JMIR Publications

ABSTRACT

Background:

Diabetes mellitus management requires considerable patient self-efficacy, knowledge, and support for social determinants of health. These needs become particularly acute during pregnancy. Mobile health (mHealth) tools are a promising approach to enhance patient engagement, education, and health promotion, and may be particularly helpful during the period of rapid skills acquisition that is a hallmark of experiencing diabetes during pregnancy. Therefore, we developed SweetMama, a web-based mHealth tool designed to support and provide information to low-income pregnant people with gestational or type 2 diabetes mellitus (GDM, T2DM).

Objective:

To understand the user experiences of low-income pregnant people who were randomized to use SweetMama during a feasibility trial.

Methods:

This secondary analysis of data from a feasibility randomized controlled trial includes participants randomized to SweetMama, an interactive, web-based mHealth app with multiple culturally-tailored, motivational, and educational features that help reduce barriers to care, offer health education, and aim to improve diabetes self-care during pregnancy. In the parent trial, English-speaking pregnant people with GDM or T2DM were randomized to SweetMama use during pregnancy or usual care. SweetMama users experienced an individualized curriculum from enrollment through 6 weeks postpartum. Upon exit, users completed two qualitative interviews (during the delivery hospitalization and at the postpartum visit) and surveys assessing standardized usability metrics. Surveys included the System Usability Survey (SUS), Usefulness, Satisfaction, Ease of Use (USE), and mHealth App Usability Questionnaire (MAUQ) to assess their usability experiences. Qualitative data were analyzed using constant comparative techniques.

Results:

Of 30 SweetMama users, 60% had GDM, 83% had publicly funded prenatal care, and the majority identified as non-Hispanic Black (N=17, 57%) or Hispanic (N=11, 37%). Scores on the SUS (median 85.0/100, interquartile range [IQR] 70.0-88.8, 66.7% acceptable or higher usability), USE (overall median 84.5/100, IQR 81.0-91.4), and MAUQ (median 84.1/100, IQR 79.0-91.3) indicated favorable usability assessments, particularly for the “ease of learning” domain. Qualitative interviews generated positive feedback regarding usability, visual features, content, and frequency of communication. Areas for improvement included greater customization and aesthetic appeal.

Conclusions:

In this user experience evaluation of a novel mHealth application for low-income pregnant people with diabetes, participants found the tool to be user-friendly, visually appealing, informative, and motivating. Constructive feedback for application improvement for use in a future larger trial of clinical effectiveness was collected. Clinical Trial: ClinicalTrials.gov Registration Identifier: NCT03240874; https://clinicaltrials.gov/study/NCT03240874