Schier de Fraga Fernanda, Narita Mayara Marenda, Schreiner Monique, Belli Flavio, Leonel Celestino Jaqueline, Braz Pereira Karolayne, Soecki Gabriella, Bevervanso Vitória, de Fraga Rogério
Department of Obstetrics and Gynecology of the Federal University of Paraná, Rua General Carneiro, 181, Curitiba, 80060-900, Brazil, 55 41991213082.
Department of Surgical Clinics at the Federal University of Paraná, Curitiba, Brazil.
JMIR Hum Factors. 2025 Aug 21;12:e67680. doi: 10.2196/67680.
The use of mobile technologies during high-risk pregnancy, placing patients at the center of care, affords them self-management and easier access to health information.
This study aims to understand the health perception of pregnant women at the beginning of high-risk antenatal care, the usability of a mobile health app-the Health Assistant-and to compare maternal-fetal outcomes between users and nonusers of the app.
This is an observational longitudinal cohort study that looked into clusters of high-risk pregnant women admitted to antenatal care at the maternity unit of a public university hospital in southern Brazil between April 2022 and November 2023. Pregnant women who did not have a compatible smartphone to download the app or who did not have internet access were excluded from the study. According to systematic randomization, one patient was allocated to the app group and the other to the control group. They all answered an inclusion questionnaire (Q1), and those in the app group were instructed to use the Health Assistant app to prepare for their first antenatal appointment, which would take place in a few weeks' time, when they would answer the Brazilian version of the Mobile App Usability Questionnaire. After childbirth, maternal-fetal outcomes were assessed. Student 2-tailed t test, Mann-Whitney test, Fisher exact test, and the chi-square test were used for statistical analysis. A hierarchical cluster analysis was performed using the Ward method and the Euclidean squared distance measure.
The sample contained 111 pregnant women, of whom 55 (49.5%) were allocated to the app group and 56 (50.5%) to the control group. Of the 55 pregnant women who used the app, 21 (38.2%) demonstrated adherence, with an average Mobile App Usability Questionnaire score of 6.2 (SD 1.0). Clustering included 110 pregnant women, and the dendrogram resulted in three clusters, which show several significant differences in terms of family income, medical history, medication adherence, and lifestyle habits. Cluster 2 had the lowest adherence to the app (P=.08) and attended significantly fewer antenatal appointments (6.9 appointments) as compared with Clusters 1 (10.3) and 3 (9.1; P=.006). Cesarean section was more frequent in Cluster 3 (n=41, 95.3%) as compared with Clusters 1 (n=12, 27.9%) and 2 (n=5, 20.8%), P<.001.
Cluster analysis, revealing different profiles of pregnant women, allowed us to identify groups that would benefit from personalized approaches and digital interventions to improve self-awareness and gestational outcomes. The Health Assistant app showed good usability in this context.
在高危妊娠期间使用移动技术，将患者置于护理中心，使她们能够进行自我管理并更轻松地获取健康信息。
本研究旨在了解高危产前护理开始时孕妇的健康认知、一款移动健康应用程序——健康助手的可用性，并比较该应用程序使用者和非使用者之间的母婴结局。
这是一项观察性纵向队列研究，调查了2022年4月至2023年11月期间在巴西南部一所公立大学医院产科接受产前护理的高危孕妇群体。没有兼容智能手机来下载该应用程序或没有互联网接入的孕妇被排除在研究之外。根据系统随机化，一名患者被分配到应用程序组，另一名被分配到对照组。她们都回答了一份纳入问卷（Q1），应用程序组的孕妇被指示使用健康助手应用程序为几周后的首次产前预约做准备，届时她们将回答巴西版的移动应用程序可用性问卷。分娩后，评估母婴结局。采用学生双侧t检验、曼-惠特尼检验、费舍尔精确检验和卡方检验进行统计分析。使用沃德方法和欧几里得平方距离度量进行层次聚类分析。
样本包括111名孕妇，其中55名（49.5%）被分配到应用程序组，56名（50.5%）被分配到对照组。在使用该应用程序的55名孕妇中，21名（38.2%）表现出依从性，移动应用程序可用性问卷的平均得分为6.2（标准差1.0）。聚类包括110名孕妇，树形图产生了三个聚类，这三个聚类在家庭收入、病史、药物依从性和生活方式习惯方面存在若干显著差异。聚类2对该应用程序的依从性最低（P = 0.08），与聚类1（10.3次预约）和聚类3（9.1次预约；P = 0.006）相比，产前预约次数明显更少（6.9次预约）。与聚类1（n = 12，27.9%）和聚类2（n = 5，20.8%）相比，聚类3（n = 41，95.3%）剖宫产更为频繁，P < 0.001。
聚类分析揭示了孕妇的不同特征，使我们能够识别出将从个性化方法和数字干预中受益的群体，以提高自我认知和妊娠结局。在这种情况下，健康助手应用程序显示出良好的可用性。
