Feasibility of Passive ECG Bio-sensing and EMA Emotion Reporting Technologies and Acceptability of Just-in-Time Content in a Well-being Intervention, Considerations for Scalability and Improved Uptake

Abstract

Researchers increasingly use passive sensing data and frequent self-report to implement personalized mobile health (mHealth) interventions. Yet, we know that certain populations may find these technical protocols burdensome and intervention uptake as well as treatment efficacy may be affected as a result. In the present study, we predicted feasibility (participant adherence to protocol) and acceptability (participant engagement with intervention content) as a function of baseline sociodemographic, mental health, and well-being characteristics of 99 women randomized in the personalized preventive intervention Wellness-for-Two (W-4-2), a randomized trial evaluating stress-related alterations during pregnancy and their effect on infant neurodevelopmental trajectories. The W-4-2 study used ecological momentary assessment (EMA) and wearable electrocardiograph (ECG) sensors to detect physiological stress and personalize the intervention. Participant adherence to protocols was 67% for EMAs and 52% for ECG bio-sensors. Higher baseline negative affect significantly predicted lower adherence to both protocols. Women assigned to the intervention group engaged on average with 42% of content they received. Women with higher annual household income were more likely to engage with more of the intervention content. Researchers should carefully consider tailoring of the intensity of technical intervention protocols to reduce fatigue, especially among participants with higher baseline negative affect, which may improve intervention uptake and efficacy findings at scale.

How Wearable Sensors Can Support the Research on Foetal and Pregnancy Outcomes: A Scoping Review

“…Twenty-one studies described the application of wearable sensors to collect information about maternal parameters and activities during pregnancy [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. These studies are described in Table 2 , together with a summary of the design and population, wearable device used, and main findings.…”

“…Another aspect to consider in these studies is the elevated burden for participants, which might affect the response to interventions. This issue was examined by Cummings and colleagues by evaluating the feasibility and acceptability of a body-conforming flexible ECG sensor and EMA to detect physiological stress and adjust the intervention accordingly [ 26 ]. Participants’ adherence was relatively low both for wearable device and EMA, especially among pregnant women with high perceived stress.…”

“…Participants’ adherence was relatively low both for wearable device and EMA, especially among pregnant women with high perceived stress. Those with high household income, instead, were more likely to engage with the intervention content [ 26 ]. These considerations should therefore be kept in mind for the scalability and uptake of well-being interventions.…”

“…For the second domain of application, selected studies reported on wearable devices used to collect maternal parameters and activities during pregnancy, and to investigate their association with maternal and neonatal health [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Devices used were varied, including wristband and finger-based trackers, body-conforming flexible sensors, and more complex systems made of different sensors.…”

“…Some studies reported high correlations between sensor-based measurements and those obtained using current monitoring technologies, which are too often expensive and complex [ 34 , 36 ]. However, these studies largely focused on uncomplicated pregnancies [ 21 , 26 , 34 , 36 ], while future research will have to be done on women with pregnancy complications. At the moment, the main fields of application appear to be those relating to the study of childbirth complications and physiological changes during pregnancy [ 21 , 26 , 34 , 36 ].…”