Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
BMC Pregnancy Childbirth. 2022 Jul 13;22(1):559. doi: 10.1186/s12884-022-04887-6.
Women with a vulnerable health status, as determined by a low socioeconomic status and poor lifestyle behaviours, are at risk for adverse pregnancy outcomes. Offering tailored preconception lifestyle care can significantly help to improve pregnancy outcomes. We hypothesize that so-called 'nudges' can be a successful way of increasing the uptake of preconception lifestyle care. A nudge is a behavioural intervention that supports healthy choices by making them easier to choose. Nudging, however, raises many moral questions. Effectiveness and respect for autonomy are, among other criteria, required for a nudge to be morally permissible. In general, the target group knows best what they find permissible and what would motivate them to change their lifestyle. Therefore, this study - conducted in women with a vulnerable health status - aimed to identify their preferences towards a nudge, provided via a mobile application that aims to help them adopt healthy lifestyle behaviours by offering rewards. METHODS: We conducted semi-structured interviews with twelve women with a vulnerable health status. A framework approach was used to analyse the data. A thematic content analysis was conducted on five themes: (1) "Usefulness of an app as an integral information source", (2) "Permissibility and effects of offering rewards", (3) "Preferences regarding content", (4) "Preferences regarding type of rewards and system of allocation", and (5) "Barriers".
Of the 12 participants, 11 deemed an app as integral information source concerning the preconception period useful. None of the participants objected to being nudged i.e., being rewarded for healthy behaviour. All participants stated that they would like the app to contain information on healthy nutrition and 8 participants wanted to know how to get pregnant quickly. Furthermore, participants stated that the freedom to choose the timing and content of the reward would increase the probability of successful behavioural change, and having to pay or contact a healthcare provider to access the app may prevent women using the app.
These insights into the preferences of women with a vulnerable health status towards nudging will inform the design of an effective app-based nudge. This may help to improve prepregnancy health as investment in health of current and future generations.
健康状况脆弱的女性（通过低社会经济地位和不良生活方式行为来确定）面临不良妊娠结局的风险。提供量身定制的孕前生活方式护理可以显著帮助改善妊娠结局。我们假设所谓的“推动”可以成为增加孕前生活方式护理的有效途径。推动是一种行为干预措施，通过使健康选择更容易选择来支持健康选择。然而，推动引发了许多道德问题。有效性和对自主权的尊重是推动在道德上可允许的其他标准之一。一般来说，目标群体最了解他们认为可接受的是什么，以及是什么促使他们改变生活方式。因此，这项研究——在健康状况脆弱的女性中进行——旨在确定他们对通过提供奖励来帮助他们采用健康生活方式的移动应用程序的偏好。
我们对 12 名健康状况脆弱的女性进行了半结构化访谈。使用框架方法分析数据。对五个主题进行了主题内容分析：（1）“应用程序作为综合信息来源的有用性”，（2）“提供奖励的可允许性和效果”，（3）“关于内容的偏好”，（4）“关于奖励类型和分配系统的偏好”，以及（5）“障碍”。
在 12 名参与者中，有 11 名参与者认为应用程序作为孕前期间的综合信息来源很有用。没有参与者反对被推动，即因健康行为而获得奖励。所有参与者都表示希望应用程序包含有关健康营养的信息，8 名参与者希望快速了解如何怀孕。此外，参与者表示，自由选择奖励的时间和内容将增加成功改变行为的可能性，而必须支付费用或联系医疗保健提供者才能访问应用程序可能会阻止女性使用该应用程序。
这些对健康状况脆弱的女性对推动的偏好的见解将为有效的基于应用程序的推动的设计提供信息。这可能有助于改善备孕健康，因为这是对当前和未来几代人的健康投资。
