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      Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study

      research-article
      , MSc 1 , , , MSc 1 , , MSc 1 , , Dipl theol 2 , , MSc 1 , , Dr rer nat 3 , , MSc 3 , , Dr med 3 , , Dr med 3 , , Dr med 3 , , Dr med 3 , , PhD 1 , , Dr ing 1
      (Reviewer), (Reviewer)
      JMIR Pediatrics and Parenting
      JMIR Publications Inc
      maternity log, maternity logbook, log, logbook, experience, experiences, attitude, attitudes, opinion, opinions, perception, perceptions, perspective, perspectives, pregnancy record, personal health record, PHR, health records, health record, feature, features, develop, development, maternity record, electronic, digital, paper hand-held record, mHealth, mobile health, app, apps, application, applications, smartphone, smartphones, wearable, wearables, usability, pregnant, pregnancy, maternal, maternity, electronic maternity record, pregnancy app, data sharing, privacy, online search, searching, information behavior, information behaviour, information seeking

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          Abstract

          Background

          Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study.

          Objective

          The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy.

          Methods

          A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective.

          Results

          A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated “above average” in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes.

          Conclusions

          Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects.

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          Most cited references39

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          A mathematical model of the finding of usability problems

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            The Usability and Effectiveness of Mobile Health Technology–Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review

            Background A growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods We performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care.
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              Item benchmarks for the system usability scale

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                Author and article information

                Journal
                JMIR Pediatr Parent
                JMIR Pediatr Parent
                pediatrics
                30
                JMIR Pediatrics and Parenting
                JMIR Publications Inc
                2561-6722
                2023
                15 December 2023
                : 6
                : e50765
                Affiliations
                [1]Machine Learning and Data Analytics Lab, Friedrich-Alexander Universität Erlangen-Nürnberg , Erlangen, Germany
                [2]Department of Social Ethics, University of Bonn , Bonn, Germany
                [3]Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg , Erlangen, Germany
                Author notes
                Correspondence to Michael Nissen, MSc michael.j.nissen@ 123456googlemail.com
                Article
                50765
                10.2196/50765
                10750977
                38109377
                54bdea56-d314-4cc9-b18f-731b1a5ee3aa
                © Michael Nissen, Carlos A Perez, Katharina M Jaeger, Hannah Bleher, Madeleine Flaucher, Hanna Huebner, Nina Danzberger, Adriana Titzmann, Constanza A Pontones, Peter A Fasching, Matthias W Beckmann, Bjoern M Eskofier, Heike Leutheuser. Originally published in JMIR Pediatrics and Parenting ( https://pediatrics.jmir.org), 15.12.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete bibliographic information, a link to the original publication on https://pediatrics.jmir.org, as well as this copyright and license information must be included.

                History
                : 12 July 2023
                : 20 September 2023
                : 02 October 2023
                Categories
                Original Paper
                Pregnancy Information, Education and Lifestyle Interventions
                Personal Health Records, Patient-Accessible Electronic Health Records, Patient Portals
                Mobile Health and Apps for Maternal and Child Health
                Perinatal Education for Parents
                Usability of Apps and User Perceptions of mHealth
                Mobile Health (mhealth)
                Participatory Medicine & E-Patients
                Personal Health Records, Patient-Accessible Electronic Health Records, Patient Portals
                Mobile Health and Apps for Maternal and Child Health
                Mobile Health (mhealth)
                Participatory Medicine & E-Patients
                Usability of Apps and User Perceptions of mHealth
                Perinatal Education for Parents

                maternity log,maternity logbook,log,logbook,experience,experiences,attitude,attitudes,opinion,opinions,perception,perceptions,perspective,perspectives,pregnancy record,personal health record,phr,health records,health record,feature,features,develop,development,maternity record,electronic,digital,paper hand-held record,mhealth,mobile health,app,apps,application,applications,smartphone,smartphones,wearable,wearables,usability,pregnant,pregnancy,maternal,maternity,electronic maternity record,pregnancy app,data sharing,privacy,online search,searching,information behavior,information behaviour,information seeking

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