Do mHealth lifestyle and medical intervention apps used during pregnancy deliver usability and user satisfaction? A Systematic Review
Background: Mobile apps have become part of almost everyone’s lives. The majority of apps in the health sector are related to supporting women during pregnancy. These include lifestyle apps and medical apps. Ensuring the usability and user satisfaction of these apps is important to successful implementation. Objective: This research aimed to provide a systematic review of evidence relevant to the user satisfaction, usability and effectiveness of mHealth medical and lifestyle apps to support healthcare during pregnancy. Method: The following electronic databases were searched for studies on mHealth apps used by women during pregnancy: The Cochrane Library, Web of Science, EMBASE, Medline (Ovid) and Google Scholar. All included studies were published after 2007 in the English language, comprising randomised controlled trials and all quantitative, qualitative, and mixed-method studies that explored usability or user satisfaction with mHealth apps. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements (PRISMA) were followed in this review. After full screening of search results, the data were extracted from the included studies. Three quality assessments were used in this review: the Cochrane Collaboration criteria for randomised controlled trials, a set of criteria developed by Walsh and Downe (2006) for qualitative studies, and criteria assessed and developed by the National Heart, Lung and Blood Institute for other studies. This systematic review followed a narrative synthesis approach. Results: The search strategy returned 3,332 studies. After removing duplicates, 2,727 studies were screened by title and abstract. Of these, 2,693 were excluded due to not meeting the eligibility criteria, and the full text was read of 34 studies. Another 23 studies were excluded for not meeting the eligibility criteria, and the remaining 13 were included in the study. Of the 13 studies, eight were qualitative or mixed-method designs that reported the usability and acceptability of mobile apps, and five were randomised controlled trials that reported the efficiency of apps. The risk of bias was satisfactory in the pre- and post-test observational study, unclear or high in the randomised controlled trials, and low in the qualitative studies. Page 10 of 73 Discussion: mHealth apps delivered user satisfaction and usability. However, the quality of these studies was categorised as low. In addition, the randomised controlled trials failed to show that apps increased the odds of pregnant women adopting lifestyle changes, such as smoking cessation or weight control. Moreover, the quality of the evidence was unclear or at high risk of bias. However, this review has several limitations. Conclusion: This review found from the included studies that lifestyle and medical apps used during pregnancy could deliver usability and user satisfaction but were not effective. Adherence, cost effectiveness, and data security of apps need further investigation.