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Vani K, Katehis I, Bernstein PS, Lebron-Reyes C, Chung H, Bruney T, Karkowsky CE. Piloting a prenatal care smartphone application and care navigation intervention at a federally qualified health center. Am J Obstet Gynecol MFM 2023; 5:101135. [PMID: 37597800 DOI: 10.1016/j.ajogmf.2023.101135] [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: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Given that smartphones are widely used among reproductive-age people of all socioeconomic backgrounds, a smartphone application may be a useful supplement to routine prenatal care. OBJECTIVE This study aimed to describe the implementation of a smartphone app that offers patient education, depression screening, social determinants of health screening, and care coordination as an adjunct to routine prenatal care at a federally qualified health center. We further sought to characterize app engagement and the association of app use with pregnancy outcomes. STUDY DESIGN The implementation of the smartphone app was a quality improvement initiative in which the app was made available to all people receiving prenatal care at a designated federally qualified health center between December 2020 and December 2021. Individuals who both initiated prenatal care at this site before 28 weeks of gestation and delivered at our institution during the above-defined period were studied retrospectively after obtaining institutional approval. Summary statistics were used to describe app implementation and information regarding social determinants of health and depression screening. Demographics and maternal and neonatal outcomes were compared between app enrollees and patients receiving prenatal care at the same site who were not enrolled in the app. Data were analyzed using the 2-sample t test to compare continuous variables and the chi-square test to compare categorical variables. RESULTS Overall, 800 patients receiving prenatal care at the federally qualified health center during the identified period were telephonically approached for enrollment in the smartphone app. A total of 613 people (76.6%) were successfully reached, and of those successfully reached, 538 (87.7%) accepted enrollment in the app; 76.6% of app enrollees (n=412) completed at least 1 social determinants of health screen. Of those, 29.1% (n=120) screened positive for at least 1 need. Of those with positive screens, 51.7% (n=62) accepted referral to resources to address the identified need. Furthermore, 81% of app enrollees (n=443) completed at least 1 depression screen. Of those, 13.1% (n=58) screened positive for depression, and 37.9% (n=22) of those with positive screens accepted a referral to behavioral health services. A total of 483 people met the inclusion criteria for retrospective review: 264 were enrolled in the smartphone app and 219 were not. App enrollees were more likely to speak English (79.9% of app group vs 61.6% of the non-app group; P<.0001), identify as Hispanic (52.7% vs 39.7%; P=.02), and be privately insured (24.6% vs 15.5%; P=.005), and less likely to have a social determinants of health-related need (10.0% vs 21.0%; P=.01). There were no significant differences in mode of delivery or maternal and neonatal outcomes between the 2 groups. CONCLUSION A high proportion of patients receiving care through our federally qualified health center enrolled in and used the smartphone app and its associated care coordination. This could be a useful tool to screen for depression and adverse social determinants of health in underserved communities. Given that individuals of higher-resource backgrounds seem more likely to enroll in smartphone apps, a more targeted approach is needed to help connect patients of lower-resource backgrounds to smartphone apps and the resources that they offer.
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Affiliation(s)
- Kavita Vani
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY (Drs Vani and Karkowsky).
| | - Ioanna Katehis
- City University of New York School of Medicine, New York City, NY (Dr Katehis); Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, Mineola, NY (Dr Katehis)
| | - Peter S Bernstein
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Bernstein); Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Bernstein)
| | - Christine Lebron-Reyes
- Montefiore Care Management Organization, Montefiore Medical Center, New York City, NY (Ms Lebron-Reyes)
| | - Henry Chung
- Montefiore Care Management Organization, Albert Einstein College of Medicine, New York City, NY (Dr Chung)
| | - Talitha Bruney
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY (Dr Bruney); Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, NY (Dr Bruney)
| | - Chavi Eve Karkowsky
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY (Drs Vani and Karkowsky)
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Pérez JC, Aldoney D, García MI, Olhaberry M, Fernández O, Alamo N, Franco P, Pérez F, Fisher J, Rowe H, Coo S. Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial. Health Informatics J 2022; 28:14604582221135440. [DOI: 10.1177/14604582221135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.
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Affiliation(s)
- J. Carola Pérez
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Facultad de Psicología. Universidad del Desarrollo (UDD), Santiago, Chile
| | - Daniela Aldoney
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - María I García
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Marcia Olhaberry
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Olga Fernández
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Universidad de Chile, Santiago, Chile
| | - Nicolle Alamo
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Social Work, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pamela Franco
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Pérez
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Universidad Alberto Hurtado, Santiago, Chile
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
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Theory-Based Social and Non-Social Engagement Features in Smoking Cessation Mobile Apps: A Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179106. [PMID: 34501696 PMCID: PMC8431714 DOI: 10.3390/ijerph18179106] [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] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Despite the ubiquity of smartphone ownership and the increasing integration of social engagement features in smoking cessation apps to engage users, the social and non-social engagement features that are present in current smoking cessation apps and the effectiveness of these features in engaging users remain understudied. To fill the gap in the literature, a content analysis of free and paid smoking cessation mobile apps was conducted to examine (a) the presence of social features (i.e., social support, social announcement, and social referencing) and non-social engagement features (e.g., personal environmental changes, goal setting, progress tracking, reinforcement tracking, self-monitoring, and personalized recommendations) and (b) their relationships with user engagement scores measured by the Mobile App Rating Scale. In this study, 28.2% of the smoking cessation apps enable social announcement and 8.1% offered the social support feature. Only two apps provided a social referencing feature (1.3%). No app included reinforcement tracking, with the percentage of other non-social engagement features ranging from 9.4% to 49.0%. Social support (β = 0.30, p < 0.001), social announcement (β = 0.21, p < 0.05), and social referencing (β = 0.18, p < 0.05) were significant predictors of user engagement. Regarding the non-social engagement features, personal environment changes (β = 0.38, p < 0.001), progress tracking (β = 0.18, p < 0.05), and personalized recommendations (β = 0.37, p < 0.001) significantly predicted user engagement. The findings not only contribute to the mobile communication literature by applying and extending the theory-based mobile health apps engagement typology, but also inform the future architecture design of smoking cessation mobile apps.
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Schindler-Ruwisch J, Peters A. Mobile applications for emerging adults transitioning to independent diabetes monitoring. Inform Health Soc Care 2020; 46:56-67. [PMID: 33241702 DOI: 10.1080/17538157.2020.1837839] [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: 10/22/2022]
Abstract
Access to high-quality mhealth tools for diabetes management is critical. The purpose was to systematically review mobile apps for features relevant to helping emerging adults manage their diabetes as they transition to independent diabetes monitoring. Mobile apps were reviewed for relevance to emerging adults, aged 18-25, living with diabetes. The GooglePlay store was systematically searched to identify diabetes management mobile tools. Of the 29 apps, only one app had any features relevant to emerging adults. In total, 20 apps had a feature to share a copy of diet or blood sugar logs with a family member or provider. Only 9 apps had any interactivity other than tracking. While most apps had graphics, only 5 were deemed high quality. Just one app met all three included Mobile Application Rating Scale (MARS) criteria. This review serves as a starting point to guide educators and patients, especially to aid continuity of care when in-person support is not feasible. Ongoing review of new apps with improved functionality and effectiveness studies of the apps' impact on emerging adults' diabetes management is imperative.
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Affiliation(s)
| | - Abby Peters
- Egan School of Nursing and Health Studies, Public Health, Fairfield University , Fairfield, CT, USA
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Dol J, Richardson B, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Impact of mHealth interventions during the perinatal period on maternal psychosocial outcomes: a systematic review protocol. ACTA ACUST UNITED AC 2020; 17:2491-2498. [PMID: 31356572 DOI: 10.11124/jbisrir-d-19-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries. INTRODUCTION Mobile health (i.e. mHealth) is defined as the use of mobile devices to transmit health content and services. The use of mHealth to provide education and support to mothers is a growing field of health innovation. Mothers seek health information online during the postpartum period to learn about health concerns and get advice and support. Despite the potential benefits of mHealth, the potential impact on maternal psychosocial outcomes requires further evaluation. INCLUSION CRITERIA The review will consider studies that include mHealth interventions targeting mothers in high-income countries. The mHealth education interventions must occur during the antenatal or postnatal period. This review will consider studies that compare the intervention to any comparators. Studies published in English from 2000 will be included. METHODS The search strategy will aim to locate both published and unpublished studies. Following the search, all identified citations will be collated and duplicates removed. Titles and abstracts will be screened and full text of selected citations will then be assessed in detail against inclusion criteria. The results of the search will be reported in full in the final systematic review. Eligible studies will be critically appraised by two independent reviewers. Data extracted will include specific details about the interventions, populations, study methods and outcomes. Studies will be pooled in statistical meta-analysis or presented in narrative form including tables and figures.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
| | - Brianna Richardson
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | | | - Megan Aston
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Marsha Campbell-Yeo
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
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Suter MA, Aagaard KM. The impact of tobacco chemicals and nicotine on placental development. Prenat Diagn 2020; 40:1193-1200. [PMID: 32010988 PMCID: PMC7396310 DOI: 10.1002/pd.5660] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
Despite decades of messages warning about the dangers of tobacco use in pregnancy, 10% to 15% of pregnant women continue to smoke. Furthermore, an increased popularity of electronic nicotine delivery systems (ENDS) over the past decade in women of childbearing age raises parallel concerns regarding the effects of vaporized nicotine use in pregnancy. While research using animal models which mimic tobacco smoke and nicotine exposure in pregnancy have largely replicated findings in humans, few studies focus directly on the effects of these exposures on the placenta. Because the placenta is a fetal derived tissue, and nicotine and other components of tobacco smoke are either processed by or transported directly through the placenta, such studies help us understand the risks of these exposures on the developing fetus. In this review, we summarize research on the placenta and placental-derived cells examining either tobacco smoke or nicotine exposure, including both histologic and subcellular (ie, epigenetic and molecular) modifications. Collectively, these studies reveal that tobacco and nicotine exposure are accompanied by some common and several unique molecular and epigenomic placental modifications. Consideration of the nature and sequelae of these molecular mediators of risk may help to better inform the public and more effectively curtail modifiable behavior.
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Affiliation(s)
- Melissa A Suter
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX
| | - Kjersti M Aagaard
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX
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Mobile phone-based Multimedia Application Could improve Maternal Health in Rural Southwestern Uganda: Mixed Methods Study. Online J Public Health Inform 2020; 12:e8. [PMID: 32742558 DOI: 10.5210/ojphi.v12i1.10557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Reducing maternal and infant mortality rates remains challenging. Illiteracy, lack of reliable information, long distances to health centers continue to limit access to quality maternal healthcare in Uganda. Mobile health technologies could be promising affordable strategies for enhancing access to maternal health services. However, there is lack of studies assessing the experiences of illiterate rural pregnant women regarding these technologies. Objective: To explore how illiterate pregnant women perceive a maternal health mobile application composed of tailored video and audio messages, appointment reminders and calling function. Methods: We purposively sampled illiterate pregnant women initiating antenatal care at Mbarara Regional Referral Hospital. We carried out three focus group discussions with 14 women to elicit information on perceptions of the proposed mobile phone based multimedia application. We used STATA 13 to describe study participants and their preferences. Results: Pregnant women anticipated that intervention would enhance maternal health by reminding them to attend antenatal appointments, enabling transport cost and time saving, providing tailored information that is easy to understand, and recall. However, financial constraints and phone sharing would limit the functionality. Conclusion: Mhealth application may provide acceptable and affordable alternative approaches to providing maternal health services, especially in settings where face-to-face approaches are challenging.
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ERBAŞ G, ŞENGEZER T, ÖZKARA A. Ankara’da Bir Kadın Doğum Hastanesine Başvuran Gebelerde Sigara Kullanımı ve Sigara Dumanından Pasif Etkilenme Durumlarının Araştırılması. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.653859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Heslehurst N, Hayes L, Jones D, Newham J, Olajide J, McLeman L, McParlin C, de Brun C, Azevedo L. The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: A systematic review of systematic reviews. PLoS One 2020; 15:e0232774. [PMID: 32469872 PMCID: PMC7259673 DOI: 10.1371/journal.pone.0232774] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy is a teachable moment for behaviour change. Multiple guidelines target pregnant women for behavioural intervention. This systematic review of systematic reviews reports the effectiveness of interventions delivered during pregnancy on changing women's behaviour across multiple behavioural domains. METHODS Fourteen databases were searched for systematic reviews published from 2008, reporting interventions delivered during pregnancy targeting smoking, alcohol, diet or physical activity as outcomes. Data on behaviour change related to these behaviours are reported here. Quality was assessed using the JBI critical appraisal tool for umbrella reviews. Consistency in intervention effectiveness and gaps in the evidence-base are described. RESULTS Searches identified 24,388 results; 109 were systematic reviews of behaviour change interventions delivered in pregnancy, and 36 reported behavioural outcomes. All smoking and alcohol reviews identified reported maternal behaviours as outcomes (n = 16 and 4 respectively), whereas only 16 out of 89 diet and/or physical activity reviews reported these behaviours. Most reviews were high quality (67%) and interventions were predominantly set in high-income countries. Overall, there was consistent evidence for improving healthy diet behaviours related to increasing fruit and vegetable consumption and decreasing carbohydrate intake, and fairly consistent evidence for increase in some measures of physical activity (METs and VO2 max) and for reductions in fat intake and smoking during pregnancy. There was a lack of consistent evidence across reviews reporting energy, protein, fibre, or micronutrient intakes; smoking cessation, abstinence or relapse; any alcohol behaviours. CONCLUSIONS The most consistent review evidence is for interventions improving dietary behaviours during pregnancy compared with other behaviours, although the majority of diet reviews prioritised reporting health-related outcomes over behavioural outcomes. Heterogeneity between reported behaviour outcomes limits ability to pool data in meta-analysis and more consistent reporting is needed. Limited data are available for alcohol interventions in pregnancy or interventions in low- or middle-income-countries, which are priority areas for future research.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
| | - Daniel Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - James Newham
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Joan Olajide
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Louise McLeman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine McParlin
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- Department of Nursing Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Caroline de Brun
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Liane Azevedo
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
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Nebeker C. mHealth Research Applied to Regulated and Unregulated Behavioral Health Sciences. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:49-59. [PMID: 32342758 DOI: 10.1177/1073110520917029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Behavioral scientists are developing new methods and frameworks that leverage mobile health technologies to optimize individual level behavior change. Pervasive sensors and mobile apps allow researchers to passively observe human behaviors "in the wild" 24/7 which supports delivery of personalized interventions in the real-world environment. This is all possible because these technologies contain an incredible array of sensors that allow applications to constantly record user location and can contextualize current environmental conditions through barometers, thermometers, and ambient light sensors and can also capture audio and video of the user and their surroundings through multiple integrated high-definition cameras and microphones. These tools are a game changer in behavioral health research and, not surprisingly, introduce new ethical, regulatory/legal and social implications described in this article.
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Affiliation(s)
- Camille Nebeker
- Camille Nebeker, Ed.D, M.S., is an associate professor in the University of California, San Diego Department of Family Medicine and Public Health, with a primary appointment in Behavioral Medicine and a secondary appointment in Global Health
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Kamke K, Grenen E, Robinson C, El-Toukhy S. Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study. JMIR Mhealth Uhealth 2019; 7:e14699. [PMID: 31593542 PMCID: PMC6803886 DOI: 10.2196/14699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.
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Affiliation(s)
- Kristyn Kamke
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | | | | | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
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Tombor I, Beard E, Brown J, Shahab L, Michie S, West R. Randomized factorial experiment of components of the SmokeFree Baby smartphone application to aid smoking cessation in pregnancy. Transl Behav Med 2019; 9:583-593. [PMID: 30011020 PMCID: PMC6629841 DOI: 10.1093/tbm/iby073] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Smartphone applications (apps) might be able to reach pregnant smokers who do not engage with face-to-face support. However, we do not know how far pregnant smokers will engage with smoking cessation apps or what components are likely to be effective. This study aimed to assess pregnant smokers' engagement with the SmokeFree Baby app (v1) and to assess the short-term efficacy of selected components ("modules") for smoking abstinence. Positive outcomes would provide a basis for further development and evaluation. SmokeFree Baby was developed drawing on behavior change theories and relevant evidence. Pregnant smokers (18+) who were interested in quitting and set a quit date were recruited. Following multiphase optimization development principles, participants (N = 565) were randomly allocated to one of 32 (2 × 2 × 2 × 2 × 2) experimental groups in a full factorial design to evaluate five modules (each in minimal and full version: identity, health information, stress management, face-to-face support, and behavioral substitution). Measures of engagement included duration and frequency of engagement with the app. Smoking abstinence was measured by self-reported number of smoke-free days up to 4 weeks from the quit date. Participants engaged with the app for a mean of 4.5 days (SD = 8.5) and logged in a mean of 2.9 times (SD = 3.1). Main effects of the modules on the number of smoke-free days were not statistically significant (identity: p = .782, health information: p = .905, stress management: p = .103, face-to-face support: p = .397, behavioral substitution: p = .945). Despite systematic development and usability testing, engagement with SmokeFree Baby (v1) was low and the app did not appear to increase smoking abstinence during pregnancy.
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Affiliation(s)
- Ildiko Tombor
- Department of Behavioural Science and Health, University College London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, UK
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Spears CA, Abroms LC, Glass CR, Hedeker D, Eriksen MP, Cottrell-Daniels C, Tran BQ, Wetter DW. Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e13059. [PMID: 31237242 PMCID: PMC6613894 DOI: 10.2196/13059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. OBJECTIVE This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. METHODS A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants' ratings), participants' feedback regarding the text messaging intervention, and smoking cessation (assessed in person). RESULTS Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. CONCLUSIONS Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. TRIAL REGISTRATION ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819.
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Affiliation(s)
- Claire Adams Spears
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta, GA, United States
| | - Lorien C Abroms
- Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Carol R Glass
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Michael P Eriksen
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta, GA, United States
| | - Cherell Cottrell-Daniels
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta, GA, United States
| | - Binh Q Tran
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - David W Wetter
- Center for Health Outcomes and Population Equity, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, United States
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Magee JC, Adut S, Brazill K, Warnick S. Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:345-362. [PMID: 30397577 PMCID: PMC6214367 DOI: 10.1007/s40501-018-0154-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care. RECENT FINDINGS Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice. SUMMARY Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.
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Affiliation(s)
- Joshua C Magee
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Sarah Adut
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Kevin Brazill
- University of Illinois College of Medicine at Urbana-Champaign/Carle Physician Group, Department of Family Medicine and Department of Psychiatry, 611 West Park St., Urbana, IL 61801
| | - Stephen Warnick
- University of Michigan Medical School, Department of Family Medicine and Department of Psychiatry, 1150 W. Medical Center Dr., M7300 Med Sci I, SPC 5625, Ann Arbor, MI 48109-5625
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15
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Schindler-Ruwisch JM, Roess A, Robert RC, Napolitano MA, Chiang S. Social Support for Breastfeeding in the Era of mHealth: A Content Analysis. J Hum Lact 2018; 34:543-555. [PMID: 29787686 DOI: 10.1177/0890334418773302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several barriers to successful breastfeeding exist, including a lack of support from peers or professionals. With the emergence of mobile health (mHealth) tools to provide additional breastfeeding support, a more thorough review of social support resources was needed. Research Aim: The aim of this study was to determine mHealth breastfeeding support resources and characterize the type of social support they provide. METHODS A content analysis of mHealth programs ( n = 65), including text messaging ( n = 12) and mobile applications ( n = 53), was conducted on the basis of searches of the iTunes and Google Play stores ( n = 50) and PubMed, the Cumulative Index of Nursing and Allied Health, and American Business Information/INFORM Complete Plus ( n = 15). Results were then dual-coded for key characteristics and types of support provided. RESULTS Thirty-eight apps (76%) were free to users, 14 (28%) were offered in a variety of languages, and 47 (94%) provided informational support. The mobile applications were targeted largely to postpartum women, focused on breastfeeding duration, and included troubleshooting information. Mobile applications often included media components ( n = 12 [24%]); few were tailored or personalized ( n = 5 [10%]) and interactive ( n = 15 [30%]). Text-messaging programs were available in a variety of countries ( n = 7 [58%]) and provided mostly informational support ( n = 5 [42%]), were pro-breastfeeding ( n = 12 [100%]), were targeted to both pregnant and postpartum women ( n = 6 [50%]), focused on both breastfeeding initiation and duration ( n = 9 [75%]), and had two-way interactivity ( n = 6 [50%]) and personalization ( n = 5 [42%]). CONCLUSIONS Although freely available mobile applications and text-messaging programs exist, with potential for wide reach, the majority provide only informational support. These programs would benefit from additional study of their usefulness.
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Affiliation(s)
| | - Amira Roess
- 1 The George Washington University, Washington, DC, USA
| | | | | | - Shawn Chiang
- 1 The George Washington University, Washington, DC, USA
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16
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Improving fetal lung development with vitamin C and reducing asthma in children. J Perinatol 2018; 38:775-777. [PMID: 30046178 DOI: 10.1038/s41372-018-0148-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 11/08/2022]
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17
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Griffiths SE, Parsons J, Naughton F, Fulton EA, Tombor I, Brown KE. Are digital interventions for smoking cessation in pregnancy effective? A systematic review and meta-analysis. Health Psychol Rev 2018; 12:333-356. [PMID: 29912621 DOI: 10.1080/17437199.2018.1488602] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of 9 databases resulted in the inclusion of 12 published articles (n = 2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04-2.00, p = .03) in favour of digital interventions compared with comparison groups. Computer-based (OR = 3.06, 95% CI 1.28-7.33) and text-message interventions (OR = 1.59, 95% CI 1.07-2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy.
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Affiliation(s)
- Sarah Ellen Griffiths
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Joanne Parsons
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Felix Naughton
- b School of Health Sciences , University of East Anglia , Norwich , UK
| | - Emily Anne Fulton
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
| | - Ildiko Tombor
- d Department of Behavioural Science and Health , University College London , London , UK
| | - Katherine E Brown
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
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18
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van den Heuvel JF, Groenhof TK, Veerbeek JH, van Solinge WW, Lely AT, Franx A, Bekker MN. eHealth as the Next-Generation Perinatal Care: An Overview of the Literature. J Med Internet Res 2018; 20:e202. [PMID: 29871855 PMCID: PMC6008510 DOI: 10.2196/jmir.9262] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
| | - T Katrien Groenhof
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Hw Veerbeek
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Titia Lely
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mireille N Bekker
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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19
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Abroms LC, Johnson PR, Leavitt LE, Cleary SD, Bushar J, Brandon TH, Chiang SC. A Randomized Trial of Text Messaging for Smoking Cessation in Pregnant Women. Am J Prev Med 2017; 53:781-790. [PMID: 28982527 PMCID: PMC5696101 DOI: 10.1016/j.amepre.2017.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/29/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a need for innovation in both the enrollment of pregnant smokers in smoking cessation treatment programs and in the types of treatments offered. The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby. METHODS Between July 2015 and February 2016, a total of 35,957 recruitment text messages were sent to Text4baby subscribers. Eligible pregnant smokers were enrolled and randomized to receive Text4baby (control) or Text4baby and Quit4baby (intervention; N=497). Participants were surveyed at 1 month, 3 months, and 6 months post-enrollment, and saliva samples were collected at 3 months for biochemical verification of smoking status. Data were collected from 2015 to 2016 and analyzed in 2016. RESULTS Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period. CONCLUSIONS Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.
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Affiliation(s)
- Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
| | | | - Leah E Leavitt
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Sean D Cleary
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | | | - Shawn C Chiang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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20
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Van Dijk MR, Koster MP, Rosman AN, Steegers-Theunissen RP. Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals. JMIR Mhealth Uhealth 2017; 5:e123. [PMID: 28818820 PMCID: PMC5579320 DOI: 10.2196/mhealth.7834] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/08/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022] Open
Abstract
Background The importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low. Objective The aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC. Methods Patients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC. Results We composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67% (18/27) were familiar with the concept of PCC, but only 15% (4/27) received any form of PCC. A majority of 56% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC. Conclusions Our findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC.
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Affiliation(s)
| | - Maria Ph Koster
- Erasmus MC, Obstetrics and Gynecology, Rotterdam, Netherlands
| | - Ageeth N Rosman
- Erasmus MC, Obstetrics and Gynecology, Rotterdam, Netherlands
| | - Regine Pm Steegers-Theunissen
- Erasmus MC, Obstetrics and Gynecology, Rotterdam, Netherlands.,Erasmus MC, Pediatrics, Division of Neonatology, Rotterdam, Netherlands
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Wu J, Tombor I, Shahab L, West R. Usability testing of a smoking cessation smartphone application ('SmokeFree Baby'): A think-aloud study with pregnant smokers. Digit Health 2017; 3:2055207617704273. [PMID: 29942594 PMCID: PMC6001180 DOI: 10.1177/2055207617704273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Only a few digital interventions have been developed for pregnant smokers, and little is known about the acceptability and usability of smartphone apps to aid cessation in pregnancy. This study aimed to explore pregnant smokers' views on the design, content and usability of a pregnancy-specific smoking cessation app in order to inform intervention development and optimisation. METHODS Ten interviews were conducted and the 'think-aloud' protocol was used in order to explore participants' views about a smoking cessation smartphone app ('SmokeFree Baby'). The data were subsequently thematically analysed. Participants were 18 and over, pregnant, and daily or weekly cigarette smokers. RESULTS Three main themes were identified: views about the design elements, mode of delivery and content of the intervention. App design was considered as an important element that might influence potential users' engagement with the intervention. Participants felt that the intervention content was educational, motivational and non-judgemental. However, it was emphasised that the app should provide further options for personalisation and include more practical features. CONCLUSIONS Delivering smoking cessation support via a smartphone app can be feasible and acceptable for pregnant smokers. They appear to value content that is motivational, educational and personalised, and meeting these requirements may be important for user experience and promoting engagement with the intervention.
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Affiliation(s)
- Joyce Wu
- Department of Behavioural Science and Health,
University College London, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health,
University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health,
University College London, UK
| | - Robert West
- Department of Behavioural Science and Health,
University College London, UK
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Griffiths SE, Brown KE, Fulton EA, Tombor I, Naughton F. Are digital interventions for smoking cessation in pregnancy effective? A systematic review protocol. Syst Rev 2016; 5:207. [PMID: 27906071 PMCID: PMC5131429 DOI: 10.1186/s13643-016-0390-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Behavioural support for smoking cessation in pregnancy can be effective; however, many pregnant women face barriers to seeking support to stop smoking. Some digital interventions have been found to be effective for smoking cessation in the general population and may be effective for supporting cessation in pregnancy due to their flexibility and the potential for personalisation. To date, there is limited evidence of the effectiveness of digital interventions for smoking cessation in pregnancy. This review aims to assess the following: (1) whether digital interventions are effective at promoting smoking cessation among pregnant women; (2) which behaviour change techniques (BCTs) or combinations of BCTs are associated with the effectiveness of digital interventions for smoking cessation in pregnancy; and (3) whether the number of BCTs used is associated with the effectiveness of digital interventions for smoking cessation in pregnancy. METHODS This review will include digital interventions delivered largely through computer (PC or laptop), video/DVD, mobile phone (including smartphones) or portable handheld device (e.g. tablet, iPad) and include websites, mobile or tablet applications and SMS text messages. Interventions must be randomised or quasi-randomised controlled trials aimed at women who smoke in pregnancy, with smoking cessation as a measured outcome (preferably the latest available point prevalence smoking status measure taken during pregnancy, biochemically verified if available). Electronic bibliographic databases will be searched to identify suitable studies indexed in the following: Academic Search Complete, ASSIA, CINAHL, The Cochrane Library, EMBASE, Medline, PsycINFO, Scopus, and Web of Science. The search strategy will include key words and database-specific subject headings relating to 'pregnancy' and 'smoking' and synonyms for the terms 'digital' and 'randomised controlled trial'. Where required and where possible, the first and second authors will independently code interventions and control groups for BCTs. If data allows, meta-analyses will be used to assess intervention effectiveness and the effectiveness of BCTs. DISCUSSION This systematic review will provide a detailed synthesis of the effectiveness of current research using digital interventions for smoking cessation in pregnancy, to build on the evidence base and guide the development of future research in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036201.
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Affiliation(s)
- Sarah Ellen Griffiths
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK.
| | - Katherine E Brown
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK
| | - Emily Anne Fulton
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK
| | - Ildiko Tombor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Norwich, NR4 7UL, UK
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