Preferences of women with a vulnerable health status towards nudging for adequate pregnancy preparation as investment in health of future generations: a qualitative study

Abstract

Background Women with a vulnerable health status, as determined by a low socioeconomic status and poor lifestyle behaviours, are at risk for adverse pregnancy outcomes. Offering tailored preconception lifestyle care can significantly help to improve pregnancy outcomes. We hypothesize that so-called ‘nudges’ can be a successful way of increasing the uptake of preconception lifestyle care. A nudge is a behavioural intervention that supports healthy choices by making them easier to choose. Nudging, however, raises many moral questions. Effectiveness and respect for autonomy are, among other criteria, required for a nudge to be morally permissible. In general, the target group knows best what they find permissible and what would motivate them to change their lifestyle. Therefore, this study – conducted in women with a vulnerable health status – aimed to identify their preferences towards a nudge, provided via a mobile application that aims to help them adopt healthy lifestyle behaviours by offering rewards. Methods We conducted semi-structured interviews with twelve women with a vulnerable health status. A framework approach was used to analyse the data. A thematic content analysis was conducted on five themes: (1) “Usefulness of an app as an integral information source”, (2) “Permissibility and effects of offering rewards”, (3) “Preferences regarding content”, (4) “Preferences regarding type of rewards and system of allocation”, and (5) “Barriers”. Results Of the 12 participants, 11 deemed an app as integral information source concerning the preconception period useful. None of the participants objected to being nudged i.e., being rewarded for healthy behaviour. All participants stated that they would like the app to contain information on healthy nutrition and 8 participants wanted to know how to get pregnant quickly. Furthermore, participants stated that the freedom to choose the timing and content of the reward would increase the probability of successful behavioural change, and having to pay or contact a healthcare provider to access the app may prevent women using the app. Conclusions These insights into the preferences of women with a vulnerable health status towards nudging will inform the design of an effective app-based nudge. This may help to improve prepregnancy health as investment in health of current and future generations.

Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App–Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study

“…In our earlier ethical research and interview study [ 34 ], it became apparent that adequately respecting participants’ autonomy and preferences is imperative when it comes to increasing motivation for certain behaviors. Women wanted to have the option to either save up for a large reward or spend their coins on multiple smaller rewards.…”

“…Second, we conducted semistructured interviews with 15 women from the target group, which allowed us to gain insight into how they regard loyalty programs; which type of loyalty program they prefer; and which rewards are considered most legitimate, attractive, and effective [ 34 ]. The interviews were analyzed using a framework approach and thematic content analyses of five themes: (1) “usefulness of an app as an integral information source,” (2) “permissibility and effects of offering rewards,” (3) “preferences regarding content,” (4) “preferences regarding the type of rewards and system of allocation,” and (5) “barriers.” Involving the target group in the design of the app, thereby respecting their autonomy and preferences, is an imperative criterion of the ethical framework.…”

“…These insights were then implemented in the app, leading to the design of a new and improved version of the app, adhering to the ethical framework. Through an iterative process ( Figure 2 ), adjusted versions of the app were discussed by the communication bureau multiple times with 10 women in the target group who had previously participated in the interview study [ 34 ] and the aforementioned professionals, until all were satisfied with the design of the app and the app was considered morally permissible. The resulting app-based nudge Pregnant Faster can be viewed as an umbrella or a macro-level nudge, containing multiple micro-level nudges .…”

“…This research group has previously experienced difficulty in including women with a vulnerable health status in an interview study [ 34 ]. Although we believe that the nature of the intervention Pregnant Faster might encourage more women to participate, we consider these previously obtained experiences.…”

Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study

“…Smarter Pregnancy has proven to be effective in supporting healthy choices in women with a VHS, in addition to being valued highly by them [ 23 ]. To further support PCC engagement in women with a VHS, we have designed an mHealth app that especially fits their needs and preferences [ 24 ]: the app-based nudge Pregnant Faster. A nudge is an intervention that stimulates making beneficial choices by increasing the attractiveness and easiness of healthy behavior [ 25 ].…”