JMIR Publications

ABSTRACT

Background:

Most people make no health or lifestyle changes before pregnancy, representing a missed opportunity to optimise outcomes. Nearly half of all pregnancies in the UK are unplanned, disproportionately affecting disadvantaged groups and contributing to health inequalities. Despite clear benefits, discussions about pregnancy intentions are not routine in healthcare, and there is increasing demand for accessible reproductive health support. Digital health interventions (DHIs) offer a promising approach but require systematic, theory-driven development to ensure effectiveness and real-world applicability.

Objective:

To use Intervention Mapping (IM) to co-develop and pilot test Orchid, a novel DHI designed to support people of reproductive age to understand their pregnancy preferences and develop a reproductive life plan (RLP).

Methods:

We used IM Steps 1-4 to guide the systematic, theory-informed co-development of Orchid. A multidisciplinary planning group and a co-development group of 21 members of the public contributed throughout. Step 1: Needs assessment - previous research and a scoping review of existing reproductive life plans informed the program goals and a logic model of the problem. Step 2: Matrices of change objectives - we identified performance objectives and behavioural determinants to specify practical strategies for each target behaviour. Step 3: Selection of theory-based methods - we applied the Capability, Opportunity, Motivation–Behaviour (COM-B) model and relevant behaviour change techniques to guide intervention design. Step 4: Intervention development and pre-testing - Orchid was co-designed as a web and mobile app providing users with a pregnancy preference group and prediction of pregnancy, a dynamic RLP, tailored evidence-based information, and optional goal-setting features to support behaviour change.

Results:

Orchid was pilot tested between January-June 2025 to explore its feasibility and acceptability in healthcare settings. Findings indicate that implementation was feasible, and healthcare professionals found it acceptable to recommend Orchid to patients, though they noted barriers including time constraints and competing priorities. Overall users were positive about Orchid, appreciating both its content and design, noting that the app contained a wealth of information about reproductive health presented in an easy-to-understand manner. They valued the autonomy, convenience, and privacy afforded by the digital format, and found it acceptable to be recommended Orchid within a healthcare setting. Orchid uptake was lower than anticipated, and use was limited, this was partly expected given the short pilot period, but feedback also suggested that targeted recruitment and navigation improvements could enhance uptake and engagement.

Conclusions:

Orchid is the first co-designed DHI to support reproductive health across the life course. Its systematic development, theoretical foundation, strong user involvement and positive pilot testing position it as a promising, scalable innovation to support reproductive health, deliver credible information in accessible formats, and promote preventative, community-based care across the NHS.