Ruiz-Burga Elisa, Bruijning-Verhagen Patricia, Palmer Paulette, Sandcroft Annalisa, Fernandes Georgina, de Hoog Marieke, Bryan Lenroy, Pierre Russell, Bailey Heather, Giaquinto Carlo, Thorne Claire, Christie Celia D C
Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
JMIR Form Res. 2022 Jul 27;6(7):e34423. doi: 10.2196/34423.
There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy.
This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica).
Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users' perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed.
Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use.
This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care.
越来越多的证据表明移动健康技术具有诸多益处，其中包括用于研究、监测和预防的症状跟踪应用程序。然而，尚无研究涉及孕期虫媒病毒症状跟踪。
本研究旨在评估一款智能手机应用程序（ZIKApp）用于自我报告虫媒病毒症状和妊娠并发症的情况，并评估在一个虫媒病毒流行的亚热带中等收入国家（牙买加）的一组孕妇中，她们对孕期每日症状日记的依从性。
年龄≥16岁、拥有智能手机且计划在招募中心分娩的孕妇于2020年2月至2020年7月期间入组。ZIKApp包含一个基于算法的每日症状日记，用于识别潜在的虫媒病毒感染发作和妊娠并发症。在入组时收集社会人口统计学、流行病学和产科信息，并对医疗记录进行额外审查，通过退出调查收集用户的看法。对与日记依从性相关的可能因素进行描述性分析和逻辑回归分析。
在173名入组女性中，157名（90.8%）使用ZIKApp直至妊娠结束，中位使用时长为155天（四分位间距127 - 173天），6名（3.5%）使用该应用程序不足7天，10名（5.8%）提前退出研究。在这157名女性中，从入组到入组后150天的每个连续30天期间，121名（77.1%）至129名（82.2%）完成了她们的每日症状日记；50名（31.8%）至56名（35.7%）在同一天完成。总体而言，31.8%（50/157）的女性对日记报告具有良好的依从性（即，她们在≥80%的入组天数中在同一天或2至3天后完成任务）。年龄>34岁的参与者与25至29岁的参与者相比，具有良好依从性的几率高出3倍（调整后的优势比3.14，95%置信区间1.10 - 8.98），受过高等教育的女性与受过中等教育的女性相比，几率高出2倍（调整后的优势比2.26，95%置信区间1.06 - 4.83）。在161名曾进行日记记录的女性中，共进行了5454次个体症状报告（每位女性中位数为17次；四分位间距4 - 42次；范围0 - 278次）；9名（5.6%）女性报告了触发潜在虫媒病毒发作的症状组合（均无不良妊娠结局），55名（34.2%）女性报告了子宫疼痛性收缩或阴道出血，主要发生在分娩前一个月。总体而言，51.8%（71/137）的女性将该应用程序评为极佳体验，并且不太可能是日记依从性差的人（P = 0.04），99.3%（138/139）报告该应用程序易于理解和使用。
这项试点研究发现对ZIKApp的依从性很高。它证明了该应用程序在虫媒病毒流行地区的可行性和可用性，支持其未来发展，以促进孕期虫媒病毒感染的监测和诊断，并优化孕产妇护理。
