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Danna K, Harris DM, Rothschild CW, Brogaard B, LaCroix E, Paudel M. There's an App for That: Exploring the Market for Contraceptive Fertility Tracking Apps in the Philippines. Stud Fam Plann 2024; 55:151-169. [PMID: 38851886 DOI: 10.1111/sifp.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
For generations, women have relied on fertility awareness methods to plan and prevent pregnancy, for over a decade, many have been aided by digital tools to do so. New contraceptive fertility tracking apps (CFTAs)-that are backed by clinical efficacy trials to support their effectiveness as contraception-have the potential to enhance method choice and offer users a unique contraceptive option, but there is little evidence to inform the decisions around expanding access, particularly in low-and middle-income countries. We conducted a mixed methods study with quantitative online surveys (n = 1600) and qualitative interviews (n = 36) to explore the potential appeal of and demand for a hypothetical CFTA in one such market, the Philippines. Interest in using a CFTA was high among our Internet-engaged, urban study population, with 83.9% "definitely" or "probably" interested in using it. Across demographic profiles, respondents perceived the appeal of the method as "natural" and "convenient." A majority were willing to pay for the method, though notably at a price (5.20 USD) below that of currently available CFTAs. We discuss various important factors to be considered before bringing a method like this to new markets, including the potential implications of equity constraints in reaching a wider market and the unexpected prevalence of other period-tracking apps not intended as contraception being used in this market that could complicate any future roll-out. These issues could be explored further with additional research.
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Grayek E, Krishnamurti T, Hu L, Babich O, Warren K, Fischhoff B. Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e46237. [PMID: 37966871 PMCID: PMC10687688 DOI: 10.2196/46237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses. OBJECTIVE This systematic review aims to address 2 critical questions regarding clinical trials of software as a medical device (SaMD) apps: How well do researchers report adherence and engagement metrics for studies of effectiveness and efficacy? and What efficacy analyses do researchers use to account for nonadherence and how appropriate are their methods? METHODS We searched the Food and Drug Administration's registration database for registrations of repeated-use, patient-facing SaMD therapeutics. For each such registration, we searched ClinicalTrials.gov, company websites, and MEDLINE for the corresponding clinical trial and study articles through March 2022. Adherence and engagement data were summarized for each of the 24 identified articles, corresponding to 10 SaMD therapeutics. Each article was analyzed with a framework developed using the Cochrane risk-of-bias questions to estimate the potential effects of imperfect adherence on SaMD effectiveness. This review, funded by the Richard King Mellon Foundation, is registered on the Open Science Framework. RESULTS We found that although most articles (23/24, 96%) reported collecting information about SaMD therapeutic engagement, of the 20 articles for apps with prescribed use, only 9 (45%) reported adherence information across all aspects of prescribed use: 15 (75%) reported metrics for the initiation of therapeutic use, 16 (80%) reported metrics reporting adherence between the initiation and discontinuation of the therapeutic (implementation), and 4 (20%) reported the discontinuation of the therapeutic (persistence). The articles varied in the reported metrics. For trials that reported adherence or engagement, there were 4 definitions of initiation, 8 definitions of implementation, and 4 definitions of persistence. All articles studying a therapeutic with a prescribed use reported effectiveness estimates that might have been affected by nonadherence; only a few (2/20, 10%) used methods appropriate to evaluate efficacy. CONCLUSIONS This review identifies 5 areas for improving future SaMD trials and studies: use consistent metrics for reporting adherence, use reliable adherence metrics, preregister analyses for observational studies, use less biased efficacy analysis methods, and fully report statistical methods and assumptions.
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Affiliation(s)
- Emily Grayek
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lydia Hu
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Olivia Babich
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katherine Warren
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, United States
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Ciolfi Felice M, Søndergaard MLJ, Balaam M. Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study. J Med Internet Res 2023; 25:e47131. [PMID: 37962925 PMCID: PMC10685276 DOI: 10.2196/47131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user's fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users' preferences and needs. OBJECTIVE We examined the user experience offered by Natural Cycles-the first digital contraceptive-through an analysis of app reviews written by its users worldwide. METHODS We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. RESULTS For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. CONCLUSIONS Digital contraception is experienced by users as a tamed natural approach-a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as "natural," which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception.
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Affiliation(s)
- Marianela Ciolfi Felice
- Division of Media Technology and Interaction Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Madeline Balaam
- Division of Media Technology and Interaction Design, KTH Royal Institute of Technology, Stockholm, Sweden
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Saugar EE, Katsoulos S, Kim HS, Fakharzadeh N, Schaffer J, Ahmad M, Zeher C, Benedict M, Gupta S, Foster-Moumoutjis G. Factors Used by Mobile Applications to Predict Female Fertility Status and Their Reported Effectiveness: A Scoping Review. Cureus 2023; 15:e48847. [PMID: 38106802 PMCID: PMC10723623 DOI: 10.7759/cureus.48847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
Family planning, whether for pregnancy prevention or conception, is of pivotal importance to women of reproductive age. As hormonally driven methods, such as oral contraceptive pills, are widely used but have numerous side effects, women often seek alternative non-hormonal, non-invasive options, including fertility-tracking mobile applications (apps). However, the effectiveness of these apps as a method of contraception and conception planning has not been extensively vetted. The goal of this scoping review is to identify the various factors used by apps marketed as a method of contraception and/or family planning to predict a woman's fertility status, as well as their documented effectiveness. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a literature search was performed in CINAHL, MEDLINE, and Alt HealthWatch databases for articles published between October 1, 2017, and October 4, 2022. Quality assessment of eligible full-text articles was conducted using the Joanna Briggs Institute critical appraisal tools. A total of 629 articles were screened. Overall, 596 articles were excluded and the remaining 33 articles underwent full-text review. Seven articles were included in the final analysis, yielding data on the following five apps: Natural Cycles, Ava Fertility, Clearblue Connected, Ovia Fertility, and Dynamic Optimal Timing (DOT). Data supporting the effectiveness of these apps is limited. All apps provided predictions on fertility status throughout a woman's menstrual cycle using proprietary algorithms, biometric data, and self-reported menstrual cycle data. Further research, particularly independent research following a randomized controlled design, on the efficacy of these apps is needed to produce more robust results.
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Affiliation(s)
- Elaine E Saugar
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sabine Katsoulos
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Hyun-Su Kim
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Nazanin Fakharzadeh
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Jacob Schaffer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Maubeen Ahmad
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Caitlin Zeher
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Meghan Benedict
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarina Gupta
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Gina Foster-Moumoutjis
- Department of Family Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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Young Holt B, van der Straten A, Barker T, Chirenje ZM, Cameron AI, Scott C, Casas CP, Romano J. Strategic actions to advance multipurpose prevention technologies in low- and middle-income countries. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1150857. [PMID: 37465533 PMCID: PMC10351869 DOI: 10.3389/frph.2023.1150857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 07/20/2023] Open
Abstract
Background HIV, other sexually transmitted infections (STIs) and unintended pregnancies are critical and interlinked health risks for millions of women of reproductive age worldwide. Multipurpose prevention technologies (MPTs) offer an innovative approach for expanding combined pregnancy and/or disease prevention. So far, MPT development efforts have focused mostly on HIV prevention, but about half of product candidates comprise compounds active against non-HIV STIs as well. This review aims to provide a framework that promotes the efficient advancement of the most promising preclinical products through the development pathway and into the hands of end-users, with a focus on women in low- and middle-income countries (L/MICs). Methods This mini review provides a summary of the current landscape of the MPT field. It comprises a landscape assessment of MPTs in development, complemented by a series of 28 in-depth, semi-structured key informant interviews (KIIs) with experts representing different L/MIC perspectives. Main results We identified six primary action strategies to advance MPTs for L/MICs, including identification of key research gaps and priorities. For each action strategy, progress to date and key recommendations are included. Conclusions To realize the life-saving potential of MPTs and maximize the momentum made to date, a strategic, collaborative and well-funded response to the gaps and next steps outlined in this paper is critical. A coordinated response can add rigor and efficiency to the development process, to successfully advance the most promising MPT products to the hands of end-users.
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Affiliation(s)
- Bethany Young Holt
- CAMI Health, Initiative for MPTs, Public Health Institute, Sacramento, CA, United States
| | - Ariane van der Straten
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, UCSF, San Francisco, CA, United States and ASTRA Consulting, Kensington, CA, United States
| | - Taryn Barker
- Children's Investment Fund Foundation, London, United Kingdom
| | - Z Mike Chirenje
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA, United States
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Manhart MD, Duane M. A Comparison of App-Defined Fertile Days from Two Fertility Tracking Apps using Identical Cycle Data. Contraception 2022; 115:12-16. [PMID: 35901971 DOI: 10.1016/j.contraception.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Natural Cycles app employs daily basal body temperature to define the fertile window via a proprietary algorithm and is clinically established effective in preventing pregnancy. We sought to i) compare the app-defined fertile window of Natural Cycles to that of CycleProGo™, an app that uses BBT and cervical mucus to define the fertile window and ii) compare the app-defined fertile windows to the estimated physiologic fertile window. STUDY DESIGN Daily BBT were entered into Natural Cycles from 20 randomly selected regularly cycling women with at least 12 complete cycles from the CycleProGo database. The proportion of cycles with equivalent (+/-1 cycle day) fertile-window starts and fertile-window ends was determined. The app -defined fertile windows were then compared to the estimated physiologic fertile window using Peak mucus to estimate ovulation. RESULTS Fifty seven percent of cycles (136/238) had equivalent fertile-window starts and 36% (72/181) had equivalent fertile-window end days. The mean overall fertile-window length from Natural Cycles was 12.8 days compared to 15.1 days for CycleProGo (p<0.001). The Natural Cycles algorithm declared 12%-30% of cycles with a fertile-window start and 13%-38% of cycles with a fertile-window end within the estimated physiologic fertile window. The CycleProGo algorithm declared 4%-14% of cycles with a fertile-window start and no cycles with a fertile-window end within the estimated physiologic fertile window. CONCLUSIONS Natural Cycles designated a higher proportion of cycles days as infertile within the estimated physiologic fertile window than CycleProGo. IMPLICATIONS Use of cervical mucus in addition to BBT may improve the accuracy of identifying the fertile window. Additional studies with other markers of ovulation and the fertile window would give additional insight into the clinical implications of app-defined fertile window differences.
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Affiliation(s)
- Michael D Manhart
- Couple to Couple League, Cincinnati, OH Georgetown School of Medicine, Washington, D.C..
| | - Marguerite Duane
- Fertility Appreciative Collaborative to Teach the Science & Adjunct Associate Professor Georgetown University School of Medicine
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O'Bryan SM, Connor KR, Drummer DJ, Lavin KM, Bamman MM. Considerations for Sex-Cognizant Research in Exercise Biology and Medicine. Front Sports Act Living 2022; 4:903992. [PMID: 35721874 PMCID: PMC9204149 DOI: 10.3389/fspor.2022.903992] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022] Open
Abstract
As the fields of kinesiology, exercise science, and human movement developed, the majority of the research focused on male physiology and extrapolated findings to females. In the medical sphere, basing practice on data developed in only males resulted in the removal of drugs from the market in the late 1990s due to severe side effects (some life-threatening) in females that were not observed in males. In response to substantial evidence demonstrating exercise-induced health benefits, exercise is often promoted as a key modality in disease prevention, management, and rehabilitation. However, much like the early days of drug development, a historical literature knowledge base of predominantly male studies may leave the exercise field vulnerable to overlooking potentially key biological differences in males and females that may be important to consider in prescribing exercise (e.g., how exercise responses may differ between sexes and whether there are optimal approaches to consider for females that differ from conventional approaches that are based on male physiology). Thus, this review will discuss anatomical, physiological, and skeletal muscle molecular differences that may contribute to sex differences in exercise responses, as well as clinical considerations based on this knowledge in athletic and general populations over the continuum of age. Finally, this review summarizes the current gaps in knowledge, highlights the areas ripe for future research, and considerations for sex-cognizant research in exercise fields.
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Affiliation(s)
- Samia M. O'Bryan
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kathleen R. Connor
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Devin J. Drummer
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kaleen M. Lavin
- The Florida Institute for Human and Machine Cognition, Pensacola, FL, United States
| | - Marcas M. Bamman
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- The Florida Institute for Human and Machine Cognition, Pensacola, FL, United States
- *Correspondence: Marcas M. Bamman
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da Cunha Pereira P, Monteiro I, Bahamondes L. Natural contraception apps knowledge among Brazilian women and Obstetrics and Gynaecology residents. EUR J CONTRACEP REPR 2022; 27:289-293. [PMID: 35583156 DOI: 10.1080/13625187.2022.2075844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Our objectives were to determine the knowledge and interest in apps for natural contraception among women and Obstetrics and Gynaecology (OBGYN) residents. STUDY DESIGN An online survey was sent to Brazilian women to gather sociodemographic data, knowledge and interest towards fertility-awareness contraceptive methods and smartphone apps for this purpose. Also, we sent an online survey to OBGYN residents to evaluate the reproductive physiology knowledge of natural contraception and interest in improving it and knowledge and smartphone apps for this purpose. RESULTS A total of 730 women answered the survey, and 638 were included in the study and 94 OBGYN residents answered the survey. Among the respondent women 386 (60.5%) were interested in more information about natural contraception, 226 (35.5%) showed interest in use natural contraception, 85 (13.3%) indicated that they were users of natural contraception, 15 (16.8%) of this group currently uses an app for this purpose and 485 (76%) considers a practical option to have an app for natural contraception. Regarding the respondent residents all answers were included in the study; 62 (65.9%) knew the right definition of 'Natural Contraception', 52 (55.3%) showed interest in information about this topic and 78 (82.9%) considers a practical option to have an app for natural contraception. CONCLUSIONS Less than 15% of the respondent women use natural contraception although about 60% expressed some interest in learning more, and that among OBGYN residents, half showed interest.
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Affiliation(s)
- Paula da Cunha Pereira
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Ilza Monteiro
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
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Nguyen BT, Pang RD, Nelson AL, Pearson JT, Benhar Noccioli E, Reissner HR, Kraker von Schwarzenfeld A, Acuna J. Detecting variations in ovulation and menstruation during the COVID-19 pandemic, using real-world mobile app data. PLoS One 2021; 16:e0258314. [PMID: 34669726 PMCID: PMC8528316 DOI: 10.1371/journal.pone.0258314] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As war and famine are population level stressors that have been historically linked to menstrual cycle abnormalities, we hypothesized that the COVID-19 pandemic could similarly affect ovulation and menstruation among women. METHODOLOGY We conducted a retrospective cohort study examining changes in ovulation and menstruation among women using the Natural Cycles mobile tracking app. We compared de-identified cycle data from March-September 2019 (pre-pandemic) versus March-September 2020 (during pandemic) to determine differences in the proportion of users experiencing anovulation, abnormal cycle length, and prolonged menses, as well as population level changes in these parameters, while controlling for user-reported stress during the pandemic. FINDINGS We analyzed data from 214,426 cycles from 18,076 app users, primarily from Great Britain (29.3%) and the United States (22.6%). The average user was 33 years of age; most held at least a university degree (79.9%). Nearly half (45.4%) reported more pandemic-related stress. Changes in average cycle and menstruation lengths were not clinically significant, remaining at 29 and 4 days, respectively. Approximately 7.7% and 19.5% of users recorded more anovulatory cycles and abnormal cycle lengths during the pandemic, respectively. Contrary to expectation, 9.6% and 19.6% recorded fewer anovulatory cycles and abnormal cycle lengths, respectively. Women self-reporting more (32.0%) and markedly more (13.6%) stress during the pandemic were not more likely to experience cycle abnormalities. CONCLUSIONS The COVD-19 pandemic did not induce population-level changes to ovulation and menstruation among women using a mobile app to track menstrual cycles and predict ovulation. While some women experienced abnormalities during the pandemic, this proportion was smaller than that observed prior to the pandemic. As most app users in this study were well-educated women over the age of 30 years, and from high-income countries, their experience of the COVID-19 pandemic might differ in ways that limit the generalizability of these findings.
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Affiliation(s)
- Brian T. Nguyen
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
| | - Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Anita L. Nelson
- Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA, United States of America
| | | | | | - Hana R. Reissner
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | | | - Juan Acuna
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
- Research and Data Intelligence Support Center, Khalifa University, Abu Dhabi, United Arab Emirates
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Kalampalikis A, Chatziioannou SS, Protopapas A, Gerakini AM, Michala L. mHealth and its application in menstrual related issues: a systematic review. EUR J CONTRACEP REPR 2021; 27:53-60. [PMID: 34615425 DOI: 10.1080/13625187.2021.1980873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this research was to evaluate how menstrual tracking applications can promote gynaecological health. MATERIALS AND METHODS We performed a systematic review in Medline and Scopus, for papers evaluating menstrual tracking mobile applications. We excluded review articles and those not written in English. RESULTS We identified 14 articles measuring the outcome resulting from the use of a single Fertility Tracking Application (FTA). Eight studies evaluated 2 different applications used as a contraception method. One study assessed a fecundity enhancing application. Five studies referred to applications, used to treat or monitor various gynaecologic issues. All studies reported efficacy for their intended use or a high satisfaction rate. DISCUSSION There is a plethora of FTAs, however a minority of them are appraised by medical experts. Several safety and privacy concerns have been expressed regarding their use and these issues should be addressed in the future. All studies identified in our search demonstrated that FTAs can facilitate users in terms of contraception, fertility, and menstrual awareness. CONCLUSION Menstrual tracking applications can serve as a valuable health tool, nevertheless, their content should be more vigorously evaluated.
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Affiliation(s)
- Andreas Kalampalikis
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athanasios Protopapas
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna M Gerakini
- School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Lina Michala
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Athens, Greece
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Hong JS, Wasden C, Han DH. Introduction of digital therapeutics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106319. [PMID: 34364181 DOI: 10.1016/j.cmpb.2021.106319] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Digital therapeutics are an emerging type of medical therapy and are defined as evidence-based therapeutic interventions for patients by means of qualified software programs to prevent, manage, or treat medical conditions. Today, digital therapeutics products are on the market or under development for a wide range of medical conditions such as diabetes, oncology treatment management, and neuropsychiatric disorders including anxiety disorder, depression, and substance use disorder. Digital therapeutics can be more flexible than other treatment methods to address patients' individual needs. METHODS AND RESULTS The advantages of digital therapeutics fall in line with market demand; thus, the digital therapeutics market is expanding globally, focusing on advanced medical markets. There are many digital therapeutics products such as Sleepio for insomnia, Daylight for anxiety, Livongo and Omada products for diabetes, pre-diabetes, hypertension, etc. None of these are cleared by the Food and Drug Administration (FDA), but all are commercially available through health insurance or employers. The EU, including Germany, and a number of Asian countries, including Korea, Japan, and China, are also introducing policies for the regulation of new fields and digital therapeutics. CONCLUSIONS The adoption of digital therapeutics is intricate and often involves various interests in numerous fields, decision-making processes, and individual or organizational value judgments. For digital therapeutics to be thoroughly introduced into real life, technical aspects must be supported, and an approach that considers users must be further investigated.
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Affiliation(s)
- Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
| | | | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
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Frank-Herrmann P, Freundl-Schütt T, Wallwiener LM, Baur S, Strowitzki T. Familienplanung mit Zyklus-Apps – ein Update. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Earle S, Marston HR, Hadley R, Banks D. Use of menstruation and fertility app trackers: a scoping review of the evidence. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:90-101. [PMID: 32253280 DOI: 10.1136/bmjsrh-2019-200488] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 05/23/2023]
Abstract
INTRODUCTION There has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility. METHODS This project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data. RESULTS In total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention. CONCLUSIONS Motivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.
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Affiliation(s)
- Sarah Earle
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Hannah R Marston
- Health and Wellbeing Priority Research Area, The Open University, Milton Keynes, UK
| | | | - Duncan Banks
- School of Life, Health & Chemical Sciences, The Open University, Milton Keynes, Buckinghamshire, UK
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Ford EA, Peters AE, Roman SD, McLaughlin EA, Beckett EL, Sutherland JM. A scoping review of the information provided by fertility smartphone applications. HUM FERTIL 2021; 25:625-639. [PMID: 33783305 DOI: 10.1080/14647273.2021.1871784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The growth of smartphone application use across areas of female reproductive health has led to increased interest into their functions and benefits. This scoping review aims to determine the nature and extent of the peer-reviewed literature presented on fertility-based apps, to identify the reliability of the information within the apps, and to determine the ability of this information to educate users. A systematic search of six databases was conducted in April 2020, returning a total of 21,158 records. After duplicate removal, title and abstract screening exclusionary steps, 27 records were reviewed and charted. Records covered a variety of reproductive health themes including contraception, sexual health, and family planning, and used a range of methodologies. The accuracy of fertility information within the apps reported in these studies was variable, but overall there was a lack of depth in the coverage of content in apps. It was common for studies in this review to base fertile window algorithms on stringent cycle length and variability requirements, limiting the applicability of information delivered to users. Furthermore, studies from app affiliates often lacked collaborations with researchers, minimising the potential for fertility knowledge improvements integrated across the suite of female reproductive health apps.
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Affiliation(s)
- Emmalee A Ford
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
| | - Alexandra E Peters
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
| | - Shaun D Roman
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia.,Priority Research Centre for Drug Development, University of Newcastle, Callaghan, Australia
| | - Eileen A McLaughlin
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia.,School of Science, Western Sydney University, Penrith, Australia.,School of Biological Science, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Emma L Beckett
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia.,School of Environmental & Life Sciences, Faculty of Science, University of Newcastle, Ourimbah, Australia
| | - Jessie M Sutherland
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, Australia
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Schantz JS, Fernandez CSP, Anne Marie ZJ. Menstrual Cycle Tracking Applications and the Potential for Epidemiological Research: A Comprehensive Review of the Literature. CURR EPIDEMIOL REP 2021; 8:9-19. [PMID: 34055569 DOI: 10.1007/s40471-020-00260-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of review We reviewed published studies on menstrual cycle tracking applications (MCTAs) in order to describe the potential of MCTAs for epidemiologic research. Recent Findings A search of PubMed, Web of Science, and Scopus for MCTA literature yielded 150 articles. After exclusions, there were 49 articles that addressed the primary interest areas: 1) characteristics of MCTA users in research, 2) reasons women use or continue using MCTAs, 3) accuracy of identifying ovulation and utility at promoting and preventing pregnancy, and 4) quality assessments of MCTAs across several domains. Summary MCTAs are an important tool for the advancement of epidemiologic research on menstruation. MCTA studies should describe the characteristics of their user-base and missing data patterns. Describing the motivation for using MCTAs throughout a user's life and validating the data collected should be prioritized in future research.
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Affiliation(s)
- Joelle S Schantz
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Claudia S P Fernandez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Z Jukic Anne Marie
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709
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Pearson JT, Chelstowska M, Rowland SP, Mcilwaine E, Benhar E, Berglund Scherwitzl E, Walker S, Gemzell Danielsson K, Scherwitzl R. Natural Cycles app: contraceptive outcomes and demographic analysis of UK users. EUR J CONTRACEP REPR 2021; 26:105-110. [PMID: 33539252 DOI: 10.1080/13625187.2020.1867844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Digital fertility awareness-based contraception offers an alternative choice for women who do not wish to use hormonal or invasive methods. The aim of this study was to investigate the key demographics of current users of the Natural Cycles app and assess the contraceptive outcomes of women preventing pregnancy in a UK cohort of women. MATERIALS AND METHODS This was a real world observational prospective observational study. The typical-use effectiveness of the method was calculated using both 13-cycle cumulative probability of pregnancy (life table analysis) and Pearl Index for the entire study cohort. Perfect-use PI was calculated using data from cycles where sexual intercourse during the fertile window was marked as protected and no unprotected sex was recorded on fertile days. RESULTS 12,247 women were included in the study and contributed an average of 9.9 months of data for a total of 10,066 woman years of exposure. The mean age of the cohort was 30, mean BMI 23.4, the majority were in a stable relationship (83.2%) and had a university degree or higher (83%). The one year typical use, PI was 6.1 (95% CI: 5.6, 6.6) and with perfect-use was 2.0 (95% CI: 1.3, 2.8). 13 cycle pregnancy probability was 7.1%. CONCLUSIONS This is the first study which describes the use of a digital contraceptive by women in the UK. It describes the demographics of users and how they correlate with the apps effectiveness at preventing pregnancy.
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Affiliation(s)
| | | | | | | | | | | | - Susan Walker
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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Kharbouch M, Idri A, Rachad T, Alami H, Redman L, Stelate Y. Mobile Technology for Improved Contraceptive Care in Morocco. J Med Syst 2021; 45:16. [PMID: 33426595 DOI: 10.1007/s10916-020-01684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The fulfillment of unmet needs for contraception can help women reach their reproductive goals. Therefore, there is a growing concern worldwide about contraception and women's knowledge of making an advised choice about it. In this aspect, an outgrown number of apps are now available providing information concerning contraception whether it concerns natural contraception or modern contraception. However, vast amounts of these apps contain inaccurate sexual health facts and non-evidence-based information concerning contraception. On these bases, and in respect to: (1) the needs of women to effectively prevent unintended pregnancies while conducting a stress-free healthy lifestyle. (2) the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for contraception's recommendations, and (3) the results/recommendations of a field study conducted in the reproductive health center 'Les Orangers' in Rabat to collect the app's requirements, we developed an evidence-based patient-centered contraceptive app referred to as 'MyContraception'. Thereafter, we conducted a set of functional tests to ensure that the MyContraception solution is performing as expected and is conform to the software functional requirements previously set before moving to non-functional requirements evaluation. Since customer's feedback is valuable to non-functional testing, we choose to evaluate potential users' feedback. Moreover, giving that mobile app testing is a complex process involving different skill sets, we elaborated a rigorous experimental design to conduct an empirical evaluation of the MyContraception solution, which will exhaustively assess the overall quality of this solution and examine its effects on improving the quality of patient-centered contraception care.
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Affiliation(s)
- Manal Kharbouch
- Software Project Management Research Team, Department of Web and Mobile Engineering, ENSIAS, Mohamed V University in Rabat, Rabat, Morocco
| | - Ali Idri
- Software Project Management Research Team, Department of Web and Mobile Engineering, ENSIAS, Mohamed V University in Rabat, Rabat, Morocco. .,MSDA, University Mohammed VI Polytechnic, Ben Guerir, Morocco.
| | - Taoufik Rachad
- Software Project Management Research Team, Department of Web and Mobile Engineering, ENSIAS, Mohamed V University in Rabat, Rabat, Morocco
| | - Hassan Alami
- Faculty of Medicine, University Mohammed V, Rabat, Morocco
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Youssef Stelate
- Software Project Management Research Team, Department of Web and Mobile Engineering, ENSIAS, Mohamed V University in Rabat, Rabat, Morocco
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Pearson JT, Chelstowska M, Rowland SP, Benhar E, Kopp-Kallner H, Berglund Scherwitzl E, Acuna J, Gemzell Danielsson K, Scherwitzl R. Contraceptive Effectiveness of an FDA-Cleared Birth Control App: Results from the Natural Cycles U.S. Cohort. J Womens Health (Larchmt) 2020; 30:782-788. [PMID: 33370220 DOI: 10.1089/jwh.2020.8547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Digital fertility awareness-based methods of birth control are an attractive alternative to hormonal or invasive birth control for modern women. They are also popular among women who may be planning a pregnancy over the coming years and wish to learn about their individual menstrual cycle. The aim of this study was to assess the effectiveness of the Natural Cycles app at preventing pregnancy for a cohort of women from the United States and to describe the key demographics of current users of the app in such a cohort. Materials and Methods: This prospective real-world cohort study included users who purchased an annual subscription to prevent pregnancy. Demographics were assessed through answers to in-app questionnaires. Birth control effectiveness estimates for the entire cohort were calculated using 1-year pearl index (PI) and 13-cycle cumulative pregnancy probability (Kaplan-Meier life table analysis). Results: The study included 5879 women who contributed an average of 10.5 months of data for a total of 5125 woman-years of exposure. The average user was 30 years old with a body mass index of 24 and reported being in a stable relationship. With typical use, the app had a 13-cycle cumulative pregnancy probability of 7.2% and a 1-year typical use PI of 6.2. When the app was used under perfect use, the PI was 2.0. Conclusions: The data presented in this study give insights into the cohort of women using this app in the United States, and provide country-specific effectiveness estimates. The contraceptive effectiveness of the app was in line with previously published figures from Natural Cycles (PI of seven for typical use and two for perfect use).
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Affiliation(s)
| | | | | | | | - Helena Kopp-Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Juan Acuna
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW To evaluate the recent literature on mobile health applications available to patients for contraception and abortion care. RECENT FINDINGS Women are increasingly interested in contraceptive tools utilizing mobile technology, and a majority of women expect them to be science-based. The largest number of available mobile apps supports natural family planning methods, which is recognized as the least effective contraceptive method. Many available apps cannot be relied on for accurate, science-based pregnancy prevention methods. Further, there is a paucity of data regarding use of mobile technology for women seeking or receiving abortion. SUMMARY Further research is needed to evaluate mobile health apps and how they can best provide patient consumers with accurate, evidence-based information to support the prevention of unintended pregnancy.
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Smartphone Applications for Period Tracking: Rating and Behavioral Change among Women Users. Obstet Gynecol Int 2020; 2020:2192387. [PMID: 32952563 PMCID: PMC7481939 DOI: 10.1155/2020/2192387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background The use of mobile apps for health and well-being has grown exponentially in the last decade, as such apps were reported to be ideal platforms for behavioral change and symptoms monitoring and management. Objective This study aimed to systematically review period tracking applications available at Google Play and Apple App Stores and determine the presence, features, and quality of these smartphone apps. In addition, behavioral changes associated with the top 5 rated apps were assessed. Methods This study used the Systematic Search Criteria through Google Play Store and iTunes Apple Store, using terms related to period tracking. Apps were scanned for matching the inclusion criteria and the included apps were assessed by two reviewers using the Mobile Application Rating Scale (MARS), a tool that was developed for classifying and assessing the quality of mHealth apps. Results Forty-nine apps met the inclusion criteria. Most of the apps enabled setting user goals, motivations, and interactivity, tracking multiple symptoms or mood changes, allowed notifications, and used graphs to illustrate the tracking result over a specific period of time. The majority of features and functions within these apps were offered for free, while some apps included limited in-app purchases or needed Internet connection to function. Certain apps were reported by participants to promote behavioral change and increase knowledge and awareness regarding monthly periods. Conclusions Period tracking apps were easy to use and navigate and can hence be readily adopted into routine tracking and management of periods. However, most apps were not based on significant evidence and may need further development to support period-related symptom management.
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Webb S, Cheng AL, Simmons R, Peragallo Urrutia R, Jennings V, Witt J. A Mixed-Methods Assessment of Health Care Providers' Knowledge, Attitudes, and Practices Around Fertility Awareness-Based Methods in Title X Clinics in the United States. WOMEN'S HEALTH REPORTS 2020; 1:354-365. [PMID: 33786500 PMCID: PMC7784735 DOI: 10.1089/whr.2020.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/18/2022]
Abstract
Objective: To understand how Title X providers currently engage with fertility awareness-based methods (FABMs) for pregnancy prevention in Title X clinics across the United States. Materials and Methods: We developed a survey to assess knowledge of fertility for purposes of pregnancy prevention, attitudes toward FABMs use for pregnancy prevention, and practices when patients request FABMs for pregnancy prevention. Results: In total, 329 participants who met all inclusion criteria completed the survey. Respondents were generally highly knowledgeable on fertility, felt neutrally toward FABMs or thought they were a nonviable option for most women, and were likely to respond to patient requests for FABMs for pregnancy prevention by providing information. Qualitative responses included several barriers to provision of FABMs for pregnancy prevention and few successes to provision. Conclusions: Fertility knowledge and discussion of specific methods increased with the number of methods included in the clinic's written materials or with the number of different FABMs someone at that clinic had been trained on. Significant clinician or administrative barriers may exist to offering FABMs to patients. Incorporating up-to-date information on a range of FABMs—rather than treating them as one method—into contraceptive counseling represents an opportunity to increase the contraceptive offering for clients who want them, leading to increased patient satisfaction and successful family planning outcomes.
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Affiliation(s)
- Shelby Webb
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - An-Lin Cheng
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Rebecca Simmons
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Rachel Peragallo Urrutia
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Victoria Jennings
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jacki Witt
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Ali R, Gürtin ZB, Harper JC. Do fertility tracking applications offer women useful information about their fertile window? Reprod Biomed Online 2020; 42:S1472-6483(20)30509-5. [PMID: 34756400 DOI: 10.1016/j.rbmo.2020.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/01/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION To characterize mobile fertility tracking applications (apps) to determine the use of such apps for women trying to conceive by identifying the fertile window. DESIGN An exploratory cross-sectional audit study was conducted of fertility tracking applications. Ninety out of a possible total 200 apps were included for full review. The main outcome measures were the underlying app method for predicting ovulation, the fertile window, or both, price to download and use the app, disclaimers and cautions, information and features provided and tracked, and app marketing strategies. RESULTS All the apps except one monitored the women's menstrual cycle dates. Most apps only tracked menstrual cycle dates (n = 49 [54.4%]). The remainder tracked at least one fertility-based awareness method (basal body temperature, cervical mucus, LH) (n = 41 [45.6%]). Twenty-five apps measured dates, basal body temperature, LH and cervical mucus (27.8%). Seventy-six per cent of apps were free to download with free apps having more desirable features, tracking more measures and having more and better quality educational insights than paid apps. Seventy per cent of apps were classified as feminine apps, 41% of which were pink in colour. CONCLUSIONS Mobile fertility tracking apps are heterogenous in their underlying methods of predicting fertile days, the price to obtain full app functionality, and in content and design. Unreliable calendar apps remain the most commonly available fertility apps on the market. The unregulated nature of fertility apps is a concern that could be addressed by app regulating bodies. The possible benefit of using fertility apps to reduce time to pregnancy needs to be evaluated.
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Affiliation(s)
- Roshonara Ali
- Reproductive Science and Society Group, Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - Zeynep B Gürtin
- Reproductive Science and Society Group, Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - Joyce C Harper
- Reproductive Science and Society Group, Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK.
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2020. J Midwifery Womens Health 2020; 65:567-573. [PMID: 32841485 DOI: 10.1111/jmwh.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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Simmons RG, Jennings V. Fertility awareness-based methods of family planning. Best Pract Res Clin Obstet Gynaecol 2020; 66:68-82. [DOI: 10.1016/j.bpobgyn.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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Aznar J, Tudela J. The Use of NFP When Pregnancy Is Contraindicated? LINACRE QUARTERLY 2020; 87:171-181. [PMID: 32549634 DOI: 10.1177/0024363920902631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Sacred Congregation for the Doctrine of the Faith has declared the moral liceity of hysterectomy when certain medical criteria are met but does not exclude other options, "for example, recourse to infertile periods or total abstinence." Consequently, there may be couples who prefer to use natural family planning (NFP) methods. We shall refer to these in this article. The efficacy of NFP methods is determined by knowing the day of ovulation. To that end, three parameters are used: the presence and consistency of cervical mucus, measurement of the basal body temperature, and the determination of particular hormones in urine. Of the NFP methods used, the so-called sympto-thermal method seems to be the most effective. It has been concluded that the postovulatory or luteal phase of the female menstrual cycle is the safest time to avoid pregnancy if the couple has sexual intercourse during this period. Nevertheless, the use of NFP methods has limitations if the length of the cycles varies, there are fluctuations in the basal temperature, or when there are vaginal infections. Urinary hormone levels can also be altered by the use of antibiotics or psychotropic drugs. In general, however, it can be concluded that NFP methods, if used in the conditions mentioned herein, offer a high degree of reliability, similar to that of artificial contraceptive methods. Accordingly, if pregnancy must be avoided in the medical circumstances to which the Congregation for the Doctrine of the Faith refers, NFP methods can effectively replace hysterectomy, thereby circumventing the medical difficulties of this practice. Summary The Sacred Congregation for the Doctrine of the Faith has declared the moral liceity of hysterectomy when certain medical criteria are met but does not exclude other options, "for example, recourse to infertile periods or total abstinence." Consequently, there may be couples who prefer to use natural family planning (NFP) methods. We shall refer to these in this article. In general, it can be concluded that NFP methods, if used in the conditions mentioned herein, offer a high degree of reliability, similar to that of artificial contraceptive methods. Accordingly, if pregnancy must be avoided in the medical circumstances to which the Congregation for the Doctrine of the Faith refers, NFP methods can effectively replace hysterectomy, thereby circumventing the medical difficulties of this practice.
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Affiliation(s)
- Justo Aznar
- Institute of Life Sciences, Catholic University of Valencia, Spain
| | - Julio Tudela
- Institute of Life Sciences, Catholic University of Valencia, Spain
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Ford EA, Roman SD, McLaughlin EA, Beckett EL, Sutherland JM. The association between reproductive health smartphone applications and fertility knowledge of Australian women. BMC WOMENS HEALTH 2020; 20:45. [PMID: 32131809 PMCID: PMC7057638 DOI: 10.1186/s12905-020-00912-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
Background Previous studies have identified that women living in developed countries have insufficient knowledge of factors which may be contributing to the increasingly high global infertility rates such as maternal age and assisted reproductive technologies. There is a large market of reproductive health smartphone applications, yet little is known about the advantages these apps may confer to users in regards to reproductive health knowledge. Methods An anonymous, online survey of women living in Australia aged 18 and above was open March–June 2018, until ≥200 responses were acquired for statistical power. Respondents answered questions regarding knowledge about general fertility and related factors (age, cyclic fertility, smoking, obesity, miscarriage rate, and success of assisted reproductive technologies). Fertility knowledge was compared in respondents who did or did not use apps relating to female reproductive health. Additionally the functions preferred in reproductive health apps was described by app using respondents. Sociodemographic information was also collected, and relevant data within the dataset was subject to multivariable modelling for the outcome of the fertility knowledge questions. Results Of the 673 respondents that completed the survey, 43.09% reported using mobile phone applications relating to female reproductive health. On average, respondents answered only three of the six fertility knowledge questions correctly. App using respondents were more likely to score better on one question, related to fertility during the menstrual cycle (p < 0.001). App users most commonly reported using the menstrual tracking function in apps (82.4%), which may account for the increased knowledge of cyclic fertility. Conclusions This data provides preliminary evidence toward the usefulness of smartphone applications as a medium for providing information about fertility to women. A limited understanding of one’s own fertility was demonstrated despite being essential for the decision-making of women throughout their reproductive years.
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Affiliation(s)
- Emmalee A Ford
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Ring Road, Callaghan, New South Wales, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Shaun D Roman
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Ring Road, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.,Priority Research Centre for Drug Development, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Eileen A McLaughlin
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Ring Road, Callaghan, New South Wales, 2308, Australia.,School of Science, Western Sydney University, Penrith, NSW, 2751, Australia.,School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, 1142, New Zealand
| | - Emma L Beckett
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.,School of Environmental & Life Sciences, Faculty of Science, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Jessie M Sutherland
- Priority Research Centre for Reproductive Science, Schools of Biomedical Science & Pharmacy and Environmental & Life Sciences, University of Newcastle, Ring Road, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
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Kleinschmidt TK, Bull JR, Lavorini V, Rowland SP, Pearson JT, Scherwitzl EB, Scherwitzl R, Danielsson KG. Advantages of determining the fertile window with the individualised Natural Cycles algorithm over calendar-based methods. EUR J CONTRACEP REPR 2019; 24:457-463. [PMID: 31738859 DOI: 10.1080/13625187.2019.1682544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: This study aims to compare the accuracy of fertile window identification with the contraceptive app Natural Cycles against the Rhythm Method and Standard Days Method (SDM).Materials and methods: Menstruation dates, basal body temperature (BBT), and luteinising hormone (LH) test results were collected anonymously from Natural Cycles app users. The fraction of green days (GDs) and wrong green days (WGDs) allocated by the various algorithms was determined over 12 cycles. For comparison of Natural Cycles and the Rhythm Method, 26,626 cycles were analysed.Results: Natural Cycles' algorithms allocated 59% GDs (LH, BBT) in cycle 12, while the fraction of WGDs averaged 0.08%. The Rhythm Method requires monitoring of six cycles, resulting in no GDs or WGDs in cycle 1-6. In cycle 7, 49% GDs and 0.26% WGDs were allocated. GDs and WGDs decreased to 43% and 0.08% in cycle 12. The probabilities of WGDs on the day before ovulation with Natural Cycles were 0.31% (BBT) and 0% (LH, BBT), and 0.80% with the Rhythm Method. The probability of WGDs on the day before ovulation was 6.90% with the SDM.Conclusions: This study highlights that individualised algorithms are advantageous for accurate determination of the fertile window and that static algorithms are more likely to fail during the most fertile days.
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Affiliation(s)
| | | | | | | | | | | | | | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Manhart MD. A Comparison of User Behaviors for a Fertility-Tracking App: Does Training in an NFP Method Improve Persistence and Use? LINACRE QUARTERLY 2019; 87:53-59. [PMID: 32431448 DOI: 10.1177/0024363919870435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores differences in the use of CycleProGo™ (CPG), a fertility-tracking app developed by Couple to Couple League (CCL), between those exposed to it as a part of natural family planning (NFP) instruction versus those who find it on their own. An anonymous data set of 17,543 CPG accounts opened between April 2013 and June 2016 was used for analysis. Nonmember users opened the most accounts (58 percent, n = 10,134), CCL members represented 38 percent (n = 6,758) of new accounts, and 207 CCL teachers (4 percent) were using CPG for personal charting. Significantly more nonmember accounts had zero days of use after the initial opening compared to CCL member accounts (61 percent vs. 23 percent, respectively, χ2 = 2,405.9, p < .001). Conversely, significantly more CCL member accounts were used for ninety days or longer than nonmember accounts (47 percent vs. 13 percent, respectively, χ2 = 2,404.2, p < .001). CCL students-those who began using the app as part of a formal NFP teaching curriculum-were more likely to use the app for > six cycles compared to nonmembers. In accounts with at least one complete cycle, CCL students were the most diligent at daily recording (95 percent of cycle days with observation recorded) followed by CCL members (88 percent) and nonmembers (76 percent). CCL teachers had the lowest frequency of cycle days with a recorded observation (73 percent). Within each cohort, accounts with > six recorded cycles had a lower proportion of cycle days with an observation recorded, likely reflecting increasing knowledge of their personal fertility patterns. Long-term users who had no known formal training in NFP still had the lowest proportion cycle days with a fertility observation. We conclude formal NFP instruction increases the probability of long-term app use, and regardless of training, long-term users will likely record observations on about 70 percent of cycle days. Summary "CycleProGo™ users with NFP training were more persistent and diligent about daily data input than those without training."
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Bull JR, Rowland SP, Scherwitzl EB, Scherwitzl R, Danielsson KG, Harper J. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. NPJ Digit Med 2019; 2:83. [PMID: 31482137 PMCID: PMC6710244 DOI: 10.1038/s41746-019-0152-7] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022] Open
Abstract
The use of apps that record detailed menstrual cycle data presents a new opportunity to study the menstrual cycle. The aim of this study is to describe menstrual cycle characteristics observed from a large database of cycles collected through an app and investigate associations of menstrual cycle characteristics with cycle length, age and body mass index (BMI). Menstrual cycle parameters, including menstruation, basal body temperature (BBT) and luteinising hormone (LH) tests as well as age and BMI were collected anonymously from real-world users of the Natural Cycles app. We analysed 612,613 ovulatory cycles with a mean length of 29.3 days from 124,648 users. The mean follicular phase length was 16.9 days (95% CI: 10-30) and mean luteal phase length was 12.4 days (95% CI: 7-17). Mean cycle length decreased by 0.18 days (95% CI: 0.17-0.18, R 2 = 0.99) and mean follicular phase length decreased by 0.19 days (95% CI: 0.19-0.20, R 2 = 0.99) per year of age from 25 to 45 years. Mean variation of cycle length per woman was 0.4 days or 14% higher in women with a BMI of over 35 relative to women with a BMI of 18.5-25. This analysis details variations in menstrual cycle characteristics that are not widely known yet have significant implications for health and well-being. Clinically, women who wish to plan a pregnancy need to have intercourse on their fertile days. In order to identify the fertile period it is important to track physiological parameters such as basal body temperature and not just cycle length.
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Affiliation(s)
| | | | | | | | - Kristina Gemzell Danielsson
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Joyce Harper
- Department of Reproductive Health, Institute for Women’s Health, University College London, London, UK
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31
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Symul L, Wac K, Hillard P, Salathé M. Assessment of menstrual health status and evolution through mobile apps for fertility awareness. NPJ Digit Med 2019; 2:64. [PMID: 31341953 PMCID: PMC6635432 DOI: 10.1038/s41746-019-0139-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 05/08/2019] [Indexed: 01/16/2023] Open
Abstract
For most women of reproductive age, assessing menstrual health and fertility typically involves regular visits to a gynecologist or another clinician. While these evaluations provide critical information on an individual's reproductive health status, they typically rely on memory-based self-reports, and the results are rarely, if ever, assessed at the population level. In recent years, mobile apps for menstrual tracking have become very popular, allowing us to evaluate the reliability and tracking frequency of millions of self-observations, thereby providing an unparalleled view, both in detail and scale, on menstrual health and its evolution for large populations. In particular, the primary aim of this study was to describe the tracking behavior of the app users and their overall observation patterns in an effort to understand if they were consistent with previous small-scale medical studies. The secondary aim was to investigate whether their precision allowed the detection and estimation of ovulation timing, which is critical for reproductive and menstrual health. Retrospective self-observation data were acquired from two mobile apps dedicated to the application of the sympto-thermal fertility awareness method, resulting in a dataset of more than 30 million days of observations from over 2.7 million cycles for two hundred thousand users. The analysis of the data showed that up to 40% of the cycles in which users were seeking pregnancy had recordings every single day. With a modeling approach using Hidden Markov Models to describe the collected data and estimate ovulation timing, it was found that follicular phases average duration and range were larger than previously reported, with only 24% of ovulations occurring at cycle days 14 to 15, while the luteal phase duration and range were in line with previous reports, although short luteal phases (10 days or less) were more frequently observed (in up to 20% of cycles). The digital epidemiology approach presented here can help to lead to a better understanding of menstrual health and its connection to women's health overall, which has historically been severely understudied.
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Affiliation(s)
- Laura Symul
- Department of Surgery, Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA 94305-5317 USA
- Digital Epidemiology Lab, Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Campus Biotech, Chemin des mines 9, 1202 Geneva, Switzerland
| | - Katarzyna Wac
- Department of Surgery, Stanford School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA 94305-5317 USA
- Quality of Life Technologies lab, Institute of Services Science, Center for Informatics, University of Geneva, CUI Battelle bat A, Route de Drize 7, 1227 Carouge, Switzerland
- DIKU, University of Copenhagen, Copenhagen, Denmark
| | - Paula Hillard
- Department of Obstetrics & Gynecology, Stanford School of Medicine, Stanford University, 300 Pasteur Dr. HH333, Stanford, CA 94305-5317 USA
| | - Marcel Salathé
- Digital Epidemiology Lab, Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Campus Biotech, Chemin des mines 9, 1202 Geneva, Switzerland
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Rajapreyar IN, Sinkey RG, Joly JM, Pamboukian SV, Lenneman A, Hoopes CW, Kopf S, Hayes A, Moussa H, Acharya D, Aryal S, Weeks P, Cribbs M, Wetta L, Tallaj J. Management of reproductive health after cardiac transplantation. J Matern Fetal Neonatal Med 2019; 34:1469-1478. [PMID: 31238747 DOI: 10.1080/14767058.2019.1636962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pregnancy after cardiac transplantation poses immense challenges. Maternal risks include hypertensive disorders of pregnancy, rejection, and failure of the cardiac allograft that may lead to death. Fetal risks include potential teratogenic effects of immunosuppression and prematurity. Because of the high-risk nature of pregnancy in a heart transplant patient, management of reproductive health after cardiac transplantation should include preconception counseling to all women in the reproductive age group before and after cardiac transplantation. Reliable contraception is vital as nearly half of the pregnancies in this population are unintended. Despite the associated risks, successful pregnancies after cardiac transplantation have been reported. A multidisciplinary approach proposed in this review is essential for successful outcomes. A checklist for providers to guide management is provided.
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Affiliation(s)
- Indranee N Rajapreyar
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna M Joly
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew Lenneman
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles W Hoopes
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Kopf
- Department of Transplant Operations, Cardiothoracic Transplant Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Hayes
- Department of Transplant Operations, Cardiothoracic Transplant Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hind Moussa
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Deepak Acharya
- Department of Medicine, Division of Cardiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sudeep Aryal
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phillip Weeks
- Department of Pharmacy, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Marc Cribbs
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luisa Wetta
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
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33
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Challenges for digital services in the NHS: drowning in a sea of innovation. Br J Gen Pract 2019; 69:326-327. [PMID: 31249071 DOI: 10.3399/bjgp19x704177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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34
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Study of contraceptive mobile app fails to provide convincing findings. Contraception 2019; 99:312. [DOI: 10.1016/j.contraception.2018.07.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
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35
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Bull J, Rowland S, Lundberg O, Berglund-Scherwitzl E, Gemzell-Danielsson K, Trussell J, Scherwitzl R. Typical use effectiveness of Natural Cycles: postmarket surveillance study investigating the impact of previous contraceptive choice on the risk of unintended pregnancy. BMJ Open 2019; 9:e026474. [PMID: 30904873 PMCID: PMC6475236 DOI: 10.1136/bmjopen-2018-026474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the association between contraceptive effectiveness of Natural Cycles and users' previous choice of contraceptive, and to evaluate the impact of shifting from other methods to Natural Cycles on the risk of unintended pregnancy. SETTING Natural Cycles mobile application. PARTICIPANTS 16 331 Natural Cycles users in Sweden for the prevention of pregnancy. OUTCOME MEASURES Risk of unintended pregnancy. STUDY DESIGN Real world evidence was collected from Natural Cycles users regarding contraceptive use prior to using Natural Cycles and sexual activity while using Natural Cycles. We calculated the typical use 1-year Pearl Index (PI) and 13-cycle failure rate of Natural Cycles for each cohort. The PI was compared with the population PI of their stated previous methods. RESULTS For women who had used condoms before, the PI of Natural Cycles was the lowest at 3.5±0.5. For women who had used the pill before, the PI of Natural Cycles was the highest at 8.1±0.6. The frequency of unprotected sex on fertile days partially explained some of the observed variation in PI between cohorts. 89% of users switched to Natural Cycles from methods with higher or similar reported PIs. CONCLUSION The effectiveness of Natural Cycles is influenced by previous contraceptive choice and this should be considered when evaluating the suitability of the method for the individual. We estimate that Natural Cycles usage can reduce the overall likelihood of having an unintended pregnancy by shifting usage from less effective methods.
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Affiliation(s)
- Jonathan Bull
- Department of Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
| | - Simon Rowland
- Department of Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
| | - Olof Lundberg
- Department of Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
| | | | | | - James Trussell
- Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Raoul Scherwitzl
- Department of Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
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36
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Jennings V, Haile LT, Simmons RG, Spieler J, Shattuck D. Perfect- and typical-use effectiveness of the Dot fertility app over 13 cycles: results from a prospective contraceptive effectiveness trial. EUR J CONTRACEP REPR 2019; 24:148-153. [DOI: 10.1080/13625187.2019.1581164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Victoria Jennings
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Liya T. Haile
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Rebecca G. Simmons
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jeff Spieler
- Independent Consultant in Population and Reproductive Health, Bethesda, MD, USA
| | - Dominick Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
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37
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Liu B, Shi S, Wu Y, Thomas D, Symul L, Pierson E, Leskovec J. Predicting pregnancy using large-scale data from a women's health tracking mobile application. PROCEEDINGS OF THE ... INTERNATIONAL WORLD-WIDE WEB CONFERENCE. INTERNATIONAL WWW CONFERENCE 2019; 2019:2999-3005. [PMID: 31538145 DOI: 10.1145/3308558.3313512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Predicting pregnancy has been a fundamental problem in women's health for more than 50 years. Previous datasets have been collected via carefully curated medical studies, but the recent growth of women's health tracking mobile apps offers potential for reaching a much broader population. However, the feasibility of predicting pregnancy from mobile health tracking data is unclear. Here we develop four models - a logistic regression model, and 3 LSTM models - to predict a woman's probability of becoming pregnant using data from a women's health tracking app, Clue by BioWink GmbH. Evaluating our models on a dataset of 79 million logs from 65,276 women with ground truth pregnancy test data, we show that our predicted pregnancy probabilities meaningfully stratify women: women in the top 10% of predicted probabilities have a 89% chance of becoming pregnant over 6 menstrual cycles, as compared to a 27% chance for women in the bottom 10%. We develop a technique for extracting interpretable time trends from our deep learning models, and show these trends are consistent with previous fertility research. Our findings illustrate the potential that women's health tracking data offers for predicting pregnancy on a broader population; we conclude by discussing the steps needed to fulfill this potential.
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Affiliation(s)
- Bo Liu
- Dept. of Computer Science, Stanford
| | | | | | | | - Laura Symul
- Dept. of General Surgery and Dept. of Statistics, Stanford
| | | | - Jure Leskovec
- Dept. of Computer Science, Stanford Chan-Zuckerberg Biohub
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38
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Jennings VH, Haile LT, Simmons RG, Fultz HM, Shattuck D. Estimating six-cycle efficacy of the Dot app for pregnancy prevention. Contraception 2019; 99:52-55. [DOI: 10.1016/j.contraception.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
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39
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McIlwaine E, Rowland S, Berglund Scherwitzl E, Scherwitzl R. Comment on 'Exaggerating contraceptive efficacy: the implications of the Advertising Standards Authority action against Natural Cycles'. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:78. [PMID: 30622130 DOI: 10.1136/bmjsrh-2018-200285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Emily McIlwaine
- Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
| | - Simon Rowland
- Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
| | | | - Raoul Scherwitzl
- Medical Communications, Natural Cycles Nordic AB, Stockholm, Sweden
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40
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Berglund Scherwitzl E, Lundberg O, Gemzell Danielsson K, Trussell J, Scherwitzl R. Response to "study of contraceptive mobile app fails to provide convincing findings". Contraception 2018; 99:195-196. [PMID: 30336132 DOI: 10.1016/j.contraception.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - O Lundberg
- NaturalCycles Nordic AB, Luntmakargatan 26, S-111 37 Stockholm, Sweden
| | - K Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, S-171 77 Stockholm, Sweden
| | - J Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08544, USA; The University of Edinburgh, Edinburgh, EH8 9YL, Scotland, UK
| | - R Scherwitzl
- NaturalCycles Nordic AB, Luntmakargatan 26, S-111 37 Stockholm, Sweden.
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41
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Gilmartin C, Arbe-Barnes EH, Diamond M, Fretwell S, McGivern E, Vlazaki M, Zhu L. Varsity medical ethics debate 2018: constant health monitoring - the advance of technology into healthcare. Philos Ethics Humanit Med 2018; 13:12. [PMID: 30176930 PMCID: PMC6122183 DOI: 10.1186/s13010-018-0065-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/14/2018] [Indexed: 05/20/2023] Open
Abstract
The 2018 Varsity Medical Ethics debate convened upon the motion: "This house believes that the constant monitoring of our health does more harm than good". This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year's debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate.
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Affiliation(s)
- Chris Gilmartin
- Gonville and Caius College, University of Cambridge, Trinity Street, Cambridge, CB2 1TA UK
| | | | - Michael Diamond
- St Peter’s College, University of Oxford, New Inn Hall Street, Oxford, OX1 2DL UK
| | - Sasha Fretwell
- Trinity College, University of Oxford, Broad Street, Oxford, OX1 3BH UK
| | - Euan McGivern
- Oriel College, University of Oxford, Oriel Square, Oxford, OX1 4EW UK
| | - Myrto Vlazaki
- Newnham College, University of Cambridge, Sidgwick Avenue, Cambridge, CB3 9DF UK
| | - Limeng Zhu
- Girton College, University of Cambridge, Huntingdon Road, Cambridge, CB3 0JG UK
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Gambier-Ross K, McLernon DJ, Morgan HM. A mixed methods exploratory study of women's relationships with and uses of fertility tracking apps. Digit Health 2018; 4:2055207618785077. [PMID: 30225095 PMCID: PMC6136106 DOI: 10.1177/2055207618785077] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/31/2018] [Indexed: 11/16/2022] Open
Abstract
Digital self-tracking is rising, including tracking of menstrual cycles by women using
fertility tracking apps (FTAs). However, little is known about users’ experiences of FTAs
and their relationships with them. The aim of this study was to explore women’s uses of
and relationships with FTAs. This exploratory study employed a mixed methods approach,
involving the collection and analysis of an online survey and follow-up interviews.
Qualitative analysis of survey and interview data informed hypothesis development. Online
surveys yielded 241 responses and 11 follow-up interviews were conducted. Just over a
third of women surveyed had experience of using FTAs (89/241) and follow-up interviews
were conducted with a proportion of respondents (11/241). Four main motivations to use
FTAs were identified: (a) to observe cycle (72%); (b) to conceive (34%); (c) to inform
fertility treatment (12%); and (d) as contraception (4%). Analysis of the free-text survey
questions and interviews using grounded theory methodology highlighted four themes
underpinning women’s relationships with FTAs: (a) medical grounding; (b) health trackers
versus non-trackers; (c) design; and (d) social and ethical aspects. Participants who used
other health apps were more likely to use FTAs (p = 0.001).
Respondents who used contraception were less likely to use FTAs compared with respondents
who did not use contraception (p = 0.002). FTA usage also
decreases (p = 0.001) as age increases. There was no
association between FTA usage and menstrual status (p = 0.259). This research emphasises the differing motivations for FTA use.
Future research should further explore the diverse relationships between different
subgroups of women and FTAs.
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Affiliation(s)
- Katie Gambier-Ross
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Heather M Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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43
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Hough A, Bryce M, Forrest S. Social media and advertising natural contraception to young women: the case for clarity and transparency with reference to the example of 'Natural Cycles'. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2018-200110. [PMID: 30032124 DOI: 10.1136/bmjsrh-2018-200110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/02/2018] [Accepted: 06/19/2018] [Indexed: 05/25/2023]
Affiliation(s)
- Amy Hough
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maggie Bryce
- London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Forrest
- Institute of Health and Society, Newcastle University, Newcastle, UK
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44
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Schimmoeller N, Creinin MD. More clarity needed for contraceptive mobile app Pearl Index calculations. Contraception 2018; 97:456. [DOI: 10.1016/j.contraception.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
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45
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Freis A, Freundl-Schütt T, Wallwiener LM, Baur S, Strowitzki T, Freundl G, Frank-Herrmann P. Plausibility of Menstrual Cycle Apps Claiming to Support Conception. Front Public Health 2018; 6:98. [PMID: 29666788 PMCID: PMC5891577 DOI: 10.3389/fpubh.2018.00098] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
The interval of peak fertility during the menstrual cycle is of limited duration, and the day of ovulation varies, even in women with fairly regular cycles. Therefore, menstrual cycle apps identifying the "fertile window" for women trying to conceive must be quite precise. A deviation of a few days may lead the couple to focus on less- or non-fertile days for sexual intercourse and thus may be worse than random intercourse. The aim of the present investigation was to develop a scoring system for rating available apps for determining the fertile window and secondarily pilot test 12 apps currently available in both German and English (consisting of 6 calendar-based apps: Clue Menstruations- und Zykluskalender, Flo Menstruationskalender, Maya-Mein Periodentracker, Menstruationskalender Pro, Period Tracker Deluxe, and WomanLog-Pro-Kalender; 2 calculothermal apps: Ovy and Natural Cycles; and 4 symptothermal apps: myNFP, Lady Cycle, Lily, and OvuView). The calendar-based apps were investigated by entering several series of cycles with varying lengths, whereas the symptom-based apps were examined by entering data of cycles with known temperature rise, cervical mucus pattern, and clinical ovulation. The main criteria for evaluating the cycle apps were as follows: (1) What methods/parameters were used to determine the fertile window? (2) What study results exist concerning that underlying method/parameters? (3) What study results exist concerning the app itself? (4) Was there a qualified counseling service? The calendar-based apps predicted the fertile days based on data of previous cycles. They obtained zero points in our scoring system, as they did not comply with any of the evaluated criteria. Calculothermal apps had similar deficits for predicting the most fertile days and produced suboptimal results (Ovy 3/30 points and Natural Cycles 2/30 points). The symptothermal apps determined the fertile days based on parameters of the current cycle: Lady Cycle scored 20/30 points, myNFP 20/30 points, Lily 19/30 points, and OvuView 11/30 points. We concluded that the available cycle apps vary according to their underlying scientific quality and clear rating criteria have been suggested. Three of the tested apps were judged to be eligible for further study. The scientific evaluation of cycle apps depends on good prospective studies undertaken by independent investigators who are free of commercial bias.
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Affiliation(s)
- Alexander Freis
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Heidelberg, Germany
| | | | - Lisa-Maria Wallwiener
- Department of Obstetrics and Gynecology, University Clinic of Munich, Munich, Germany
| | - Sigfried Baur
- Section Natural Fertility, German Society of Gynecological Endocrinology and Fertility Medicine (DGGEF e.V.), Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Heidelberg, Germany
| | - Günter Freundl
- Section Natural Fertility, German Society of Gynecological Endocrinology and Fertility Medicine (DGGEF e.V.), Heidelberg, Germany
| | - Petra Frank-Herrmann
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Heidelberg, Germany
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app. Reprod Health 2018; 15:37. [PMID: 29499716 PMCID: PMC5833051 DOI: 10.1186/s12978-018-0479-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates. RESULT In the resultant group of 125 women (2076 cycles in total), 2 women indicated that they had been unintentionally pregnant during the use of the device, giving a typical-use related Pearl-Index of 1.3. Counting only the pregnancies which occurred as a result of unprotected intercourse during the infertile (green) phase, we found 1 pregnancy, giving a method-related Pearl-Index of 0.6. Calculating the pregnancy rate resulting from continuous use and unprotected intercourse exclusively on green days, gives a perfect-use Pearl-Index of 0.8. CONCLUSION It seems that combining a specific biosensor-embedded device (Daysy), which gives the method a very high repeatable accuracy, and a mobile application (DaysyView) which leads to higher user engagement, results in higher overall usability of the method.
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Affiliation(s)
- Martin C Koch
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
| | - Johannes Lermann
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Simone K Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Stefanie Burghaus
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Janina Hackl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Sven Kehl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline C Hack
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Uwe G Pöhls
- Praxis, Kaiserstraße 26, 97070, Würzburg, Germany
| | - Stefan P Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Falk C Thiel
- Klinik am Eichert, Frauenklinik, Eichertstraße 3, 73035, Göppingen, Germany
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47
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Lundberg O, Berglund Scherwitzl E, Kopp Kallner H, Gemzell Danielsson K, Trussell J, Scherwitzl R. Clarifications concerning contraceptive mobile app Pearl Index calculations. Contraception 2018; 97:456-457. [PMID: 29408366 DOI: 10.1016/j.contraception.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- O Lundberg
- NaturalCycles Nordic AB, Luntmakargatan 26, S-111 37 Stockholm, Sweden
| | | | - H Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, S-182 88 Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, S-171 77 Stockholm, Sweden
| | - K Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, S-171 77 Stockholm, Sweden
| | - J Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08544, USA; The University of Edinburgh, Edinburgh EH8 9YL, Scotland, United Kingdom
| | - R Scherwitzl
- NaturalCycles Nordic AB, Luntmakargatan 26, S-111 37 Stockholm, Sweden.
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48
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Lundberg O, Berglund Scherwitzl E, Gemzell Danielsson K, Scherwitzl R. Fertility awareness-based mobile application. EUR J CONTRACEP REPR 2018; 23:166-168. [PMID: 29393704 DOI: 10.1080/13625187.2018.1428298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- O Lundberg
- a NaturalCycles Nordic AB , Stockholm , Sweden
| | | | - K Gemzell Danielsson
- b Department of Women's and Children's Health , Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden
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