JMIR Publications

ABSTRACT

Background:

The usage of pregnancy-related health applications among expectant mothers is widespread. Digital health solutions can therefore potentially be utilized as screening-instruments for pregnancy-related health problems, based on longitudinal assessments of patient reported outcomes (PRO) for quality of life, psychological and physical symptoms. However, main factors of success include high user compliance and engagement rates.

Objective:

The aim of this study was to analyze determining factors for acceptance and compliance in a pilot randomized controlled trial targeting pregnant women using a digital health assessment with self-tracking and educational health information in order to develop a prediction model for compliance.

Methods:

Data from 597 pregnant women between 19 and 27 weeks of gestation were analyzed. Patients were randomized into two groups. The intervention group (IG) had additional access to an educational health guide. All questionnaires were assessed digitally at 5 time points prenatally. Compliance was measured by the completion rate of each digital study visit for PROs, with a completion rate ≥ 80% of all due questions per visit being considered as compliant.

Results:

The compliance pattern of the sample revealed two extreme peaks, one at very low completion rates, filling out nothing at least at one checkpoint (63%), and the other highly compliant, filling out ≥ 80% of questions throughout the entire study (25%), indicating a tendency to either fill out the study visit completely or not at all. The health education guide was accessed with an average login count of 1,86. Predicting variables for higher compliance included education, income, health insurance and German origin. A negative association was found between trait-anxiety and compliance. Non-German origin was detected to have the strongest negative association with high compliance (P < .001), followed by negative associations with smoking and having access to the educational health guide. Furthermore, there was no association between a change in the number of physical complaints or depressive symptoms and acute study drop-out.

Conclusions:

As a prerequisite for coordinated care, enabling and maintaining high digital compliance rates in pregnant patients, especially over a longer period of time and in high-risk pregnancies, bear many hurdles and challenges and cannot easily be maintained. With cultural and socio-economic background factors being the strongest predictors, more research needs to be directed towards understanding the needs of patients of different demographic backgrounds and to incorporate patient engagement into clinical care.