Smith Sharissa M, Bais Babette, Ismaili M'hamdi Hafez, Schermer Maartje H N, Steegers-Theunissen Regine P M
Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
JMIR Res Protoc. 2023 Aug 9;12:e45293. doi: 10.2196/45293.
Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app-based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation.
Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster.
The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster's feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the "mHealth App Usability Questionnaire" and additional interviews or questionnaires.
Results are expected to be published by December 2023.
Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster's feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45293.
社会经济地位低下的女性往往健康状况脆弱，这是由于诸多损害健康的因素不断累积，如不良生活方式行为，包括营养不足、精神压力源以及健康素养和自主能力受损等，这些因素使她们面临不良妊娠结局的不必要高风险。通过接受孕前保健（PCC）和改善生活方式来充分做好孕前准备，可改善这些结局。我们假设助推是鼓励参与PCC的一种成功方式。助推是一种行为干预措施，通过影响激励因素来改变选择行为。基于移动健康（mHealth）应用程序的忠诚度计划“更快怀孕”旨在以符合道德规范的方式奖励女性，并通过促使她们参加PCC咨询来助推她们进行孕前准备。
在此，我们首先描述旨在提高健康状况脆弱的女性参与孕前准备的mHealth应用程序“更快怀孕”的共创过程。其次，我们描述队列研究设计，以评估“更快怀孕”的可行性。
该应用程序的内容基于电子健康生活方式指导计划“更明智怀孕”，该计划已被证明在改善孕前生活方式行为（叶酸、蔬菜、水果、吸烟和饮酒）方面有效，并且基于一项关于目标群体对促进PCC接受的mHealth应用程序偏好的访谈研究。为了在设计上提供道德指导，基于博尚和奇尔德雷斯的生物伦理原则制定了一个伦理框架。该应用程序通过与目标群体和医疗保健提供者的迭代共创进一步开发。在4周时间里，参与者将使用“更快怀孕”，在此期间，她们将有机会通过阅读信息博客和注册PCC咨询等方式赚取积分。积分可用于兑换小的趣味奖励，如叶酸、水果和睫毛膏。“更快怀孕”的可行性将在一项研究中进行测试，该研究包括40名年龄在18至45岁之间、处于孕前或怀孕8周以内、教育水平较低且生活在贫困社区的女性。后两个因素将作为社会经济地位低下的替代指标。招募将通过传单、社交媒体和医疗保健机构进行。在完成后，参与者将通过“mHealth应用程序可用性问卷”以及额外的访谈或问卷对该应用程序进行评估。
预计结果将于2023年12月公布。
“更快怀孕”是通过与目标群体和医疗保健专业人员的迭代共创设计而成。通过所设计的研究，我们将测试“更快怀孕”的可行性。如果能实现总体用户满意度并提高PCC接受率，该应用程序将进一步开发，并且队列将继续纳入另外400名参与者以确定其有效性。
国际注册报告识别码（IRRID）：DERR1-10.2196/45293。
