Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study

Abstract

Background Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226

A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach

“…Each participant used each lifestyle area and thus confirmed the value of the added psychosocial module, as suggested by a recent review [58]. The high usage of the interactive challenge system stressed the importance for women to check off completed tasks for self-monitoring [93] and to view their own progress [14] in the first years post-GDM. In contrast, coaching requirements were much lower and indicated a realistic scope for implementation in routine care, especially when considering that some coaching activities may be automated in the future.…”

“…A step-by-step guide supported the registration process of a participant. Our chosen lifestyle color scheme is yellow for physical activity, green for nutrition, and purple for psychosocial well-being, while the overarching color scheme is light blue and light grey, as often used in health care [58,92,93].…”

“…The regular overall usage of the TRIANGLE app confirmed the feasibility of our usage goal of 5 active days per week. However, just like for a similar app [93], usage varied widely between participants. Each participant used each lifestyle area and thus confirmed the value of the added psychosocial module, as suggested by a recent review [58].…”

Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs

“…57 Women with GDM, and those with a history of GDM, are regular and frequent users of mHealth technology across race and socioeconomic class and they turn to social media, mobile phone apps, and Web sites to search for health-related information. [58][59][60][61] Despite this potential and some early interventions using mHealth, 61,62 the optimal design of mHealth lifestyle interventions within this cohort is still unknown.…”

Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women

“…Studies to address maternal weight have focused on the prevention of excess gestational weight gain and postpartum weight loss. Intervention timing and strategies have varied, including a focus on gestational weight gain, healthy eating, and goal setting during pregnancy [ 6 , 7 , 8 , 9 ], postpartum weight loss [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], a combination [ 19 ], and a direct comparison [ 20 ]. The postpartum period represents a teachable window for intervention as women may be motivated to prevent future disease prevention for themselves and their families.…”