Including men in prenatal health: the potential of e-health to improve birth outcomes

Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

Positively Pregnant: Development and piloting of a mobile app for social and emotional well-being in pregnancy

This paper describes development of a mobile e-health application, Positively Pregnant, which provides tools to meet the psychological challenges of pregnancy and transition to parenthood. Positively Pregnant was developed with input from maternity carers and consumers, incorporating local cultures and contexts as well as international research on effective interventions for stress management and mental well-being. The prototype app was piloted with 88 New Zealand women. Participants in the pilot used an average of 11.96 (SD = 7.44) components, and most were satisfied (45.1%) or neutral (40.3%) regarding the app. For 23 of the 26 interactive components, the majority of those who tried the component reported that they found it helpful. Participants reported a significant reduction in subjective stress (η²  = .088, p = .023). Feedback from pilot participants was incorporated in a version of the app that was publically launched as a free tool to support developing families. Mobile e-health applications are a promising medium for providing preventative interventions and psychoeducation about the social and emotional challenges of pregnancy and early parenting; Positively Pregnant is an example of a tool, grounded in strength-based, empirically supported strategies, to provide parents with support and information at this critical time.

The need for feminist intersectionality in digital health

Digital health, including the use of mobile health apps, telemedicine, and data analytics to improve health systems, has surged during the COVID-19 pandemic. The social and economic fallout from COVID-19 has further exacerbated gender inequities, through increased domestic violence against women, soaring unemployment rates in women, and increased unpaid familial care taken up by women-all factors that can worsen women's health. Digital health can bolster gender equity through increased access to health care, empowerment of one's own health data, and reduced burden of unpaid care work. Yet, digital health is rarely designed from a gender equity perspective. In this Viewpoint, we show that because of lower access and exclusion from app design, gender imbalance in digital health leadership, and harmful gender stereotypes, digital health is disadvantaging women-especially women with racial or ethnic minority backgrounds. Tackling digital health's gender inequities is more crucial than ever. We explain our feminist intersectionality framework to tackle digital health's gender inequities and provide recommendations for future research.

Effects of mHealth-based interventions on health literacy and related factors: A systematic review

AIMS

To evaluate the effects of mobile health (mHealth)-based interventions on health literacy and related factors.

BACKGROUND

Few reviews exist on the effects of mHealth-based interventions on the improvement and changes in health literacy and related factors.

EVALUATION

A systematic review was conducted using the Mixed Methods Appraisal Tool to evaluate the quality of articles.

RESULTS

Outcome variables included eHealth literacy, mHealth literacy and health literacy. Two studies showed that health literacy was significantly enhanced after mHealth application use, particularly among those with low education and health literacy levels. Two articles reported that health information seeking and health information appraisal improved after mHealth-based interventions, thereby increasing health literacy levels. In one article, no significant relationship was found between health literacy levels and mHealth literacy.

CONCLUSION

mHealth can enhance health literacy; furthermore, mobile applications effectively improve patient health literacy. However, measurement tools used for evaluating health literacy indicators are inconsistent, with the concept and components of these tools being not specifically designed for evaluating health literacy indicators.

IMPLICATIONS FOR NURSING MANAGEMENT

To successfully and effectively overcome health problems in diverse clinical settings, the theory-based mHealth services should be adopted while considering their intensity, frequency, duration and credibility.

Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study

BACKGROUND

Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services.

METHODS

This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation.

RESULTS

The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance.

CONCLUSION

GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial

Background

The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity.

Aim

To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring.

Methods

A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care.

Results

One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt ​​for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups.

Conclusion

The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men’s involvement in prenatal, labour and postpartum care of their partners.

Trial registration

Clinical trial registry: RBR-54zf73, U1111–1163-7761.

Mobile Health Applications for Prenatal Assessment and Monitoring

BACKGROUND

A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care.

METHODS

In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care.

RESULTS

Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable.

CONCLUSIONS

Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.

Engaging Men in Prenatal Health via eHealth: Findings From a National Survey

BACKGROUND

Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors.

OBJECTIVE

The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers.

METHODS

A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey.

RESULTS

Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger.

CONCLUSIONS

We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early "teachable moment"-where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States.

Father-Inclusive Perinatal Parent Education Programs: A Systematic Review

CONTEXT

Fathers contribute to their children's health starting at the beginning of life. Few parent education programs include fathers. Among those that do, there is little effort to report program effects on father outcomes.

OBJECTIVE

In this systematic review, we examined father-inclusive perinatal parent education programs in the United States as they relate to a range of father outcomes.

DATA SOURCES

The databases searched were PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PsycINFO.

STUDY SELECTION

Studies were included if they included an evaluation of a parent education program and a report of father outcomes measured within 1 year of the child's birth and were conducted within the United States.

DATA EXTRACTION

Of 1353 total articles, 21 met study criteria.

RESULTS

The overall state of the father-inclusive perinatal parent education program literature was poor, with few interventions available to fathers. Available programs were associated with increased father involvement, coparenting relationship, partner relationship quality, father's mental health, and father's supportive behaviors. Program effects on father-infant interaction, parenting knowledge, and attitudes and parenting self-efficacy were inconclusive. Three programs emerged as best evidence-based interventions.

LIMITATIONS

Risk of bias was high for many studies. Outcome variability, small sample size, and publication bias contributed to the weak evidence base.

CONCLUSIONS

There is a need for more evidence-based interventions to support fathers. Clinicians play a key role in engaging fathers in early parent education programs and health care settings. PROSPERO registration number: CRD42017050099.

eHealth as the Next-Generation Perinatal Care: An Overview of the Literature

Background

Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions.

Objective

This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care.

Methods

We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature.

Results

The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care.

Conclusions

This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services

Background

Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father’s involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users’ health status, as well as on networks of perinatal educational services maintained with community-based partners.

Methods

This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group).

Discussion

This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services.

Protocol version

Version 1 (February 9 2018).

Engaging Men in Prenatal Health Promotion: A Pilot Evaluation of Targeted e-Health Content

Pregnancy outcomes in the United States continue to rank among the worst in the developed world. Traditional maternal–child health promotion tends to focus exclusively on women, leaving men out of programs that can affect family health. Scholars advocate including men in prenatal health to reduce maternal and infant mortality and morbidity. This study explored the perceived role of men in prenatal health, the use of an e-health application, and participant-suggested ways of improving the application moving forward. This study interviewed men in a large Southwestern U.S. city with an average age of 26.0 years (N = 23). The sample was 52% White, 26% Hispanic, 9% Asian, 9% multiracial or other, and 4% Black. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of tablets, and recommendations for a stronger application. Despite perceived barriers such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. Most found the application to contain useful and interesting information. Participants recommended the addition of videos and interactive modules to make the application stronger. This study explored the use of a targeted e-health application to introduce men to prenatal health education. Results indicate men feel favorable to this type of intervention. Additional refinement of the application could include interactive tools or “push content” to further engage men in this important topic.