Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study

Brusniak, Katharina; Arndt, Hannah Maria; Feißt, Manuel; Haßdenteufel, K; Matthies, Lina Maria; Deutsch, Thomas M.; Hudalla, Hannes; Abele, Harald; Wallwiener, Markus; Wallwiener, Stephanie

doi:10.2196/17377

Cited by 24 publications

(22 citation statements)

References 39 publications

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“…This research focussed on women from a lower socioeconomic background thereby addressing a gap in the current literature and providing a context-specific examination of user engagement. Health apps may be a useful tool for supporting behaviour change in lower socioeconomic groups (Graham et al , 2016), but differences in engagement are seen by socioeconomic background (Brusniak et al , 2020). It is important to build evidence on how continued engagement may be supported in this population group to support behaviour change and related health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Exploring engagement with health apps: the emerging importance of situational involvement and individual characteristics

Flaherty

McCarthy

Collins

et al. 2021

EJM

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Purpose Health apps offer a potential approach to support healthier food behaviours but a lack of sufficient engagement may limit effectiveness. This study aims to use a user engagement theoretical lens to examine the factors that influence app engagement over time and may prompt disengagement. Design/methodology/approach A phenomenological exploration of the lived experience was used. Women from a lower socioeconomic background (based on the occupation and employment status of the household’s primary income earner) were randomly assigned to use one of two apps for a minimum of eight weeks. Multiple data collection methods, including accompanied shops, researcher observations, interviews, participant reflective accounts and questionnaires, were used at different time-points to examine engagement. Theoretical thematic analysis was conducted to explore the engagement experience and relevant social, personal and environmental influences. Findings Healthy food involvement appears to drive app engagement. Changes in situational involvement may contribute to fluctuation in engagement intensity over time as the saliency of personal goals change. Negatively valenced engagement dimensions may contribute to the overall expression of engagement. A lack of congruency with personal goals or an imbalance between perceived personal investment and value was expressed as the primary reasons for disengagement. Research limitations/implications Situational involvement may act as a trigger of different engagement phases. There is a need to better distinguish between enduring and situational involvement in engagement research. Practical implications Individual characteristics may shape engagement and propensity for disengagement, which highlights the practical importance of incorporating tailored features into app design. Originality/value Findings broaden the current conceptualisation of engagement within the digital space and prompt a reconsideration of the role of situational involvement and negatively valenced dimensions throughout the engagement process.

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Section: Discussionmentioning

confidence: 99%

Exploring engagement with health apps: the emerging importance of situational involvement and individual characteristics

Flaherty

McCarthy

Collins

et al. 2021

EJM

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“…We found that very few (10/173, 5.8%) women exited the study early and only 3.5% (6/173) never used the app after enrollment. This compares favorably with a study in Germany, which involved monthly web-based visits and surveys to digitally assess pregnancy-related symptoms and complications (including physical symptoms, depression, and anxiety), in which 7% of the women formally exited the study and 55% overall stopped using the app and made no further contact with the study team [ 43 ]. Thus, initial concerns that there might be a high rate of attrition because of the perceived burden of symptom reporting were not borne out in our pilot study.…”

Section: Discussionmentioning

confidence: 86%

Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study

Ruiz-Burga¹,

Bruijning-Verhagen²,

Palmer³

et al. 2022

JMIR Form Res

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Background There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care.

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“…This offers a possible explanation for the barriers some women experience when booking appointments during pregnancy. For example, Brusniak et al found that most pregnant women in their study showed low compliance and engagement with digital monitoring (41). Health professionals are aware of this problem.…”

Section: Discussionmentioning

confidence: 92%

Health Literacy and Behaviour among Pregnant Women with Obesity: A Qualitative Interpretive Description Study

Meldgaard

Jensen

Johansen

et al. 2021

Preprint

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Background: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women’s health literacy experiences among a sample of pregnant women with a prepregnant body mass index (BMI) >25 kg/m2.Methods: An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI >25 kg/m2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region.Results: Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution.Conclusions: Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy.Trial registration: The study was registered cf. General Data Protection Regulation, Aarhus University Journal number 2016-051-000001, serial number 1934.

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Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study

Cited by 24 publications

References 39 publications

Exploring engagement with health apps: the emerging importance of situational involvement and individual characteristics

Exploring engagement with health apps: the emerging importance of situational involvement and individual characteristics

Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study

Health Literacy and Behaviour among Pregnant Women with Obesity: A Qualitative Interpretive Description Study

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