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

Smoking cessation in pregnant women: A randomized controlled trial investigating the effectiveness of an eHealth intervention including heart rate variability-biofeedback training

BACKGROUND

Prenatal smoking and stress are associated with adverse health effects for women themselves and are risk factors for adverse outcomes of the child. Effective interventions are needed to support women with smoking cessation and reducing stress. The aims were (1) to test the effectiveness of an 8-week eHealth intervention targeting stress reduction and smoking cessation; (2) to examine whether stress reduction mediated the intervention effect on smoking behavior; (3) to test motivation to quit as a moderator; and (4) to investigate a dose-response effect of program usage.

METHODS

Pregnant women were included if they were >18 years of age, < 28 weeks pregnant at recruitment, and currently smoking. In total, 156 consenting participants were randomly assigned to the intervention or active control condition. Study outcomes on smoking (yes/no, frequency, and quantity) were collected via online questionnaires at pre-intervention (baseline; t0), post-intervention (8 weeks after t0; t1), and follow up at two weeks (t2) and three months (t3) after birth.

RESULTS

Smoking and stress reduced over the 8-week period in both conditions. The intervention effect on smoking was not mediated by stress reduction. Motivation to quit was found to moderate the intervention effect (smoking frequency and quantity) and a dose-response effect was found for program usage in the intervention for the reduction on smoking frequency and quantity.

CONCLUSION

Program usage and motivation to quit are important for smoking reduction in pregnant women. Further research is needed to examine how the intervention could be improved to increase treatment effectiveness.

Effect of eHealth interventions on perinatal depression: A meta-analysis

BACKGROUND

Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND.

AIM

This meta-analysis aimed to determine the effect of eHealth interventions on PND.

METHODS

Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model.

RESULTS

A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy.

CONCLUSIONS

The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study

BACKGROUND

Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration.

OBJECTIVE

This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated.

METHODS

A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed.

RESULTS

Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences.

CONCLUSIONS

Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs.

The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis

INTRODUCTION

Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies.

METHODS

Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies.

RESULTS

Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs.

DISCUSSION

Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.

Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders

BACKGROUND

High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.

METHODS

This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers.

FINDINGS

Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety.

CONCLUSIONS

This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.

Internet use by pregnant women during prenatal care

OBJECTIVE

The search for medical information on the internet is a part of people's daily lives. Exponential volumes of data are available through various media and platforms. There are several problems related to the ease of creating and accessing medical information on the internet, as evidenced by the quantity of false content and increasing anxiety due to the consumption of these data. In light of this accessibility, it is necessary to understand how people use internet-based medical information and its impact on specific populations. This prospective study aimed to analyze pregnant women's behavior when searching for health-related information on the internet, and how they were influenced by the information.

METHODS

Questionnaires were administered to the participants during their immediate puerperium, and their answers were tabulated.

RESULTS

Three hundred and two patients answered the questionnaires. We observed that internet use was frequent, and most patients discussed the findings with their physicians. However, this did not affect the delivery routes.

CONCLUSION

The search for health information by pregnant women is very prevalent but does not interfere with the delivery route.

Telegenetics to provide comprehensive prenatal diagnosis

Telehealth is an effective way to increase access to genetic services and can address several challenges, including geographic barriers, a shortage of interpreter services, and workforce issues, especially for prenatal diagnosis. The addition of prenatal telegenetics to current workflows shows promise in enhancing the delivery of genetic counseling and testing in prenatal care, providing accessibility, accuracy, patient satisfaction, and cost-effectiveness. Further research is needed to explore long-term patient outcomes and the evolving role of telehealth for prenatal diagnosis. Future studies should address the accuracy of diagnoses, the impact of receiving a diagnosis in a virtual setting, and patient outcomes in order to make informed decisions about the appropriate use of telemedicine in prenatal genetics service delivery.

Self-monitoring blood pressure in Pregnancy: Evaluation of health professional experiences of the BUMP trials

BACKGROUND

The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether they improved detection or control of hypertension for women at risk of hypertension or with hypertension during pregnancy. This process evaluation aimed to understand healthcare professionals' perspectives and experiences of the BUMP trials of self-monitoring of blood pressure during pregnancy.

METHODS

Twenty-two in-depth qualitative interviews and an online survey with 328 healthcare professionals providing care for pregnant people in the BUMP trials were carried out across five maternity units in England.

RESULTS

Analysis used Normalisation Process Theory to identify factors required for successful implementation and integration into routine practice. Healthcare professionals felt self-monitoring of blood pressure did not over-medicalise pregnancy for women with, or at risk of, hypertension. Most said self-monitored readings positively affected their clinical encounters and professional roles, provided additive information on which to base decisions and enriched their relationships with pregnant people. Self-monitoring of blood pressure shifts responsibilities. Some healthcare professionals felt women having responsibility to decide on timing of monitoring and whether to act on self-monitored readings was unduly burdensome, and resulted in healthcare professionals taking additional responsibility for supporting them.

CONCLUSIONS

Despite healthcare professionals' early concerns that self-monitoring of blood pressure might over-medicalise pregnancy, our analysis shows the opposite was the case when used in the care of pregnant people with, or at higher risk of, hypertension. While professionals retained ultimate clinical responsibility, they viewed self-monitoring of blood pressure as a means of sharing responsibility and empowering women to understand their bodies, to make judgements and decisions, and to contribute to their care.

Using self-monitoring to detect and manage raised blood pressure and pre-eclampsia during pregnancy: the BUMP research programme and its impact

Raised blood pressure affects around ten percent of pregnancies worldwide, causing maternal and perinatal morbidity and mortality. Self-monitoring of blood pressure during higher-risk or hypertensive pregnancy has been shown to be feasible, acceptable, safe, and no more expensive than usual care alone. Additionally, self-testing for proteinuria has been shown to be just as accurate as healthcare professional testing, creating the potential for monitoring of multiple indicators through pregnancy. The work suggests however, that an organisational shift is needed to properly use and see benefits from self-monitored readings. This paper describes the findings from a large programme of work examining the use of self-monitoring in pregnancy, summarising the findings in the context of the wider literature and current clinical context. The BUMP Research Programme developed and tested self-monitoring and self-testing interventions for pregnancy. The work showed that self-monitoring during pregnancy was feasible, acceptable, safe, and no more expensive, but did not improve the detection or control of hypertension.

Assessing women's and health professionals' views on developing a midwifery-led mobile health app intervention in pregnancy: A descriptive qualitative study

AIMS

To explore women's and health professionals' views on the development of a midwifery-led mHealth app intervention in antenatal care and their demands for app functionality.

DESIGN

Descriptive qualitative research was utilized.

METHODS

In total, 15 pregnant or postpartum women were interviewed via in-depth interviews and 10 health professionals including obstetricians, midwives and obstetric nurses were invited to participate in a focus group discussion (FGD). All interviews and the FGD were analysed using qualitative content analysis.

RESULTS

Four key themes emerged from the data, including (1) limitations of current maternity care services; (2) potential benefits for mHealth app-based midwifery care; (3) possible challenges for providing midwifery care through mHealth apps and (4) suggestions and needs for developing a midwifery-led mHealth app. Participants agreed on the potential need of developing a midwifery-led mHealth app in antenatal care to increase access to midwifery care services and to meet women's diverse needs. Participants preferred to develop professional, reliable, full-featured and interactive mobile applications. The main functions of midwifery-led mHealth apps included personalized assessment and health education, self-monitoring and feedback, data sharing and interactive functions. Women mentioned that online communication and consultation with midwives could help them receive continuous support outside facilities. Health professionals expressed it would be of great convenience and timeliness to send personalized messages to women and to inform them of healthy lifestyles during pregnancy. The challenges included a shortage of human resources, medico-legal risks associated with mHealth and data security risks.

CONCLUSIONS

This study explores the individual views and functional needs of target users and healthcare providers for developing a midwifery-led mHealth app in antenatal care, which will serve as a reference for future application development.

IMPACT

Our study has important and practical implications for guiding the development of future midwifery-led mHealth app interventions.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Expectations related to home-based telemonitoring of high-risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway

INTRODUCTION

A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in antenatal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk pregnancies before implementation.

MATERIAL AND METHODS

To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n = 21). Focus group interviews were conducted separately with midwives, obstetricians, and women who had previously experienced stillbirth. Six individual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach.

RESULTS

The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly addressed and articulated in the following themes: eligibility and ability of women, availability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to maintaining a sense of safety also for the care providers. Conditions for HBTM were understood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the importance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so in situations involving emerging acute health issues.

CONCLUSIONS

HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.

The Future of Social Media, Anesthesiology, and the Perioperative Physician

Social media has rapidly developed in the past decade to become a powerful and influential force for patients, physicians, health systems, and the academic community. While the use of social media in health care has produced many positive changes, such as rapid dissemination of information, crowd-sourced sharing of knowledge, learning, and social interaction, social media in health care has also negative effects. Recent examples of negative impacts of social media include rapid and unchecked information dissemination leading to patient misinformation and inadvertent reputational harm for health care professionals due to engaging in controversial topics on public platforms. Members of the anesthesiology community, like other medical specialties, have rapidly adopted social media at many different levels. However, most anesthesiologists, health systems, and academic communities have little education, preparation, and guidelines on optimizing the use of social media technology while minimizing the risks of social media. Anesthesiology has been and will continue to be impacted by the forces of technology and the cultural influences of social media for the foreseeable future. The purpose of this article was to examine the recent history of social media adoption in anesthesiology and perioperative medicine, understand the current impact of social media across our specialty, and consider how the future development of technology and evolving social and cultural dynamic influences of social media will have on anesthesiology over the next quarter century.

Integrating technologies to provide comprehensive remote fetal surveillance: A prospective pilot study

OBJECTIVE

To determine the feasibility of extending remote maternal-fetal care to include fetus well-being.

METHODS

The authors performed a prospective pilot study investigating low-risk pregnant participants who were recruited at the time of their first full-term in-person visit and scheduled for a follow-up telemedicine visit. Using novel self-operated fetal monitoring and ultrasound devices, fetal heart monitoring and amniotic fluid volume measurements were obtained to complete a modified biophysical profile (mBPP). Total visit length was measured for both the in-person first visit and the subsequent telemedicine encounter. A patient satisfaction survey form was obtained.

RESULTS

Ten women between 40 + 1 and 40 + 6 weeks of gestation participated in telemedicine encounters. Nine women (90%) were able to complete remote mBPP assessment. For one participant, fetal assessment was not completed due to technically inconclusive fetal monitoring. Another participant was referred for additional assessment in the delivery room. Satisfactory amniotic fluid volume measurements were achieved in 100% of participants. The telemedicine encounter was significantly shorter (93.1 ± 33.1 min) than the in-person visit (247.2 ± 104.7 min; P < 0.001). We observed high patient satisfaction.

CONCLUSION

Remote fetal well-being assessment is feasible and time-saving and results in high patient satisfaction. This novel paradigm of comprehensive remote maternal and fetal assessment is associated with important clinical, socioeconomic, and logistics advantages.

Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom

INTRODUCTION

Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth and low birth weight. Barriers to prenatal class attendance faced by parents in Canada include geography, socioeconomic status, age, education, and, among Indigenous peoples and other equity-deserving groups, stigma. To address the need for easily accessible and reliable information, we created 'SmartMom', Canada's first prenatal education programme delivered by short message service text messaging. SmartMom provides evidence-based information timed to be relevant to each week of pregnancy. The overall goal of SmartMom is to motivate the adoption of positive prenatal health behaviours with the ultimate goal of improving health outcomes among women and their newborns.

METHODS AND ANALYSIS

We will conduct a two-arm single-blinded randomised controlled trial. Blinding of participants to trial intervention will not be possible as they will be aware of receiving the intervention, but data analysts will be blinded. Our primary research questions are to determine if women experiencing uncomplicated pregnancies randomly assigned to receive SmartMom messages versus messages addressing general topics related to pregnancy but without direction for behaviour change, have higher rates of: (1) weight gain within ranges recommended for prepregnancy body mass index and (2) adherence to Canadian guidelines regarding attendance at prenatal care appointments.

ETHICS AND DISSEMINATION

The study has been granted a Certificate of Approval, number H22-00603, by the University of British Columbia Research Ethics Board. To disseminate our findings, we are undertaking both integrated and end-of-grant knowledge translation, which will proactively involve potential end-users and stakeholders at every phase of our project.

TRIAL REGISTRATION NUMBER

NCT05793944.

Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals

BACKGROUND

Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management.

OBJECTIVE

This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women's perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology.

METHODS

In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis.

RESULTS

Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women's lifestyle constraints, technology's design not meeting women's needs, and optimizing the technology's design to meet women's needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology's design to improve the quality of care, technology to support women's independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management.

CONCLUSIONS

The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement.

Intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, West Shoa zone, Ethiopia 2022

BACKGROUND

Mental health problems are the most common morbidities of women during the prenatal period. In LMICs mobile phones have been identified as a good vehicle for monitoring individuals with a high risk of mental health conditions. However, evidence is scarce and the purpose of this study was to assess the intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, Ethiopia 2022.

METHODS AND MATERIALS

An institutional-based cross-sectional study design was conducted from May 20th to June 20th, 2022. A total of 715 prenatal women were included and a systematic random sampling technique was employed. An interviewer-administered structured questionnaire was used. Collected data was exported to SPSS version 25 for the descriptive part, and AMOS 26 structural equation modeling was also used to describe and assess the degree and significance of relationships between variables.

RESULTS

A total of 699 (97.8% response rate) responded to complete all the questionnaires. About 530 (77.3%) 95% CI (74%-80.3%) of women intended to use a mobile phone to receive mental health support. The perceived usefulness has a positive effect on attitude (β = 0.391, p < 0.001) and intention to use (β = 0.253, p < 0.001). The perceived ease of use influences perceived usefulness (β = 0.253, p < 0.001) and attitude β = 0.579, p < 0.001). The intention to use is positively affected by attitude (β = 0.662, p < 0.001).Trust has a positive effect on perceived usefulness (β = 0.580, p < 0.001) and intention to use (β = 0.113, p = 0.005). Subjective norm has a direct positive effect on perceived usefulness (β = 0.248, p < 0.001). Attitude serves as a partial mediator between perceived usefulness and intention to use and a complete mediating role between perceived ease of use and intention to use.

CONCLUSION

The level of intention to use a mobile phone among prenatal women is relatively high and attitude, perceived usefulness, and trust had direct positive effects on intention to use a mobile phone. Therefore, hospitals and healthcare providers should take proactive measures to implement the strategies and policies for providing mobile phone-based mental health support to prenatal women in remote areas.

Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial

Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy. A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ). Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG. The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.

Creating a Telemedicine Network of Specialists in Maternal-Fetal Medicine: A Prospective Cohort Study

Background: Even before coronavirus disease 2019, integrating telemedicine into routine health care has become increasingly attractive. Evidence regarding the benefits of telemedicine in prenatal care is still inconclusive. As one of the largest sectors of preventive medicine with a relative paucity of specialists in maternal-fetal medicine (MFM), the implementation of telemedicine solutions into prenatal care is promising. Our objective aimed at establishing a telemedicine network of specialists in MFM for interprofessional exchange regarding high-risk pregnancies. Furthermore, the aims were to evaluate the providers' attitude toward the telemedicine solutions and to quantify the number of inpatient appointments that were avoided through interprofessional video consultations. Methods: This prospective trial was part of a larger telemedicine project funded by the European Regional Development Fund. MFM experts were brought together using the ELVI software. A questionnaire was designed for the evaluation of video consultations. The responses were analyzed by the exact McNemar-Bowker test to compare planned procedures before and after video consultation. Results: An interprofessional network of specialists in prenatal ultrasound was established with a total of 140 evaluations for statistical analysis. Interprofessional video communication was viewed favorably by providers. Overall, 47% (33/70) of the scheduled visits were avoided after video consultation. The providers' tendency to refrain from sending their patients to the University Hospital Münster was statistically noticeable (p = 0.048). Conclusions: Interprofessional exchange through video consultation holds great potential in the context of prenatal care. More prospective research is needed to clearly establish the most beneficial standard of care for both patients and providers. Clinical trial registration number: 2019-683-f-S.

Impact of telemedicine on antenatal care at a teaching institution in Eastern India: An insight into the future of better India

Objectives

Telemedicine (TM) emergence has been profound in using technology to address the problems of obstetrics in remote and rural places, especially in low-risk pregnancy. Through this study, we made an effort to assess the satisfaction level and concerns of antenatal and postnatal patients who availed the telemedicine facility during the study period. We also made an effort to facilitate improved access to antenatal and postnatal care, especially the low-risk pregnancies through telemedicine for patients from remote areas of eastern India that do not have the availability of specialists.

Materials and Methods

Primary data were collected by means of a telephonic survey of all the antenatal patients who used telemedicine services of AIIMS, Kalyani, based on a preformed questionnaire.

Results

A total of 80 antenatal patients gave consent to participate in the study. Most of the patients were from the upper lower class [43.75%] followed by the lower middle class [35%]. The average gestational age of respondents was 23.95 weeks. Seventy-one out of 80 patients felt that the appointment was made within a reasonable time. Only 12 patients [15.3%] had waiting time greater than 10 min. The average waiting time was 6.93 min. 56.3% of respondents felt that the person who attended their call was very cooperative. 86.3% of respondents strongly agreed that the consultant was able to understand their health issues completely. Eighty percent of the respondents said that they would like to continue using telemedicine in the future. There is a significant difference between those preferring to use telemedicine in the future and those who do not prefer telemedicine in the future. Poor internet facility and privacy were prominent reasons for not opting for telemedicine in the future by some respondents.

Conclusion

From this study, it was concluded that TM certainly has great potential to make health care accessible to people residing in rural and far-off places.

Evaluation of a telehealth program for high-risk pregnancy in a health service provider institution

INTRODUCTION

eHealth offers a solution to current challenges in maternal health. Telemonitoring can rethink antenatal care, achieving more personalized medicine, especially in high-obstetric risk conditions. A home care model mediated by the development of a mobile and web application that seeks support in clinical decision-making was created in our institution. The software architecture consists of an information system (HCIS, Health Care Information System), a database, an authentication server, and an interoperability bus.

METHODS

The usability of the software by patients was assessed using the Information Systems Usability Questionnaire (CSUQ) version 3, as well as the satisfaction of the care model designed through a survey in a prospective observational study in 62 patients with a high-risk pregnancy. Participants were monitored in real-time through blood glucose, blood pressure, and weight measurements, and attended telemedicine appointments with an obstetrician from admission to six weeks postpartum.

RESULTS

The CSUQ results show a good acceptance of the use of the application by patients both in the global score and the different domains, Global, System utility (SYSUSE), Information Quality (INFOQUAL), and Interface quality (INTERQUAL). The satisfaction survey also shows good results in general and by domains.

CONCLUSION

The findings of this study provide some suggestions for the implementation of a technological development and a care model from the patient's perspective.

Gestational diabetes mellitus care re-imagined - A cost-minimisation analysis: Cost savings from a tertiary hospital, using a novel, digital-based gestational diabetes management model

BACKGROUND

Diagnosis of gestational diabetes mellitus (GDM) in a pregnancy has a significant impact on health service resources and represents a substantial financial and time impost on women.

AIM

To describe a cost-minimisation analysis conducted following the demonstration of clinically equivalent care of women using a novel, digital model for GDM management, compared with conventional care.

MATERIALS AND METHODS

A pre-implementation model of care was compared with the post-implementation model of care which included systematic development and delivery of education videos, use of the Commonwealth Scientific and Industrial Research Organisation 'M♡THer' smart phone app/portal and a dramatically reduced schedule of visits. The Mater Mothers' Hospital Brisbane cares for approximately 1200 women with GDM per annum, on which the cost estimates were based. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a cohort of the study population.

RESULTS

Health service costs showed a modest saving of AU$17 441.78 (US$12 158.92) in the intervention group over a 12-month period. Cost savings for the woman were estimated at $566.56 (US$394.96) per patient after accounting for lost wages, childcare expenses, and travel expenses avoided. This reduction led to an overall saving of $679 872 (US$473 948.82) for the cohort of 1200 women, primarily due to the reduction in face-to-face visits.

CONCLUSION

Re-imagining GDM patient care by introducing a novel, digital-based GDM model of care has substantial positive cost implications for patients.

Piloting a prenatal care smartphone application and care navigation intervention at a federally qualified health center

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.

The effectiveness of technology-based cognitive behavioral therapy on perinatal depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Extensive literature has shown the effectiveness of cognitive behavioral therapy in treating perinatal depression, but little is known about the effectiveness of its technology-based version.

AIM

The aim of this review was to examine the effectiveness of technology-based cognitive behavioral therapy in reducing depressive and anxiety symptoms in women suffering from or at risk of experiencing perinatal depression.

METHODS

Six electronic databases were searched until February 2023 for articles published in English. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Sensitivity analyses and subgroup analyses were also performed, and quality appraisals at the study and outcome levels were conducted.

RESULTS

A total of 16 randomized controlled trials were included in the review. Results from meta-analyses suggest that technology-based cognitive behavioral therapy has a medium effect in reducing perinatal depressive symptoms and a small effect in reducing perinatal anxiety symptoms. Overall, women suffering from or at risk of perinatal depression may benefit from technology-based cognitive behavioral therapy.

LINKING EVIDENCE TO ACTION

Future interventions can be improved by addressing both perinatal depression and anxiety, paying more attention to antenatal women to prevent postnatal mental health issues, and using self-guided mobile applications for accessibility.

Yourtime: The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach

INTRODUCTION

Maternal anxiety and depression are major public health issues with prevalence as high as one in five women. There is a need to focus on preventative strategies to enable women to self-monitor their mental health status during pregnancy and postnatally.

AIM

To co-design and test a perinatal mental health digital tool to enable women to self-monitor their mental wellbeing during pregnancy and early parenting and promote positive self-care strategies.

METHODS AND ETHICS

A sequential mixed methods study utilising two stages 1) co-design workshops; 2) fit for purpose pilot with women through a purpose designed survey to evaluate acceptability, useability, functionality, and satisfaction.

FINDINGS

Mothers, midwives, design researchers and students, participated in co-designing a digital tool and prototype application, YourTime. Fourteen participants engaged in the pilot, with all women agreeing that the tool would be beneficial in alerting them to changes in mental wellbeing. Seventy-seven percent agreed that this prototype had the potential to positively affect wellbeing during the perinatal period.

DISCUSSION

The need to develop a perinatal mental health digital tool that enables women to self-monitor their wellbeing was identified. Women reported the YourTime app offered an acceptable and effective means to self-assess and monitor their wellbeing.

CONCLUSION

The YourTime app responds to the growing agenda for digital approaches to address perinatal mental health challenges. The pilot study demonstrated that the app offered potential to alert women to changes in mental wellbeing, but functionality need further development.

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy

OBJECTIVE

We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond.

METHODS

We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy.

RESULTS

We found that remote antenatal care had far-reaching effects on access when understood through the lens of candidacy. It altered women's own identification of themselves and their babies as eligible for antenatal care. Navigating services became more challenging, often requiring considerable digital literacy and sociocultural capital. Services became less permeable, meaning that they were more difficult to use and demanding of the personal and social resources of users. Remote consultations were seen as more transactional in character and were limited by lack of face-to-face contact and safe spaces, making it more difficult for women to make their needs - both clinical and social - known, and for professionals to assess them. Operational and institutional challenges, including problems in sharing of antenatal records, were consequential. There were suggestions that a shift to remote provision of antenatal care might increase risks of inequities in access to care in relation to every feature of candidacy we characterised.

CONCLUSION

It is important to recognise the implications for access to antenatal care of a shift to remote delivery. It is not a simple swap: it restructures many aspects of candidacy for care in ways that pose risks of amplifying existing intersectional inequalities that lead to poorer outcomes. Addressing these challenges through policy and practice action is needed to tackle these risks.

Integration of Telehealth in Routine Perinatal Care: A Model of Care for Primary Healthcare Clinics in Saudi Arabia

This study aims to introduce a new model of antenatal/postnatal care that integrates virtual clinics with the current model of care, including a discussion on the current model, pre-existing barriers, and prenatal framework, and the need for transition to telehealth beyond the pandemic. In antenatal primary health care centers, such as King Abdulaziz Medical City (KAMC), low-risk antenatal/postnatal care receives clinical care through complete physical attendance in antenatal/postnatal clinics in primary care clinics for pregnancy follow-up and in tertiary hospitals for fetal ultrasound and invasive procedures if needed. Pregnancy is confirmed through a regular family medicine (FM) clinic where risk assessment through history, physical examination, and investigations are carried out. If the pregnant woman is at low risk, she will be started on folic acid, 1 mg or 5 mg based on the risk assessment (if it was not received before). Pregnant women will be given a telehealth appointment for the lab results. Concomitantly, the pregnant women will receive an appointment in the antenatal clinics, which board-certified family physicians run. High-risk patients will be referred to the hospital for further care. Current postnatal care is delivered through regular booking with the FM clinic through physical attendance sometimes, and virtual care is provided upon physican/patient request. Current care meets the past quality care and patient expectations. However, with the current Saudi Vision 2030 and after the experience with virtual care during the COVID-19 pandemic, the current services need to move a step forward to meet the rapidly developing medical care/needs in Saudi Arabia. Various challenges must be addressed, and new models must be included in clinical care for pregnant and postnatal women. Introducing virtual antenatal/postnatal care to the current care could be a new era in maternity primary health care; this model will move the clinical care provided to pregnant/postnatal women a step forward that meets the excellence of high-quality, evidence-based medical care.

Gestational diabetes mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies-a scoping review

BACKGROUND

Globally, gestational diabetes mellitus complicates 1 in 6 pregnancies and increases future risk of type 2 diabetes and cardiovascular disease in the affected women. There is a lack of consensus on the optimal follow-up of these women. eHealth is emerging as a health care tool, but its practical utility and advantages over standard care in the follow-up after pregnancy complications remains to be determined. Our aim was to systematically review the existing literature on cardiovascular follow-up after gestational diabetes, the utility of eHealth technology for this purpose, and to identify research gaps.

METHODS

We performed a systematic scoping review following a published protocol and the Joanna Briggs methodology for studies up until May 2022. Four databases were searched: Ovid MEDLINE, Embase, Maternity and Infant Care, and Cochrane Database of Systematic Reviews. Primary research articles and systematic reviews were included in the final analyses. Two reviewers independently screened abstracts and performed full text assessment. Data was extracted using a data charting form. In all stages of the process, if consensus was not reached, a third reviewer was consulted. The findings from the data charting process provided the basis for summarizing the findings from the included studies.

RESULTS

The search of the databases generated 2772 hits. After removing duplicates and manually adding a total of 19 studies, reviews, and guidelines, a total of 2769 titles and abstracts were screened, and 97 papers underwent full-text review. In the final analyses, 15 articles and 12 systematic reviews were included, whereas guidelines are presented as supplementary material. No studies were identified that examined follow-up regarding long-term overall cardiovascular risk after gestational diabetes. Various lifestyle interventions were tested for individual cardiovascular risk factors, with diverging effects. eHealth technologies were found acceptable by participants but had no consistent, statistically significant effect on relevant health outcomes.

CONCLUSIONS

This scoping review of the existing literature revealed neither an established systematic cardiovascular follow-up strategy for women after gestational diabetes nor evidence that eHealth technologies are superior to conventional follow-up. Further research into the utility of eHealth in cardiovascular follow-up after complicated pregnancies should include longer-term follow-up and core cardiovascular outcomes.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this scoping review was published at Open Science Framework (osf.io/p5hw6).

Athletes' experiences of using a self-directed psychological support, the BAck iN the Game (BANG) smartphone application, during rehabilitation for return to sports following anterior cruciate ligament reconstruction

BACKGROUND

Following anterior cruciate ligament reconstruction (ACLR), many athletes do not return to their sport, often driven by concerns about re-injury. Psychological support strategies might help, but are not routinely included in rehabilitation after ACLR. The BAck iN the Game (BANG) intervention is a 24-week eHealth program delivered via smartphone application (app), beginning directly after ACLR, with a self-directed approach that aims to target the specific challenges athletes encounter in rehabilitation.

AIM

To describe athletes' experiences of using the BANG app during rehabilitation, to support returning to sport following ACLR.

METHOD

Participants were athletes, in contact and/or non-contact pivoting sports, who had ACLR with the goal to return to sports. Semi-structured, individual interviews were conducted 6-10 months after their ACLR; all had access to the BANG intervention. Verbatim transcripts were analysed with a qualitative content analysis.

RESULTS

The 19 participants were 17-30 years, mean 21.6 years (SD 3.5); 7 men and 12 women. The analysis generated three main categories. (A) Interacting with the app illustrated how, when, or why the participants engaged with the app. The app was helpful because of its varying content, the notifications served as reminders and participants stopped using the app when no longer needing it. (B) Challenging experiences with the app illustrated that the app itself came with some difficulties e.g., content not appearing with the right timing and material not tailored to their sport. (C) Supportive experiences with the app reflected how the app facilitated the participants' rehabilitation progress; it included positive aspects of the app content and navigation, boosting their confidence to return to sport, and motivated them to continue with rehabilitation.

CONCLUSION

The analysis of the interviews illustrates athletes' awareness in interacting with, and the challenging and supportive experiences of using the app. The BANG app might provide support for returning to sport, primarily psychological support, as an adjunct to regular physiotherapy-guided rehabilitation. Athletes' experiences of the BANG app could be improved by healthcare professionals providing additional advice about when to use which content and why.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03959215. Registered 22 May 2019.

Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study

BACKGROUND

Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services.

OBJECTIVE

To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China.

METHODS

The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies.

RESULTS

Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice.

CONCLUSIONS

The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.

Patient Experience with Telehealth Medicine During the Ongoing COVID-19 Pandemic in New York City

Background: The COVID-19 pandemic accelerated integration of telehealth services into OBGYN practices in New York City. Since then, studies have shown high patient satisfaction with OBGYN telehealth services. However, few studies have compared satisfaction between obstetric and gynecologic patients. The primary objective of this study was to compare satisfaction with telehealth services between obstetric and gynecologic patients. Methods: This was an institutional review board-approved cross-sectional survey study among patients who had a telehealth visit at NYU OBGYN Faculty Group Practice from March 2020 to March 2021. Results: Gynecologic patients had higher rates of being "completely satisfied" compared with obstetric patients (40% vs. 24%, p < 0.001). Gynecologic patients were more likely to opt for telehealth services than obstetric patients both during a pandemic (70% vs. 59%, p < 0.001) and in the absence of a pandemic (53% vs. 37%, p < 0.001). Discussion: Prior studies have demonstrated high satisfaction with OBGYN telehealth. However, obstetric patients were less likely than gynecologic patients to feel satisfied with and opt for telehealth services.

Digital solutions to follow up on discharged new parents-A systematic literature review

New parents and their newborns are followed up after discharge either through home visits from midwives/nurses or using information and communication technology. This follow-up focuses on individual needs related to breastfeeding and infant feeding, practical advice on caring for babies, supporting and strengthening the new mother's knowledge and self-confidence concerning child development and parenting skills, and supporting the relationship between parents and baby. This systematic review aims to integrate available research results that describe new parents' experiences when health and care providers used telemedicine as a platform for follow-up after discharge from the childbirth department. This literature review was conducted following the PRISMA statement and was prospectively registered in PROSPERO CRD42021236912. The studies were identified through the following databases: AMED, Academic, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Cochrane database, and CINAHL. Results from these studies were compiled using thematic analysis. A total of 886 studies were identified. Screening resulted in eight studies that met the inclusion criteria. Thematic analysis produced the following themes: a) Flexibility and convenience of digital support, b) Digital literacy, c) Parents feeling safe with digital support, and d) Adequate substitute for physical meetings. New parents who live in a home environment with a relaxed atmosphere and around-the-clock digital support experience a sense of control, security, full attention, and encouragement. Digital follow up at home has proven effective because it can meet the support needs of new parents when necessary.

Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview

Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

BACKGROUND

Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

OBJECTIVE

In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

METHODS

A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

RESULTS

We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

CONCLUSIONS

The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT).

OBJECTIVE

The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability.

METHODS

In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh.

RESULTS

SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition.

CONCLUSIONS

SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3389/fgwh.2021.620759.

Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study

Background

Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA.

Methods

Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored.

Results

Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude.

Conclusion

These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.

Pregnant women's attitudes to and experiences with a smartphone-based self-test for prediction of pre-eclampsia: a qualitative descriptive study

OBJECTIVES

To explore attitudes to and experiences using a smartphone-based self-test for prediction of pre-eclampsia among pregnant women.

DESIGN

A qualitative, descriptive study.

SETTING

An obstetrical care unit at a university hospital in Denmark.

PARTICIPANTS

Twenty women who had participated in the Salurate trial, a clinical trial testing the efficacy of a smartphone-based self-test for prediction of pre-eclampsia, were purposefully chosen for the study, using maximum variation sampling.

DATA COLLECTION AND ANALYSIS

Data were collected by semistructured, individual, face-to-face interviews conducted from 4 October 2018 to 8 November 2018. Data were transcribed verbatim and analysed by means of thematic analysis.

RESULTS

Qualitative thematic analysis resulted in the identification of three main themes: Raising awareness, self-testing has the potential to be an integrated part of pregnancy and trusting in technology. Two subthemes were identified under each main theme.

CONCLUSIONS

The smartphone-based self-test for prediction of pre-eclampsia has potential to be integrated into antenatal care, and women found it feasible to use. However, testing affected the participating women psychologically, leading to feelings of worry as well as safety. Therefore, if self-testing is implemented, it is important to take actions to handle adverse psychological side effects, including increasing knowledge on pre-eclampsia and having healthcare professionals ongoingly address the psychological state of women throughout pregnancy. In addition, it is essential to emphasise the importance of subjective bodily sensations during pregnancy, including fetal movements. Further studies on the experience of being labelled low risk versus high risk for pre-eclampsia are warranted since this was not investigated in this trial.

Patient engagement practice within perinatal eHealth: A scoping review

BACKGROUND

There is a gap in knowledge about how perinatal eHealth programs function to support autonomy for new and expectant parents from pursuing wellness goals.

OBJECTIVES

To examine patient engagement (access, personalization, commitment and therapeutic alliance) within the practice of perinatal eHealth.

DESIGN

Scoping review.

METHODS

Five databases were searched in January 2020 and updated in April 2022. Reports were vetted by three researchers and included if they documented maternity/neonatal programs and utilized World Health Organization (WHO) person-centred digital health intervention (DHI) categories. Data were charted using a deductive matrix containing WHO DHI categories and patient engagement attributes. A narrative synthesis was conducted utilizing qualitative content analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 'extension for scoping reviews' guidelines were followed for reporting.

RESULTS

Twelve eHealth modalities were found across 80 included articles. The analysis yielded two conceptual insights: (1) The nature of perinatal eHealth programs: (1) emergence of a complex structure of practice and (2) practising patient engagement within perinatal eHealth.

CONCLUSION

Results will be used to operationalize a model of patient engagement within perinatal eHealth.

Association Between the Use of a Digital Health Platform During Pregnancy and Helping Users Avoid Emergency and In-Person Care: Retrospective Observational Study

BACKGROUND

Almost one-third of pregnant people visit the emergency room during pregnancy. Although some emergency care is necessary, gaps in patient education and inaccessibility of preventive services have been identified as key reasons for high-cost, low-value care in pregnancy. Digital platforms present a promising solution for providing resources to supplement routine prenatal care, thereby reducing the use of low-value in-person services.

OBJECTIVE

This study aimed to describe the relationship between the use of Maven and in-person care avoidance (emergency room or office visits) during pregnancy. Maven is a digital prenatal health platform that supplements routine prenatal care. Maven offers educational content (articles, videos, and classes), care coordination (through a care advocate), and provider services (web-based appointments and communication with providers) designed to complement prenatal care. Specifically, the aims of this study were to examine whether the use of Maven is associated with in-person care avoidance overall and whether improvements in pregnancy-related knowledge facilitate in-person care avoidance. To assess aim 2, we tested if the use of Maven is associated with improvements in self-reported understanding of warning signs and medically accurate information and if self-reported understanding of medically accurate information and warning signs is associated with in-person care avoidance in a population of Maven users.

METHODS

In this retrospective study, we used adjusted logistic regression to examine the relationship between digital platform use, avoidance of in-person care, and the platform's influence on pregnancy-related knowledge (learning medically accurate information and recognizing warning signs). Demographics, medical history, and in-person care avoidance were self-reported.

RESULTS

Of the 5263 users, 280 (5.32%) reported that Maven helped them avoid in-person care during pregnancy. More users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs (231/280, 82.5%) and learned medically accurate information (185/280, 66.1%). In the adjusted models, all modes of digital service use (assessed as quartiles) were associated with avoiding in-person care in a dose-response manner (eg, web-based provider appointments: Q2 adjusted odds ratio [aOR] 1.57, 95% CI 1.00-2.41; Q3 aOR 2.53, 95% CI 1.72-3.72; Q4 aOR 5.26, 95% CI 3.76-7.42). Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs (aOR 3.55, 95% CI 2.60-4.94) or learn medically accurate information (aOR 2.05, 95% CI 1.59-2.67).

CONCLUSIONS

These results suggest that digital platforms can be effective in helping patients to avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping patients recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when in-person care is medically appropriate. Future work is needed to assess other pathways through which digital resources can support pregnant people and improve perinatal care use.

The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review

Purpose of Review

This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space.

Recent Findings

The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain.

Summary

Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.

Translating Research Evidence Into Marketplace Application: Cohort Study of Internet-Based Intervention Platforms for Perinatal Depression

BACKGROUND

Internet-based intervention platforms may improve access to mental health care for women with perinatal depression (PND). Though the majority of platforms in the market lack an evidence base, a small number of them are supported by research evidence.

OBJECTIVE

This study aims to assess the current status of internet-based PND intervention platforms supported by published evidence, understand the reasons behind the disappearance of any of these previously accessible platforms, examine adjustments made by those active platforms between research trials and market implementation, and evaluate their current quality.

METHODS

A cohort of internet-based PND intervention platforms was first identified by systematic searches in multiple academic databases from database inception until March 26, 2021. We searched on the World Wide Web and the iOS and Android app stores to assess which of these were available in the marketplace between April and May 2021. The basic characteristics of all platforms were collected. For inaccessible platforms, inquiries were made via email to the authors of publications to determine the reasons for their unavailability. We compared the intervention-related information of accessible platforms in the marketplace with that reported in original publications and conducted quality assessments using the App Evaluation Model of the American Psychiatric Association. Fisher exact tests were used to compare the functional characteristics in publications of available and unavailable platforms and to investigate potential associations between functional adjustments or quality indices and platform survival time.

RESULTS

Out of 35 platforms supported by research evidence, only 19 (54%) were still accessible in the marketplace. The main reason for platforms disappearing was the termination of research projects. No statistically significant differences were found in functional characteristics between available and unavailable platforms. A total of 18 (95%) platforms adapted their core functions from what was reported in related publications. The adjustments included changes to intervention methods (11/19, 58%), target population (10/19, 53%), human resources for intervention support (9/19, 47%), mood assessment and monitoring (8/19, 42%), communication modality (4/19, 21%), and platform type (2/19, 11%). Quality issues across platforms included low frequency of update, lack of crisis management mechanism, poor user interactivity, and weak evidence base or absence of citation of supporting evidence. Platforms that survived longer than 10 years had a higher tendency to use external resources from third parties compared to those that survived less than 10 years (P=.04). No significant differences were found for functional adjustments or other quality indices.

CONCLUSIONS

Internet-based platforms supported by evidence were not effectively translated into real-world practice. It is unclear if adjustments to accessible platforms made during actual operation may undermine the proven validity of the original research. Future research to explore the reasons behind the success of the implementation of evidence-based platforms in the marketplace is warranted.

Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis

OBJECTIVE

To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum.

SETTINGS

Any healthcare setting servicing pregnant women, including any country globally.

PARTICIPANTS

Pregnant women of any social, ethnic or geographical background who smoke.

METHODS

We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence.

RESULTS

We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision.

CONCLUSION

NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.

Maternal and perinatal outcomes in mixed antenatal care modality implementing telemedicine in the southwestern region of Colombia during the COVID-19 pandemic

INTRODUCTION

Contingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine.

OBJECTIVE

We aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine.

METHODS

We conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20,202, determining each group's maternal and neonatal outcomes.

RESULTS

A total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6-9) vs 6 (4-8) p < 0.001), with an earlier gestational age at onset (7.1 (6-8.5) vs 9.3 (6.6-20.3), p < 0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p = 0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications.

DISCUSSION

Incorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.

Teleconsultation management in healthcare during the COVID-19 pandemic: The impact of Perceived Justice on satisfaction and Word-Of-Mouth

Following the restrictions on movement imposed during the COVID-19 pandemic, the greater demands placed on physicians and many healthcare infrastructures, a large number of health teleconsultation platforms have emerged around the world. The aim of this paper is to obtain a better understanding of the acceptance of teleconsultation platforms by patients. To this end, a survey of 1273 patients was carried out using a teleconsultation platform during the pandemic period in France (from 9 July to 29 October 2020). The questionnaire mobilized existing scales to measure Satisfaction, Perceived Justice and, finally, the intention to disseminate by Word-Of-Mouth (WOM). Data were analysed using a Partial Least Squares approach. The study confirms the impact of Distributive, Informational and Procedural Justice on Satisfaction and the impact of Distributive and Informational Justice on WOM. The findings emphasize the influence of Satisfaction on WOM. The results detect a mediating effect of Satisfaction on WOM and moderating effects of gender, age and long-standing use. This research contributes to both theoretical and practical COVID-19 research and may be used by healthcare professionals to develop teleconsultation services, one of the means of supporting interaction and satisfying patients’ treatment requirements during the pandemic.

Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review

Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD).

METHODS

Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed.

RESULTS

A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design.

CONCLUSIONS

The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.

Patients' experiences with an obstetric telephone triage system: A qualitative study

BACKGROUND

Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied.

OBJECTIVE

The purpose of this study is to explore patients' experiences with obstetric telephone triage.

METHODS

A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding.

RESULTS

Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations.

CONCLUSION

Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care.

PRACTICE IMPLICATIONS

Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.

Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review

OBJECTIVE

 This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices.

METHODS

 This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish.

RESULTS

 The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content.

CONCLUSION

 There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.

SmartMoms Canada: An evaluation of a mobile app intervention to support a healthy pregnancy

BACKGROUND

There is a lack of cost-effective and readily available access to evidence-based information to manage healthy behaviours for pregnant individuals. Mobile health (mHealth) tools offer a cost-effective, interactive, personalized option that can be delivered anywhere at a time most convenient for the user. This study protocol was primarily developed to, i) assess the feasibility of the SmartMoms Canada intervention in supporting participants to achieve gestational weight gain (GWG) guidelines. The secondary objectives are to, ii) assess user experience with the app, measured by adherence to the program via app software metrics and frequency of use, iii) determine the impact of SmartMoms Canada app usage on the adoption of healthful behaviours related to nutrition, physical activity and sleep habits, improvements in health-related quality of life, pregnancy-related complications, and symptoms of depression, and iv) investigate the potential extended effects of the app on postpartum health-related outcomes.

METHODS

This is a feasibility trial. Pregnant individuals aged 18-40 years with pre-gravid body mass index between 18.5 and 39.9 kg/m², carrying a singleton fetus, having Wi-Fi access, and at ≤20 weeks' gestation will be recruited. Eligible people will be followed from recruitment until 12 months postpartum.

DISCUSSION

SmartMoms Canada is the first bilingual Canadian-centric app designed for pregnant people. This mHealth intervention, with its ability to supply frequent interactions, provides pregnancy- related health knowledge to users, potentially leading to an improvement in pregnancy-related outcomes and behaviours, and, ultimately a reduction in the present economic burden related to in-person interventions.

TRIAL REGISTRATION

ISRCTN, ISRCTN16254958. Registered 20 December 2019, http://www.isrctn.com/ ISRCTN16254958.

Home telemonitoring versus hospital care in complicated pregnancies in the Netherlands: a randomised, controlled non-inferiority trial (HoTeL)

BACKGROUND

Women with complicated pregnancies often require hospital admission. Telemonitoring at home is a promising alternative that fulfils a worldwide need in obstetric health care. Moreover, the COVID-19 pandemic has accelerated the transformation to digital care. The aim of this study was to evaluate safety, clinical effectiveness, patient satisfaction, and costs of home telemonitoring against hospital care in complicated pregnancies.

METHODS

We did a multicentre, randomised, controlled, non-inferiority trial in six hospitals (four general teaching hospitals and two university hospitals) in the Netherlands (located in Utrecht, Amsterdam, and Groningen). Women aged 18 years and older with singleton pregnancies (>26 weeks gestation) requiring monitoring for pre-eclampsia, fetal growth restriction, fetal anomaly, preterm rupture of membranes, reduced fetal movements, or history of fetal death were included in the study. Participants were randomly assigned to either hospital admission or telemonitoring in (1:1), stratified for the six diagnoses for inclusion and the six centres of inclusion, using block randomisation (block sizes of four and six). When assigned to telemonitoring, participants went home with devices for cardiotocography and blood pressure measurements and had daily contact with their care providers after digitally sending their home measurements. When assigned to hospital admission, participants received care as usual on the ward until the postpartum period. The primary outcome was a composite of adverse perinatal outcomes assessed after delivery, including mortality; an Apgar score below 7 after 5 min or an umbilical arterial pH at birth below 7·05; maternal morbidity; admission of the newborn to the neonatal intensive care unit; and rate of caesarean section. The primary outcome was assessed in the intention-to-treat population. The non-inferiority margin for the primary outcome was a 10% absolute increase in composite primary endpoint based on baseline 20% incidence. The study was registered at the Dutch Trial Registration (NL5888) and is now closed to new participants.

FINDINGS

From Dec 1, 2016, to Nov 30, 2019, 201 pregnant women were randomly assigned to an intervention procedure. 101 women were allocated to the telemonitoring group and 100 to the hospital admission group. One participant in the telemonitoring group withdrew consent before the intervention was initiated, and 100 participants were analysed for the primary outcome. In the hospital admission group, four participants did not receive the allocated intervention because they did not accept hospital admission. 100 participants in each group were analysed for the primary outcome according to the intention-to-treat principal. No participants were lost to follow-up. The primary outcome occurred in 31 (31%) of 100 participants in the telemonitoring group and in 40 (40%) of 100 participants in the hospital admission group. Adjusted for centre of inclusion, diagnosis, and nulliparity, the risk difference in primary outcome between both groups was 10·3% (95% CI -22·4 to 2·2) lower in the telemonitoring group, below the pre-defined non-inferiority margin of 10% absolute increase. A similar distribution for each of the individual components within the composite primary outcome was seen between groups. Five serious adverse events were reported: one neonatal death in the hospital admission group, in addition to one intra-uterine fetal death, two neonatal deaths, and one case of eclampsia in the telemonitoring group, all unrelated to the study.

INTERPRETATION

This non-inferiority trial shows the first evidence that telemonitoring might be as safe as hospital admission for monitoring complicated pregnancies.

FUNDING

Stichting Achmea Gezondheidszorg and ICT Healthcare Technology Solutions.

Primary Care Physician's Perception and Satisfaction With Telehealth in the National Guard Primary Healthcare Centers in Jeddah, Saudi Arabia in 2022

Background Telehealth is a tool to facilitate the connection between patients and their healthcare providers. With the recent emergence of telehealth, implementation of this service in primary healthcare centers (PHCs) has been accompanied by specific challenges despite the high levels of satisfaction reported. This study aimed to assess the factors that affect clinicians' perceptions and satisfaction with telehealth in National Guard PHCs to help explore and overcome any barriers and challenges. Methods A cross-sectional survey was distributed among primary healthcare physicians using virtual clinics in the National Guard PHCs in Jeddah, Saudi Arabia, in 2022. A validated questionnaire from previous literature was used to evaluate clinicians' perceptions and satisfaction with telehealth. Results The study included 53 primary healthcare physicians, with an overall response rate of 90%. Most physicians (77%) were satisfied with their overall experience with offering virtual visits. Nevertheless, 72% of physicians perceived patients' limited technical knowledge, and 70% considered limited access to technology a significant barrier against virtual visits. Higher satisfaction levels were significantly associated with those who did not consider the lack of integration of virtual visits with current workflow or electronic medical records (EMRs) a significant barrier to conducting virtual visits (p-value = 0.005). Conclusion Despite the undeniable advantages of telehealth, barriers, and challenges remain extant and can influence clinicians' satisfaction. Continuous monitoring for improvements is needed to enhance the telehealth experience.