Supporting Self-Management in Women with Gestational Diabetes: The Effect of eMOM Mobile Application on Self-Discovery and Psychological Factors – A Mixed-Methods Study (Preprint)

Abstract

BACKGROUND Gestational diabetes (GDM) is a type of diabetes that develops during pregnancy and predisposes a mother to the later type 2 diabetes. The prevalence of GDM increases, that underscores the need to adopt more comprehensive treatment strategies, especially supporting maternal self-management. We showed recently that a mobile app (eMOM) where glucose, nutrition, and physical activity are combined within a single app improves significantly multiple clinical outcomes among women with gestational diabetes. OBJECTIVE This study aims to explore the effects of the eMOM on maternal self-discovery, learning, autonomous motivation to manage GDM, and psychological well-being. We also examined the correlation between improved maternal clinical outcomes and change in autonomous motivation. METHODS Building upon the original randomized controlled trial (RCT), in which the intervention arm used a mobile app (eMOM), we conducted a mixed-methods study which included semi-structured interviews on self-discovery, examination of eMOM log files, and questionnaires assessing motivation (TSRQ and PCS), technology usage and acceptance (UTAUT), usability (modified SUMI), and depression (EPDS). Additionally, we monitored participants' stress levels using wearable EKG devices (FirstBeat Bodyguard 2). RESULTS A total of 148 women participated in the RCT study, with 76 in the intervention arm and 72 in the control arm. From the intervention arm, 18 participants were randomly selected for interviews. Results show that novel visualization supported self-discovery in women with GDM. The vast majority of participants (94%, 17 out of 18) indicated that the eMOM app helped to find the correlations between their daily activities and glucose levels. Especially having nutrition visualized together with glucose was highly appreciated. Participants also reported learning about the associations between physical activity and glucose levels. However, there weren´t any differences between intervention and control arm in autonomous motivation, depression, or stress. In addition, there were no correlations between improved clinical outcomes and changes in motivation. CONCLUSIONS The mobile application combining data from continuous glucose monitoring, food diary, and physical activity tracker supports maternal self-discovery regarding GDM. This encourages the utilization of such a mobile app into maternity care. CLINICALTRIAL ClinicalTrials.gov NCT04714762