Dalton, Julia A., Dianne Rodger, Michael Wilmore et al., “The Health-e Babies App for Antenatal Education: Feasibility for Socially Disadvantaged Women,” PLOS One 13, no.5 (May 2018), doi:10.1371/journal.pone.0194337

URL: journals.plos.org/plosone/article?id=10.1371/journal.pone.0194337

Abstract

Background: The use of mobile technology such as phone applications (apps) has been proposed as an efficient means of providing health and clinical information in a variety of healthcare settings. We developed the Health-e Babies app as an Android smart phone application for pregnant women attending a tertiary hospital in a low socio-economic community, with the objective of providing health information about early pregnancy that would increase maternal confidence and reduce anxiety. Based on our earlier research, this form of health communication was viewed as a preferred source of information for women of reproductive age. However, the pilot study had a poor participation rate with 76% (n = 94) not completing the study requirements. These initial findings raised some very important issues in relation to the difficulties of engaging women with a pregnancy app. This paper analyses the characteristics of the participants who did not complete the study requirements in an attempt to identify potential barriers associated with the implementation of a pregnancy app.

Methods: This retrospective review of quantitative and qualitative data collected at the commencement of the Health-e Babies App trial, related to the participant’s communication technology use, confidence in knowing where to seek help and mental health status, maternal-fetal attachment and parenting confidence. Engagement and use of the Health-e Babies App was measured by the completion of a questionnaire about the app and downloaded data from participant’s phones. Mental health status, confidence and self-efficacy were measured by questionnaires.

Results: All women were similar in terms of age, race, marital status and level of education. Of the 94 women (76%) who did not complete the trial, they were significantly more anxious as indicated by State Trait Anxiety Inventory (p = 0.001 Student T-test) and more likely to be unemployed (50% vs 31%, p = 0.012 Student T-Test).

Conclusion: This study provides important information about the challenges associated with the implementation of a pregnancy app in a socially disadvantaged community. The data suggests that factors including social and mental health issues, financial constraints and technological ability can affect women’s engagement with a mobile phone app.

This study from Australia demonstrates the potential good and challenges mobile technology can produce for pregnant women, particularly in low socio-economic settings. While the test app, Health-e Babies, sought to meet the needs of women in low-income settings, it is worth noting that it “promoted healthy eating, exercise and relaxation during pregnancy with scientifically based information with particular emphasis on relieving anxiety and depression.” Because many women in low socio-economic settings live in food deserts and encounter stress-inducing circumstances outside of their control, may have low literacy, do not have Wifi access, and cannot afford the data charges, it is worth questioning if the app gave participants advice on how to achieve a healthy pregnancy in their specific context.