JMIR Publications

ABSTRACT

Background:

A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors including inadequate nutrition, chronic stress, and impaired health literacy. For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive, and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. With the aim to support adequate pregnancy preparation, we have designed an mHealth app that fits the preferences of women with a VHS and uses nudging to encourage visiting a PCC consultation and engagement in education on healthy lifestyle behaviors.

Objective:

To test the feasibility of the mHealth app Pregnant Faster through determining usability and user satisfaction, the number of visited PCC consultations and the course of practical study conduction.

Methods:

Women 18-45 years of age, with a low to intermediate educational attainment, who were trying to become pregnant within 12 months, were included in this open cohort. Recruitment took place through social media, healthcare professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for four weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation. Earned coins could be spent on rewards such as fruit, mascara and baby products. Evaluation took place through the ‘mHealth App Usability Questionnaire’ (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction.

Results:

Because of the limited inclusions, we dropped the inclusion criterion living in a deprived neighborhood. This resulted in the inclusion of 47 women of whom 39 completed the intervention. In total, 16 PCC consultations were visited (41.0%), and participants’ main reason was to receive more personalized information. Two-third of the participants agreed with 16/18 statements of the MAUQ, indicating overall high user satisfaction. The mean rating was 7.7/10. Notable points of improvement concerned the identification and inclusion of the target group, simplification of the log-in system and automation of the work flow.

Conclusions:

Nudging women through Pregnant Faster, stimulating engagement in pregnancy preparation and PCC uptake, has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were visited and this study will therefore be continued with an open cohort of 400 women, aiming to establish (cost-)effectiveness of an updated version named Pregnant Faster 2. Clinical Trial: Not applicable.