The association between reproductive health smartphone applications and fertility knowledge of Australian women

Problematising menstrual tracking apps: presenting a novel critical scoping review methodology for mapping and interpreting research literature

OBJECTIVES

To showcase a novel, theoretically informed methodology for conducting scoping reviews by operationalising critical theory. And to advance the field of women's digital health by applying this critical scoping review methodology (CSR) to research on menstrual tracking apps (MTAs).

METHODS AND MEASURES

116 articles published in English, between November 2015 and November 2023, focusing on MTAs, and/or user's experiences of MTAs, were thematically analysed through the Foucauldian concept of problematisation and analytics from critical psychology. This method examined what was produced as a problem, and the underpinning discourses, subject positions, paradigms, desired outcomes, and absences within these problem categories.

RESULTS

Four problematisations were identified, (1) the problem of data privacy (subproblems: type of data, consent, abortion surveillance); (2) the problem with efficacy (subproblems: evaluating efficacy, accuracy, useability); (3) the problem of regulation (subproblems: self-surveillance, normative femininity, hormonal imperative, cycle regularity imperative, menstrual stigma); and (4) the problem of women (subproblems: health literacy, technology use, medically unknown, hard to design for).

CONCLUSION

MTA researchers would benefit from understanding their field through these problematisations. The CSR offers an important theoretically informed methodology for mapping and interpreting a research literature, which can identify, and expand, possibilities for research thought and practice.

The sexual and reproductive health knowledge of women in Australia: A scoping review

ISSUE ADDRESSED

Sexual and reproductive health (SRH) knowledge influences health literacy and promotes positive health behaviours. This scoping review explores the SRH knowledge of women in Australia and reports on knowledge assessment, ways of learning, enablers and barriers, and interventions to improve knowledge.

METHODS

Seven databases were searched for eligible articles published in English between 2012 and 2022.

RESULTS

Eighty-five sources were included for analysis. Data were mapped by knowledge topic and population group and charted against four review objectives. Assessment of knowledge was the primary focus in 59% of sources. Two sources used a validated knowledge assessment tool. Knowledge was assessed using self-assessment, a measurement of correctness, or both. Women learnt about SRH through a range of sources, including healthcare providers, peers, family, internet, and school. Enablers and barriers spanned information content, delivery, timing, accessibility, interactions with those providing information, cultural and gendered norms, pre-migration experiences, and functional health literacy. Nine sources reported on interventions to facilitate SRH knowledge.

CONCLUSIONS

This review identified topics, population groups, and gaps in assessment of SRH knowledge of women in Australia. Overall, the measurement of women's SRH knowledge is largely conducted using unvalidated tools focusing on specific topics. SO WHAT?: It is recommended a validated tool be developed to comprehensively assess the SRH knowledge of women in Australia allowing for intersectional population analysis and exploration of knowledge conceptualisation. This would enable assessment of interventions aiming to improve SRH knowledge thereby facilitating improved health literacy and outcomes.

Trends, outcomes and knowledge gaps in mobile apps for reproductive endocrinology and infertility: a scoping review protocol

INTRODUCTION

Infertility is a complex condition that affects millions worldwide, with significant physical, emotional and social implications. Mobile apps have emerged as potential tools to assist in the management of infertility by offering features such as menstrual cycle tracking, ovulation prediction, fertility education, lifestyle modification guidance and emotional support, thereby promoting reproductive health. Despite promising advancements such as the development of apps with sophisticated algorithms for ovulation prediction and comprehensive platforms offering integrated fertility education and emotional support, there remain gaps in the literature regarding the comprehensive evaluation of mobile apps for reproductive endocrinology and infertility. This scoping review distinguishes itself by systematically mapping and synthesising evidence on mobile apps specifically for reproductive endocrinology and infertility, unlike previous reviews that may not have focused exclusively on this intersection. This review aims to analyse recent trends, identify outcomes used to assess usability and highlight knowledge gaps.

METHODS AND ANALYSIS

This scoping review will adhere to the methodological frameworks outlined by Arksey and O'Malley and Levac et al, alongside the Joanna Briggs Institute's recommendations. The research question, 'What is known about mobile apps in reproductive health and infertility?' was formulated using the Population, Concept, Context (PCC) strategy. We will include studies published from January 2019 to April 2024 in English, Portuguese and Spanish that focus on the use of mobile apps in reproductive health and infertility. Searches will be conducted across electronic databases (EMBASE, ERIC, PubMed, Science Direct, Scopus and Web of Science) and grey literature sources. Two independent reviewers will carry out the study selection using Covidence software. Data extraction will follow a standardised format and will be synthesised narratively using tables and graphs. Expert consultations will be conducted to validate the findings.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review as it will only use published data. The findings will be disseminated through publication in a peer-reviewed journal, conference presentations and stakeholder meetings. The review protocol will be registered with the Open Science Framework to ensure transparency and reproducibility.

Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study

BACKGROUND

Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance.

OBJECTIVE

This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women.

METHODS

A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews.

RESULTS

In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level.

CONCLUSIONS

Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users' needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health.

"UPDATE: I'm pregnant!": Inferring global downloads and reasons for using menstrual tracking apps

Objective

The market for smartphone apps tracking menstrual cycles has expanded in recent years. These apps market themselves as empowering users to achieve their reproductive goals and maximize the chance of pregnancy. This paper presents the first open-access quantification of menstrual tracking app downloads globally, covering both the Global North and South. We also explore macro and micro-level reasons for app usage, testing national associations with downloads and analyzing user reviews.

Methods

We use data on app installations, reviews, and ratings from the Google Play Store and Apple App Store to estimate global app downloads using a Bayesian model. We perform regressions to test for national predictors of use, and multilingual topic models to analyze/cluster reviews left by users to understand individual reasons for use.

Results

We find that the majority of downloads are for three apps: Clue, Flo, and Period Tracker. Higher modern contraceptive prevalence and internet access are associated with more downloads, while low-income countries tend to have fewer. In low-income countries, a higher unmet need for family planning and total fertility rate are associated with more downloads. Individual reviews reveal the most common reasons for use are menstrual cycle tracking, achieving a pregnancy, community engagement, and avoiding pregnancy.

Conclusion

Existing research on menstrual tracking apps is largely confined to the Global North, but our study finds the use of these apps to be as prevalent throughout the Global South. Future research needs to urgently understand the implications these apps could have in a diversity of contexts.

A Comparison of Two Hormonal Fertility Monitoring Systems for Ovulation Detection: A Pilot Study

Background and Objectives: Accuracy in detecting ovulation and estimating the fertile window in the menstrual cycle is essential for women to avoid or achieve pregnancy. There has been a rapid growth in fertility apps and home ovulation testing kits in recent years. Nevertheless, there lacks information on how well these apps perform in helping users understand their fertility in the menstrual cycle. This pilot study aimed to evaluate and compare the beginning, peak, and length of the fertile window as determined by a new luteinizing hormone (LH) fertility tracking app with the Clearblue Fertility Monitor (CBFM). Materials and Methods: A total of 30 women were randomized into either a quantitative Premom or a qualitative Easy@Home (EAH) LH testing system. The results of the two testing systems were compared with the results from the CBFM over three menstrual cycles of use. Potential LH levels for estimating the beginning of the fertile window were calculated along with user acceptability and satisfaction. Results: The estimates of peak fertility by the Premom and EAH LH testing were highly correlated with the CBFM peak results (R = 0.99, p < 0.001). The participants had higher satisfaction and ease-of-use ratings with the CBFM compared to the Premom and EAH LH testing systems. LH 95% confidence levels for estimating the beginning of the fertile window were provided for both the Premom and EAH LH testing results. Conclusions: Our pilot study findings suggest that the Premom and EAH LH fertility testing app can accurately detect impending ovulation for women and are easy to use at home. However, successful utilization of these low-cost LH testing tools and apps for fertility self-monitoring and family planning needs further evaluation with a large and more diverse population.

The nutritional content required to design an educational application for infertile women

BACKGROUND

Infertility has been considered as a critical health problem for couples and society. Given the worldwide exponential rise of infertility, mobile phone-based applications are drastic ways to deliver nutrition educational content to women with infertility. The present study aimed to prepare the required educational content for designing a mobile phone-based nutrition educational application for women with infertility.

METHODS

Educational contents were initially determined based on the literature review and library studies. As a result, a researcher-made questionnaire was designed containing 28 items in six dimensions. To ensure about the questionnaire's validity, a panel of experts (15 nutritionists and 5 infertility specialists) was asked to review the items, make revisions (if necessary), and confirm the final contents. The questionnaire reliability was also corroborated using the KR-20 coefficient (0.89).

RESULTS

While the amount of consumed calories per meal and between meals were not significantly effective on fertility, factors such as main definitions, disease and treatment instructions, personal activities and habits, and menstruation were deemed necessary by the respondents. Participants also suggested adding sections entailing introductions to different types of diets, users' suggestions and opinions, and of the address and contact information of senior nutrition centers to the questionnaire.

CONCLUSIONS

Followed by obtaining the required valid and reliable contents, a mobile phone- based nutrition education application can be designed to improve the patients' knowledge and facilitate their treatment process.

A scoping review of the information provided by fertility smartphone applications

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.

Impact of a Mobile Application for Tracking Nausea and Vomiting During Pregnancy (NVP) on NVP Symptoms, Quality of Life, and Decisional Conflict Regarding NVP Treatments: MinSafeStart Randomized Controlled Trial

Background

Pregnant women are active users of mobile apps for health purposes. These apps may improve self-management of health-related conditions. Up to 70% of pregnant women experience nausea and vomiting (NVP). Even mild NVP can significantly reduce quality of life (QoL), and it can become an economic burden for both the woman and society. NVP often occurs before the first maternal care visit; therefore, apps can potentially play an important role in empowering pregnant women to recognize, manage, and seek appropriate treatment for NVP, when required.

Objective

This study investigated whether the MinSafeStart (MSS) mobile app could impact NVP-related symptoms, QoL, and decisional conflict regarding NVP treatment.

Methods

This randomized controlled trial enrolled 268 pregnant women with NVP in Norway from 2019 to 2020. The intervention group had access to the MSS app, which could be used to track NVP symptoms and access tailored advice. NVP severity was rated with the Pregnancy Unique Quantification of Emesis (PUQE) score. The control group followed standard maternal care. We collected data on maternal baseline characteristics, NVP severity, QoL, and decisional conflict using 2 sets of online questionnaires. One set of questionnaires was completed at enrollment, and the other was completed after 2 weeks. We performed linear regression analyses to explore whether the use of the MSS app was associated with NVP severity, QoL, or decisional conflict.

Results

Among the 268 women enrolled in the study, 192 (86.5%) completed the baseline questionnaires and were randomized to either the intervention (n=89) or control group (n=103). In the intervention group, 88 women downloaded the app, and 468 logs were recorded. In both groups, women were enrolled at a median of 8 gestational weeks. At baseline, the average PUQE scores were 4.9 and 4.7; the average QoL scores were 146 and 149; and the average DCS scores were 40 and 43 in the intervention and control groups, respectively. The app had no impact on NVP severity (aβ 0.6, 95% Cl −0.1 to 1.2), QoL (aβ −5.3, 95% Cl −12.5 to 1.9), or decisional conflict regarding NVP treatment (aβ −1.1, 95% Cl −6.2 to 4.2), compared with standard care.

Conclusions

Tracking NVP symptoms with the MSS app was not associated with improvements in NVP symptoms, QoL, or decisional conflict after 2 weeks, compared with standard care. Future studies should include a process evaluation to improve our understanding of how pregnant women use the app and how to optimize its utility within maternity care. Specifically, studies should focus on how digital tools might facilitate counseling and communication between pregnant women and health care providers regarding NVP management during pregnancy.

Trial Registration

ClinicalTrails.gov (NCT04719286): https://www.clinicaltrials.gov/ct2/show/NCT04719286

Design and evaluation of a mobile-based nutrition education application for infertile women in Iran

Background

The prevalence of infertility in Iran is higher than the world average. Furthermorte, education and nutrition are among the effective factors in improving the quality of life of women with infertility. According to the significant role of smartphones in people's lives as well as health education, the present study aimed to design and evaluate a mobile-based nutrition education application for infertile women.

Methods

This quantitative research was conducted in two stages. Initially, the educational contents were determined based on a review of the literature. Later, the obtained contents were given to 10 nutritionists and five infertility specialists to determine the necessity of each item. In the next stage, the application prototype was designed based on the results of the first stage and distributed among 220 infertile women. After two months, the Questionnaire of User Interface Satisfaction was administrated to assess the usability of the developed application. The results were analyzed via SPSS software version 20.

Results

According to the nutritionists and infertility specialists, the contents determined for the nutrition educational application were categorized under three general sections of user's demographic data, educational contents, required capabilities. The users' mean score of the application usability was calculated as 7.44 out of 9 indicating a good level of satisfaction.

Conclusions

Nutrition education of women with infertility problems can play a significant role in improving their awareness and treatment outcomes. Due to the increasing use of smartphones, designing a mobile-based nutrition educational application can be of great benefit for women with infertility according to the cultural conditions and characteristics of each community.

A survey of women’s experiences of using period tracker applications: Attitudes, ovulation prediction and how the accuracy of the app in predicting period start dates affects their feelings and behaviours

Introduction:

Using an online survey, the aim of this study was to ask women about their real-life experiences of using period tracker apps, their attitudes towards using their app, the information the app provided regarding ovulation and how the accuracy of the app in predicting period start dates affects their feelings and behaviours if their period comes earlier or later than predicted.

Methods:

This mixed-methods observational study was conducted by an online survey of 50 multiple-choice and open-ended questions. The survey was generated with Qualtrics XM^® and promoted via social media. It was open to any person who had used a period tracker.

Results:

From 375 total responses, 330 complete responses were obtained, giving a completion rate of 88.0%. Respondents were aged between 14 and 54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) of respondents selected ‘To know when I’m ovulating’. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of periods starting earlier revealed four themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed and feeling confused/intrigued. Thematic analysis when their period arrived later revealed six themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about menopause, feeling unaffected and being better prepared.

Conclusion:

Period trackers need to be clearer on their intended use and reliability, especially for period due date and ovulation. Qualitative analysis shows the impact of inaccurate predictions on aspects of the users’ health. This study calls for period tracker app companies to update their apps to provide transparency to their users about their intended use and capabilities.

Fertility Awareness and Perceptions among Procreant Age Group in Western India: An Exploration with Mixed Methodology

BACKGROUND

In India, fertility rate demonstrates a descending trend whereas there is upsurge in infertility rate. In addition, a knowledge gap concerning fertility has been identified among the current generation.

AIM

To quantify the fertility awareness and in-depth exploration of perceptions about fertility among procreant age group.

MATERIALS AND METHODS

Explanatory mixed method design with sequential data collection, nested sampling technique was assumed. Purposive sampling was incorporated to recruit 1000 participants into the prospective cohort study. Awareness was measured using fertility knowledge questionnaire, while qualitative data were collected by in-depth interview of 28 participants until data saturation. The study was intact in terms of ethical compliance.

RESULTS

Sociodemographic data revealed that the mean age of the respondents was 31.33 ± 6.4 years, 59.6% were female, 78.3% were married, 61.5% completed their university education, 76.0% were working. The mean of overall fertility awareness score was 50.2 ± 13.5. There was no statistical difference in responses of the subgroups (P > 0.05) and only educational status was significantly associated (P = 0.001*) with awareness scores. Perceptions pertinent to fertility were evidently varying amongst the general group and couples accessing fertility treatment, which subsequently was elucidated with the qualitative thematic analysis.

CONCLUSION

Procreant age group of western India demonstrated low to average fertility awareness. Assertive recommendations were proposed for fertility awareness initiatives across both genders, irrespective of educational status.

Menstrual Cycle Tracking Applications and the Potential for Epidemiological Research: A Comprehensive Review of the Literature

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.

Women’s Knowledge and Awareness of the Effect of Age on Fertility in Kazakhstan

An accurate understanding of reproductive facts is essential for appropriate decision making regarding whether, when, and how to conceive. The objective of this study was to investigate women’s knowledge of how age affects fertility and their knowledge about the effectiveness for assisted reproductive technologies for treating fertility. A cross-sectional study was conducted including women seeking fertility treatment at the University Medical Center, Nur-Sultan, Kazakhstan in 2018–2019. Patients were interviewed with a structured questionnaire. Socio-demographic, clinical characteristics, and knowledge and awareness about the implications of aging for fertility (advanced maternal age (AMA)) and pregnancy outcomes using fertility treatments (assisted reproductive technologies ((ART)) and the sum of both scores total knowledge score (TKS). TKS mean was 7.7 (SD = 2.1), AMA was 5.0 (SD = 1.5), and ART was 2.7 (SD = 1.5). No socio-demographic factors correlated with lower knowledge. Fertility knowledge was found to be low. No differences were found associated with socio-economic level, although they were identified in women with certain types of infertility and a history of gynecological problems. Delaying childbearing based on incorrect perceptions of female fertility could lead to involuntary childlessness. Health education regarding fertility has to be part of broader health promotion programs to enhance awareness of the effect of age on fertility.

Do fertility tracking applications offer women useful information about their fertile window?

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.

Regret over the delay in childbearing decision negatively associates with life satisfaction among Japanese women and men seeking fertility treatment: a cross-sectional study

BACKGROUND

Currently, in developed countries, increasing numbers of women and men are delaying childbearing but begin seeking fertility treatment later in life. Some women undergoing infertility treatment develop negative feelings such as depression associated with low life satisfaction and regret over the delay in childbearing. We therefore examine the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors among Japanese women and men seeking fertility treatment.

METHODS

This cross-sectional study included 253 women and 196 men referred to fertility facilities in Japan from July to December 2018. Participants completed a questionnaire on life satisfaction, regret over the delay in childbearing decision, infertility-related factors and sociodemographic characteristics. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS), and the degree of regret over delay in childbearing decision was measured on a 7-point Likert scale. Multiple linear regressions, conducted separately by sex, were used to analyze the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors.

RESULTS

Of the 253 women and 196 men, 102 (40.3%) women and 43 (21.9%) men answered "strongly agree" regarding their regret over the delay in childbearing decision. Among women, life satisfaction was negatively associated with regret (β = - 0.155, 95% CI [- 0.938, - 0.093], p = 0.017), use of assisted reproduction technology (ART) (β = - 0.135, 95% CI [- 2.977, - 0.020], p = 0.047). In contrast, previous live birth was positively associated with life satisfaction (β = 0.134, 95% CI [0.122, 3.739], p = 0.037). In men, we found no significant association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors.

CONCLUSIONS

Regret over the delay in childbearing decision is negatively associated with life satisfaction among Japanese women seeking fertility treatment. It may be important for women to make better informed decision regarding the timing of childbearing to not regret later in life. Health professionals should address regret over the delay in childbearing decision during fertility treatment and explore ways to spread information on fertility awareness.