Comprehensively Addressing Postpartum Maternal Health: a Content and Image Review of Commercially Available Mobile Health Apps

Abstract

Background: The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated existing mobile health tools targeted to this time period for sufficiency of maternal health information, inclusivity of people of color, or accessibility to users.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were then evaluated for extent and quality of maternal health information, inclusivity of people of color, and accessibility to app users.Results: Of the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The amount of maternal health information correlated positively with the Mobile Application Rating Scale (MARS) quality score of the app, and inclusivity of people of color in app imagery also correlated positively with the MARS quality score. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between number of users as estimated by number of store ratings and MARS quality. In addition, apps with clinical authority had greater MARS engagement, information, aesthetics, and quality scores, but did not have greater numbers of store ratings.Conclusions: Current commercially available peripartum apps overall do not provide adequate maternal health information, are not inclusive of women of color, and are not optimally accessible to the target users. Apps authored with clinical authority and higher-quality apps, by MARS score, are more likely to meet these standards, but are not more likely to be downloaded and used.

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“…This should be noted as a study limitation given that other than the language barriers, there could be other issues that influence the apps uptake such as the aesthetics of the apps. 22 Further, participation bias could not be ruled out given that one of the eligibility criteria to participate in the study was to be able to communicate in English. It is possible that a large number of women from CALD background were unable to participate in the survey, and thus limits the generalisability of the study findings.…”

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“…Mobile applications help aid in patient-centric care via patient education and treatment support, which is of particular importance for healthcare affordability and access to health services and information. There has been an increase in the availability of apps for a variety of diseases, such as for vital sign monitoring, glucose monitoring for diabetes, weight management [90], mental health [91], and even for managing postpartum maternal health [92]. Informatics and artificial intelligence techniques can also be used to guide patients in management of their own care [93], such as in determining optimal drug dosage or timing [94,95], or in predicting risk and providing recommendations from surveys and inputted data points [96,97].…”