Abstract
BackgroundThe United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health (mHealth) apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated the quality of existing mHealth tools targeted to this time period in terms of sufficiency of maternal health information, inclusivity of people of color, and app usability.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were evaluated for extent and quality of maternal health information and inclusivity of people of color using an a priori coding scheme. App usability was evaluated using the Mobile Application Rating Scale (MARS) score.ResultsOf the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The coverage of maternal health information and inclusivity of people of color in app imagery both correlated positively with the MARS usability score of the app. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between MARS usability score and number of app users, as estimated by number of ratings for the app available on the app store. In addition, apps with evidence-based maternal health information had greater MARS engagement, information, and aesthetics scores. However, presence of evidence-based information did not correlate with greater numbers of app users.ConclusionsCurrent commercially available peripartum apps range widely in quality. Overall current app offerings generally do not provide adequate maternal health information and are not optimally accessible to the target users in terms of inclusivity of women of color or app usability. Apps delivering evidence-based information and more usable design are more likely to meet these standards but are not more likely to be downloaded by users.
Highlights
The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation
Highest-quality apps Four apps met or exceeded all of the following criteria for an acceptable peripartum mobile health (mHealth) application: 1) Shared evidence-based information; 2) addressed greater than or equal to 90% of maternal health information; 3) imagery portrayed at least 24% people of color; 4) received a Mobile Application Rating Scale (MARS) score of at least 4 (“Good”) in each subcategory of engagement, functionality, aesthetics, and information; 5) did not depict race-biased imagery or language
This review has shown that while some peripartum apps provide the medical information, inclusivity, and usability that is optimal for a successful clinical support tool, there is wide variability among the currently available products and many apps fail to meet these standards
Summary
The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. The United States is currently facing a maternal morbidity and mortality crisis. The maternal mortality rate has more than doubled since 1990, and currently stands at 17.4 deaths per 100,000 live births-- the highest of any resource-rich nation [1]. Pregnancy-related maternal mortality and morbidity is disproportionately high among women of color whereby non-Hispanic Black women are more than 3 times more likely to experience pregnancy-related death than non-Hispanic white women [6,7,8]. There are disparities in cause of death, with Black women being more likely to suffer from pregnancy-related cardiomyopathy, pulmonary embolism, and hypertensive disorders [9]. Black and Hispanic women are at greater risk than white women of both IPV and depression [10,11,12]
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