Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review

Abstract

Background The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems’ effectiveness in improving glycemic control and maternal and infant outcomes. Methods We conducted a scoping review using a framework adapted from Arksey and O’Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ≥3 out of 5 in our assessment of digital health literacy. Conclusions mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women’s self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes.

Personalization and localization as key expectations of digital health intervention in women pre- to post-pregnancy

“…When faced with uncertainty about the effectiveness of traditional practices and the lack of avenues available to obtain verified information, women from the current study were inclined to remain cautious and follow traditional advices from family and friends despite negative or no effects. In a recent systematic review examining culture appropriateness of digital tools designed for pregnant women with gestational diabetes mellitus, it was reported that only two out of 12 DHIs offer culturally appropriate content 44 . Accordingly, providing women with access to culturally adapted practices and information presents as a key component when designing DHIs with an education component.…”

Gestational diabetes mellitus care re‐imagined: women's experiences of a major model of care change at a large metropolitan hospital

“…Women with GDM were able to log their BGLs (with annotations, if desired) into the app manually or via a Bluetooth enabled glucometer, and the readings were then shared with their health care provider via While there is information in the literature pertaining to how health care providers experience digital models [11][12][13] and, more generally, how women experience having a diagnosis of GDM, 3 less is known about how models of care that incorporate a digital-solution are perceived by women engaging with them. 14,15 This article aims to describe women's experiences within a digitally-supported model of GDM care compared with a traditional model of GDM care.…”

“…While there is information in the literature pertaining to how health care providers experience digital models 11–13 and, more generally, how women experience having a diagnosis of GDM, 3 less is known about how models of care that incorporate a digital‐solution are perceived by women engaging with them 14,15 …”

Unlocking the flow experience in apps: Fostering long‐term adoption for sustainable healthcare systems

“…The demand for healthcare services in developed economies has significantly increased over the past decade due to factors such as an aging population, the growing prevalence of chronic diseases, unhealthy lifestyles, and a progressive focus on physical and mental well‐being in modern societies (Birati et al, 2022). As a result, healthcare systems are facing higher workloads compounded by limited funding, particularly in the case of national health systems, and scarce human resources (Kumar et al, 2020).…”

“…The incorporation of information technologies for the provision of remote medical services (e.g., telemedicine) currently plays a prominent role in the efficiency and sustainability of the healthcare systems and the improvement of the patient‐physician relationships (Birati et al, 2022; Birkmeyer et al, 2021). Within telemedicine, apps have experienced exponential growth in the last 5 years (Yan et al, 2021).…”