JMIR Publications

ABSTRACT

Background:

Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care uptake and lifestyle improvement can improve these outcomes. We hypothesize that ’nudging’ is a successful way of encouraging engagement in preconception care. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile Health application-based loyalty program (mHealth app) Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a preconception care consultation and stimulating healthy lifestyle behaviors.

Objective:

Here, we first describe the process of the co-creation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the study design to assess the feasibility of Pregnant Faster.

Methods:

The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, alcohol). For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative co-creation with the target group and healthcare providers.

Results:

For four weeks, participants will engage with Pregnant Faster daily, during which opportunities will arise to earn ‘coins’, such as filling out a daily checklist on healthy lifestyle choices, reading blogs on pregnancy preparation and registering for a preconception care consultation. These coins can be spent on healthy and fun rewards such as folic acid, fruits, and mascara. The first testing of Pregnant Faster on feasibility and effectiveness will be conducted in a survey in 40 women between 18-45 years of age, preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter two inclusion criteria will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, hospitals, midwifery practices and general practitioner practices. After finalization, participants will evaluate the app through the ‘mHealth App Usability Questionnaire’ and an interview.

Conclusions:

Pregnant Faster has been designed through iterative co-creation with the target group and healthcare professionals. With the designed study we will perform the first testing of Pregnant Faster on feasibility and effectiveness. If the results prove satisfactory, we will continue the cohort up to 400 inclusions, in order to establish the (cost)effectiveness of Pregnant Faster.