: A randomized controlled two-group pretest and repeated posttest experimental design will be used. The study will recruit 118 parents (59 couples) from the antenatal clinics of a tertiary public hospital in Singapore. Eligible parents will be randomly allocated to receive either the supportive educational parenting program or routine perinatal care from the hospital. Outcome measures include parenting self-efficacy, parental bonding, postnatal depression, social support, parenting satisfaction, and cost evaluation. Data will be collected at the antenatal period, immediate postnatal period, and at 1 month and 3 months post childbirth. Results: Recruitment of the study participants commenced in December 2016 and is still ongoing. Data collection is projected to finish within 12 months, by December 2017. Conclusions: This study will identify a potentially clinically useful, effective, and cost-effective supportive educational parenting program to improve parental self-efficacy and bonding in newborn care, which will then improve parents? social support?seeking behaviors, emotional well-being, and satisfaction with parenting. It is hoped that better supported and satisfied parents will consider having more children, which may in turn influence Singapore?s ailing birth rate. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 48536064; https://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO) 
UR  - http://www.researchprotocols.org/2018/1/e4/
UR  - http://dx.doi.org/10.2196/resprot.8062
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29321127
ID  - info:doi/10.2196/resprot.8062
ER  - 

TY  - JOUR
AU  - Kingston, Dawn
AU  - Biringer, Anne
AU  - Veldhuyzen van Zanten, Sander
AU  - Giallo, Rebecca
AU  - McDonald, Sarah
AU  - MacQueen, Glenda
AU  - Vermeyden, Lydia
AU  - Austin, Marie-Paule
PY  - 2017/10/20
TI  - Pregnant Women?s Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial
JO  - JMIR Ment Health
SP  - e42
VL  - 4
IS  - 4
KW  - pregnancy
KW  - mental health
KW  - screening
KW  - prenatal care
KW  - computers
N2  - Background: Pregnant women?s perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. Objective: The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women?s perceptions of risk and benefit of disclosure. Methods: Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women?s perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Results: Of the 675 eligible women approached, 636 (94.2%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Conclusions: Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women?s vulnerability throughout the screening process with strategies such as addressing women?s concerns, explaining the rationale for screening, and discussing how results will be used. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6tRKtGC4M) 
UR  - http://mental.jmir.org/2017/4/e42/
UR  - http://dx.doi.org/10.2196/mental.6888
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29054833
ID  - info:doi/10.2196/mental.6888
ER  - 

TY  - JOUR
AU  - Drozd, Filip
AU  - Vaskinn, Linda
AU  - Bergsund, Bugge Hans
AU  - Haga, Marie Silje
AU  - Slinning, Kari
AU  - Bjørkli, Alexander Cato
PY  - 2016/09/08
TI  - The Implementation of Internet Interventions for Depression: A Scoping Review
JO  - J Med Internet Res
SP  - e236
VL  - 18
IS  - 9
KW  - depression
KW  - scoping review
KW  - implementation
KW  - Internet interventions
N2  - Background: Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. Objective: The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. Methods: We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. Results: Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. Conclusions: Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care. 
UR  - http://www.jmir.org/2016/9/e236/
UR  - http://dx.doi.org/10.2196/jmir.5670
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27608548
ID  - info:doi/10.2196/jmir.5670
ER  - 

TY  - JOUR
AU  - Hamilton, Kyra
AU  - Kavanagh, David
AU  - Connolly, Jennifer
AU  - Davis, Leigh
AU  - Fisher, Jane
AU  - Halford, Kim
AU  - Hides, Leanne
AU  - Milgrom, Jeannette
AU  - Rowe, Heather
AU  - Sanders, Davina
AU  - Scuffham, A. Paul
AU  - Tjondronegoro, Dian
AU  - Walsh, Anne
AU  - White, M. Katherine
AU  - Wittkowski, Anja
PY  - 2016/07/01
TI  - Baby Steps - An Online Program Promoting the Well-Being of New Mothers and Fathers: A Study Protocol
JO  - JMIR Res Protoc
SP  - e140
VL  - 5
IS  - 3
KW  - Perinatal
KW  - Wellbeing
KW  - Fathers
KW  - Mothers
KW  - Online Intervention
KW  - Randomized Controlled Trial
KW  - Quality of Life
KW  - Mental Health
N2  - Background: Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection. Objective: This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents? perinatal well-being, comparing two versions of the online program Baby Steps. Methods: The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program. Results: Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016. Conclusions: Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being. ClinicalTrial: Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL) 
UR  - http://www.researchprotocols.org/2016/3/e140/
UR  - http://dx.doi.org/10.2196/resprot.5706
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27370711
ID  - info:doi/10.2196/resprot.5706
ER  - 

TY  - JOUR
AU  - Moore, Donna
AU  - Ayers, Susan
AU  - Drey, Nicholas
PY  - 2016/05/19
TI  - A Thematic Analysis of Stigma and Disclosure for Perinatal Depression on an Online Forum
JO  - JMIR Mental Health
SP  - e18
VL  - 3
IS  - 2
KW  - perinatal
KW  - online
KW  - Internet
KW  - depression
KW  - eHealth
N2  - Background: Perinatal mental illness is a global health concern; however, many women do not get the treatment they need to recover. Some women choose not to seek professional help and get no treatment because they feel stigmatized. Online forums for various health conditions, including perinatal mental health, can be beneficial for members. Little is known about the role that online forums for perinatal mental illness play in reducing stigma and subsequent disclosure of symptoms to health care providers and treatment uptake. Objective: This study aimed to examine stigma and disclosure in forums and describe any potential disadvantages of forum use. Methods: An online forum for mothers was examined and 1546 messages extracted from 102 threads from the antenatal and postnatal depression section. These messages were subjected to deductive systematic thematic analysis to identify common themes regarding stigma and disclosure of symptoms and potential disadvantages of forum use. Results: Two major themes were identified: stigma and negative experiences of disclosure. Stigma had 3 subthemes: internal stigma, external stigma, and treatment stigma. Many women were concerned about feeling like a ?bad? or ?failed? mother and worried that if they disclosed their symptoms to a health care provider they would be stigmatized. Posts in response to this frequently encouraged women to disclose their symptoms to health care providers and accept professional treatment. Forum discourse reconstructed the ideology of motherhood as compatible with perinatal mental illness, especially if the woman sought help and adhered to treatment. Many women overcame stigma and replied that they had taken advice and disclosed to a health care provider and/or taken treatment. Conclusions: Forum use may increase women's disclosure to health care providers by challenging their internal and external stigma and this may strengthen professional treatment uptake and adherence. However, a few posts described negative experiences when disclosing to health care providers. 
UR  - http://mental.jmir.org/2016/2/e18/
UR  - http://dx.doi.org/10.2196/mental.5611
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27197516
ID  - info:doi/10.2196/mental.5611
ER  - 

TY  - JOUR
AU  - Kelman, R. Alex
AU  - Stanley, L. Meagan
AU  - Barrera, Z. Alinne
AU  - Cree, Michelle
AU  - Heineberg, Yotam
AU  - Gilbert, Paul
PY  - 2016/04/15
TI  - Comparing Brief Internet-Based Compassionate Mind Training and Cognitive Behavioral Therapy for Perinatal Women: Study Protocol for a Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e65
VL  - 5
IS  - 2
KW  - perinatal depression
KW  - comparative trial
KW  - Internet intervention
KW  - Amazon Mechanical Turk
N2  - Background: Depression that occurs during the perinatal period has substantial costs for both the mother and her baby. Since in-person care often falls short of meeting the global need of perinatal women, Internet interventions may function as an alternate to help women who currently lack adequate access to face-to-face psychological resources. However, at present there are insufficient empirically supported Internet-based resources for perinatal women. Objective: The aim of this study is to compare the relative efficacy of Internet-based cognitive behavioral therapy (CBT) to a novel Internet-based compassionate mind training approach (CMT) across measures of affect, self-reassurance, self-criticizing, self-attacking, self-compassion, depression, and anxiety. While CBT has been tested and has some support as an Internet tool for perinatal women, this is the first trial to look at CMT for perinatal women over the Internet. Methods: Participants were recruited through Amazon Mechanical Turk (MTurk) and professional networks.  Following completion of demographic items, participants were randomly assigned to either the CBT or CMT condition. Each condition consisted of 45-minute interactive didactic and follow-up exercises to be completed over the course of two weeks. Results: Post course data was gathered at two weeks. A 2x2 repeated measures analysis of variance will be conducted to analyze differences between conditions at post course. Conclusions: The implications of the trial will be discussed as well as the strengths and limitations of MTurk as a tool for recruitment. We will also briefly introduce the future directions along this same line of research. Trial Registration: ClinicalTrials.gov NCT02469324; https://clinicaltrials.gov/ct2/show/NCT02469324 (Archived by WebCite at http://www.webcitation.org/6fkSG3yuW) 
UR  - http://www.researchprotocols.org/2016/2/e65/
UR  - http://dx.doi.org/10.2196/resprot.5332
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27084301
ID  - info:doi/10.2196/resprot.5332
ER  - 

TY  - JOUR
AU  - Baumel, Amit
AU  - Schueller, M. Stephen
PY  - 2016/03/21
TI  - Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety
JO  - JMIR Mental Health
SP  - e11
VL  - 3
IS  - 1
KW  - online
KW  - peer
KW  - support
KW  - perinatal
KW  - postpartum
KW  - depression
KW  - anxiety
N2  - Background: Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services.  Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective: The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient?s feedback on the resultant program. Methods: This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results: In response to clinicians? feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions: The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood disorders. Further research should focus on the benefits accrued from such a service. However, this article highlights how a publicly available eHealth product can be leveraged to create new services in a health care setting. 
UR  - http://mental.jmir.org/2016/1/e11/
UR  - http://dx.doi.org/10.2196/mental.5335
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27001373
ID  - info:doi/10.2196/mental.5335
ER  - 

TY  - JOUR
AU  - Milgrom, Jeannette
AU  - Danaher, G. Brian
AU  - Gemmill, W. Alan
AU  - Holt, Charlene
AU  - Holt, J. Christopher
AU  - Seeley, R. John
AU  - Tyler, S. Milagra
AU  - Ross, Jessica
AU  - Ericksen, Jennifer
PY  - 2016/03/07
TI  - Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster
JO  - J Med Internet Res
SP  - e54
VL  - 18
IS  - 3
KW  - postnatal depression
KW  - postpartum depression
KW  - cognitive behavioral therapy
KW  - Internet-based intervention
KW  - randomized controlled trial
N2  - Background: There are few published controlled trials examining the efficacy of Internet-based treatment for postnatal depression (PND) and none that assess diagnostic status (clinical remission) as the primary outcome. This is despite the need to improve treatment uptake and accessibility because fewer than 50% of postnatally depressed women seek help, even when identified as depressed. Objective: In a randomized controlled trial (RCT), we aimed to test the efficacy of a 6-session Internet intervention (the MumMoodBooster program, previously evaluated in a feasibility trial) in a sample of postnatal women with a clinical diagnosis of depression. The MumMoodBooster program is a cognitive behavioral therapy (CBT) intervention, is highly interactive, includes a partner website, and was supported by low-intensity telephone coaching. Methods: This was a parallel 2-group RCT (N=43) comparing the Internet CBT treatment (n=21) to treatment as usual (n=22). At baseline and at 12 weeks after enrollment, women?s diagnostic status was assessed by telephone with the Standardized Clinical Interview for DSM-IV (SCID-IV) and symptom severity with the Beck Depression Inventory (BDI-II). Depression symptoms were measured repeatedly throughout the study period with the Patient Health Questionnaire (PHQ-9). Results: At the end of the study, 79% (15/19) of women who received the Internet CBT treatment no longer met diagnostic criteria for depression on the SCID-IV (these outcome data were missing for 2 intervention participants). This contrasted with only 18% (4/22) remission in the treatment as usual condition. Depression scores on the BDI-II showed a large effect favoring the intervention group (d=.83, 95% CI 0.20-1.45). Small to medium effects were found on the PHQ-9 and on measures of anxiety and stress. Adherence to the program was very good with 86% (18/21) of users completing all sessions; satisfaction with the program was rated 3.1 out of 4 on average. Conclusions: Our results suggest that our Internet CBT program, MumMoodBooster, is an effective treatment option for women clinically diagnosed with PND. This is one of only two controlled evaluations of specialized online psychological treatment among women clinically diagnosed with PND. MumMoodBooster appears to be a feasible, effective treatment option, which is potentially accessible to large numbers of women in metropolitan, rural, and remote areas. Future work might be focused profitably on establishing comparability with face-to-face treatments and purely self-guided delivery. We have commenced a larger RCT comparing MumMoodBooster with face-to-face CBT. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363561 (Archived by WebCite® at http://www.webcitation.org/6f64kuyLf). 
UR  - http://www.jmir.org/2016/3/e54/
UR  - http://dx.doi.org/10.2196/jmir.4993
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26952645
ID  - info:doi/10.2196/jmir.4993
ER  - 

TY  - JOUR
AU  - Drozd, Filip
AU  - Haga, Marie Silje
AU  - Brendryen, Håvar
AU  - Slinning, Kari
PY  - 2015/10/12
TI  - An Internet-Based Intervention (Mamma Mia) for Postpartum Depression: Mapping the Development from Theory to Practice
JO  - JMIR Res Protoc
SP  - e120
VL  - 4
IS  - 4
KW  - early intervention
KW  - Internet
KW  - intervention mapping
KW  - Mamma Mia
KW  - postpartum depression
KW  - pregnancy
KW  - well-being
N2  - Background: As much as 10-15% of new mothers experience depression postpartum. An Internet-based intervention (Mamma Mia) was developed with the primary aims of preventing depressive symptoms and enhancing subjective well-being among pregnant and postpartum women. A secondary aim of Mamma Mia was to ease the transition of becoming a mother by providing knowledge, techniques, and support during pregnancy and after birth. Objective: The aim of the paper is to provide a systematic and comprehensive description of the intervention rationale and the development of Mamma Mia. Methods: For this purpose, we used the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps: (1) a needs assessment, (2) definition of change objectives, (3) selection of theoretical methods and practical strategies, (4) development of program components, (5) planning adoption and implementation, and (6) planning evaluation. Results: Mamma Mia is a fully automated Internet intervention available for computers, tablets, and smartphones, intended for individual use by the mother. It starts in gestational week 18-24 and lasts up to when the baby becomes 6 months old. This intervention applies a tunneled design to guide the woman through the program in a step-by-step fashion in accordance with the psychological preparations of becoming a mother. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. It targets risk and protective factors for postpartum depression such as prepartum and postpartum attachment, couple satisfaction, social support, and subjective well-being, as identified in the needs assessment. The plan is to implement Mamma Mia directly to users and as part of ordinary services at well-baby clinics, and to evaluate the effectiveness of Mamma Mia in a randomized controlled trial and assess users? experiences with the program. Conclusions: The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program. This meets the recent calls for intervention descriptions and may inform future studies, development of interventions, and systematic reviews. 
UR  - http://www.researchprotocols.org/2015/4/e120/
UR  - http://dx.doi.org/10.2196/resprot.4858
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26476481
ID  - info:doi/10.2196/resprot.4858
ER  - 

TY  - JOUR
AU  - De Felippe, Nanci
AU  - Kar, Farnaz
PY  - 2015/07/08
TI  - Readability of Information Related to the Parenting of a Child With a Cleft
JO  - Interact J Med Res
SP  - e14
VL  - 4
IS  - 3
KW  - cleft lip
KW  - cleft palate
KW  - parenting
KW  - readability
KW  - literacy
N2  - Background: Many parents look to various sources for information about parenting when their child has a cleft lip and/or palate. More than 8 million Americans perform health-related searches every day on the World Wide Web. Furthermore, a significant number of them report feeling ?overwhelmed? by the language and content of the information. Objective: The purpose of this study is to determine the readability of information related to parenting a child with cleft lip and/or palate. It was hypothesized that the readability of such materials would be at a level higher than 6th grade. Methods: In February of 2012, a Web-based search was conducted using the search engine Google for the terms ?parenting cleft lip and palate.? Results: A total of 15 websites, 7 books, and 8 booklets/factsheets (N=30) entered the readability analysis. Flesch-Kincaid Grade Level, Fog Scale Level, and Simple Measure of Gobbledygook (SMOG) index scores were calculated. The reading level of the websites and books ranged from 8th to 9th and 9th to10th grade, respectively. The average reading level of the booklets/factsheets was 10th grade. Overall, the mean readability of the media resources analyzed was considered ?hard to read.? No statistically significant mean difference was found for the readability level across websites, books, and booklets/factsheets (Kruskal-Wallis test, significance level .05). Conclusions: When considering websites, books, booklets, and factsheets analyzed, the average readability level was between 8th and 10th grade. With the US national reading level average at 8th grade and the general recommendation that health-related information be written at a 6th grade level, many parents may find the text they are reading too difficult to comprehend. Therefore, many families might be missing out on the opportunity to learn parenting practices that foster optimal psychosocial development of their children. 
UR  - http://www.i-jmr.org/2015/3/e14/
UR  - http://dx.doi.org/10.2196/ijmr.4210
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26155814
ID  - info:doi/10.2196/ijmr.4210
ER  - 

TY  - JOUR
AU  - Barrera, Z. Alinne
AU  - Kelman, R. Alex
AU  - Muñoz, F. Ricardo
PY  - 2014/01/09
TI  - Keywords to Recruit Spanish- and English-Speaking Participants: Evidence From an Online Postpartum Depression Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e6
VL  - 16
IS  - 1
KW  - Internet intervention
KW  - prevention
KW  - depression, postpartum
KW  - research subject recruitment
KW  - women
KW  - Spanish speaking
N2  - Background: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools. Objective: The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial. Methods: Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study. Results: The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (ie, high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001). Conclusions: The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population?s conceptualization of health issues being studied. Trial Registration: ClinicalTrials.gov NCT00816725; http://clinicaltrials.gov/show/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP). 
UR  - http://www.jmir.org/2014/1/e6/
UR  - http://dx.doi.org/10.2196/jmir.2999
UR  - http://www.ncbi.nlm.nih.gov/pubmed/24407163
ID  - info:doi/10.2196/jmir.2999
ER  - 

TY  - JOUR
AU  - Danaher, G. Brian
AU  - Milgrom, Jeannette
AU  - Seeley, R. John
AU  - Stuart, Scott
AU  - Schembri, Charlene
AU  - Tyler, S. Milagra
AU  - Ericksen, Jennifer
AU  - Lester, Whitney
AU  - Gemmill, W. Alan
AU  - Kosty, B. Derek
AU  - Lewinsohn, Peter
PY  - 2013/11/01
TI  - MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results
JO  - J Med Internet Res
SP  - e242
VL  - 15
IS  - 11
KW  - postpartum depression
KW  - Web-based intervention
N2  - Background: Postpartum depression (PPD)?the most common complication of childbirth?is a significant and prevalent public health problem that severely disrupts family interactions and can result in serious lasting consequences to the health of women and the healthy development of infants. These consequences increase in severity when left untreated; most women with PPD do not obtain help due to a range of logistical and attitudinal barriers. Objective: This pilot study was designed to test the feasibility, acceptability, and potential efficacy of an innovative and interactive guided Web-based intervention for postpartum depression, MomMoodBooster (MMB). Methods: A sample of 53 women who satisfied eligibility criteria (<9 months postpartum, ?18 years of age, home Internet access and use of personal email, Edinburgh Postnatal Depression Survey score of 12-20 or Patient Health Questionnaire score from 10-19) were invited to use the MMB program. Assessments occurred at screening/pretest, posttest (3 months following enrollment), and at 6 months follow-up. Results: All six sessions of the program were completed by 87% (46/53) of participants. Participants were engaged with the program: visit days (mean 15.2, SD 8.7), number of visits (mean 20.1, SD 12.2), total duration of visits in hours (mean 5.1, SD 1.3), and number of sessions viewed out of six (mean 5.6, SD 1.3) all support high usage. Posttest data were collected from 89% of participants (47/53) and 6-month follow-up data were collected from 87% of participants (46/53). At pretest, 55% (29/53) of participants met PHQ-9 criteria for minor or major depression. At posttest, 90% (26/29) no longer met criteria. Conclusions: These findings support the expanded use and additional testing of the MMB program, including its implementation in a range of clinical and public health settings. Trial Registration: Clinicaltrials.gov NCT00942721; http://clinicaltrials.gov/ct2/show/NCT00942721 (Archived by WebCite at http://www.webcitation.org/6KjYDvYkQ). 
UR  - http://www.jmir.org/2013/11/e242/
UR  - http://dx.doi.org/10.2196/jmir.2876
UR  - http://www.ncbi.nlm.nih.gov/pubmed/24191345
ID  - info:doi/10.2196/jmir.2876
ER  -