Määttänen Sini, Koivusalo Saila, Ylinen Hanna, Heinonen Seppo, Kytö Mikko
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
JMIR Mhealth Uhealth. 2025 Jun 4;13:e60855. doi: 10.2196/60855.
Gestational diabetes is a type of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life. The rising prevalence of gestational diabetes mellitus (GDM) highlights the need for more comprehensive treatment strategies, with a particular emphasis on supporting maternal self-management. We showed recently that a mobile app, eMOM, where glucose, nutrition, and physical activity are combined within a single app, significantly improves multiple clinical outcomes among persons with gestational diabetes.
This study aims to explore the effects of the eMOM on maternal self-discovery and learning, autonomous motivation to manage GDM, and psychological well-being. Additionally, we examine the correlation between improved maternal clinical outcomes and change in autonomous motivation. We also assess the acceptance and usability of the eMOM app.
Building upon the original randomized controlled trial (RCT), in which the intervention arm used a mobile app (eMOM), we conducted a mixed methods study that included an investigation of eMOM log files, semistructured interviews on self-discovery, and an examination of questionnaires assessing motivation (Treatment Self-Regulation Questionnaire and Perceived Competence Scale), depression (Edinburgh Postnatal Depression Scale), technology use and acceptance (Unified Theory of Acceptance of Use of Technology questionnaire), and usability (modified Software Usability Measurement Inventory). Additionally, we monitored participants' stress levels using wearable electrocardiographic devices (FirstBeat Bodyguard 2). A total of 148 individuals participated in the original RCTs, with 76 in the intervention arm and 72 in the control arm. From the intervention arm, 18 participants were randomly selected for interviews in this study.
Results show that the use rate of eMOM was high, and novel visualization supported self-discovery in persons with GDM. Most participants (17/18, 94%) indicated that the eMOM app helped to find the associations between their daily activities and glucose levels. Especially having nutrition visualized together with glucose was highly appreciated. Participants also reported learning about the associations between physical activity and glucose levels. No differences were observed between the intervention and control arms in autonomous motivation, depression, or stress. Furthermore, there were no correlations between improved clinical outcomes and changes in motivation. Accessibility and usability ratings were consistently high throughout the intervention.
The eMOM mobile app combining data from continuous glucose monitor, food diary, and physical activity tracker supports maternal self-discovery related to GDM without contributing to depression or adding extra stress. This encourages the use of such mobile apps in maternity care. Notably, motivational factors did not correlate with the positive outcomes observed in our prior RCT, suggesting that self-discovery has a greater impact on clinical results.
ClinicalTrials.gov NCT04714762; https://www.clinicaltrials.gov/study/NCT04714762.
妊娠期糖尿病是一种在孕期发生的糖尿病，会增加日后患2型糖尿病的风险。妊娠期糖尿病（GDM）患病率的上升凸显了采取更全面治疗策略的必要性，尤其强调支持孕产妇自我管理。我们最近表明，一款名为eMOM的移动应用程序，它将血糖、营养和身体活动整合在一个应用程序中，能显著改善妊娠期糖尿病患者的多项临床结局。
本研究旨在探讨eMOM对孕产妇自我发现与学习、管理GDM的自主动机以及心理健康的影响。此外，我们还研究孕产妇临床结局改善与自主动机变化之间的相关性。我们还评估eMOM应用程序的可接受性和可用性。
基于最初的随机对照试验（RCT）开展本研究，在该试验中，干预组使用了一款移动应用程序（eMOM），我们进行了一项混合方法研究，包括对eMOM日志文件的调查、关于自我发现的半结构化访谈，以及对评估动机（治疗自我调节问卷和感知能力量表）、抑郁（爱丁堡产后抑郁量表）、技术使用与接受度（技术接受与使用统一理论问卷）和可用性（改良的软件可用性测量量表）的问卷进行分析。此外，我们使用可穿戴心电图设备（FirstBeat Bodyguard 2）监测参与者的压力水平。共有148人参与了最初的RCT，其中干预组76人，对照组72人。从干预组中随机选择18名参与者进行本研究的访谈。
结果显示，eMOM的使用率很高，新颖的可视化方式有助于GDM患者进行自我发现。大多数参与者（17/18，94%）表示，eMOM应用程序有助于发现他们日常活动与血糖水平之间的关联。特别是将营养与血糖一起可视化受到高度赞赏。参与者还报告了解到身体活动与血糖水平之间的关联。在自主动机、抑郁或压力方面，干预组和对照组之间未观察到差异。此外，临床结局的改善与动机变化之间没有相关性。在整个干预过程中，可及性和可用性评分一直很高。
结合连续血糖监测、食物日记和身体活动追踪器数据的eMOM移动应用程序，支持与GDM相关的孕产妇自我发现，且不会导致抑郁或增加额外压力。这鼓励在产科护理中使用此类移动应用程序。值得注意的是，动机因素与我们之前RCT中观察到的积极结果无关，这表明自我发现对临床结果的影响更大。
ClinicalTrials.gov NCT04714762；https://www.clinicaltrials.gov/study/NCT04714762 。
