Abstract
BackgroundGestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on lifestyle modification help to reduce long-term complications. Self-management technology-based interventions can support behaviour change and diabetes control. The Baby Steps programme, a randomised controlled trial intervention offering group education and access to a mobile web application, was evaluated to explore user experience of the app and barriers and facilitators to app usability.MethodsTen semi-structured interviews and four focus group discussions were conducted with 23 trial participants between 2018 and 2019. Interviews and focus group discussions were audiotaped, transcribed and independently analysed. The analysis was informed by thematic analysis, with the use of the Nvivo 12 software.ResultsThemes identified were: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to the usability of the Baby Steps app. The Baby Steps app served as a motivator for increasing self-management activities and a tool for monitoring progress. Peer support and increased awareness of GDM and T2DM enhanced engagement with the app, while poor awareness of all the components of the app and low technical skills contributed to low usability.ConclusionsThis study documents experiences from existing GDM support, user experiences from using the Baby Steps app, and the barriers and facilitators to app usability. The app was both a motivational and a monitoring tool for GDM self-management and T2DM prevention. Peer support was a key trait for enhanced engagement, while barriers were low technical skills and poor awareness of the app components. A digital app, such as the Baby Steps app, could strengthen existing face-to-face support for the prevention of T2DM. The results also have wider implications for digital support technologies for all self-management interventions. Further research on the effect of specific components of apps will be required to better understand the long term impact of apps and digital interventions on self-management behaviours and outcomes.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.
Highlights
Gestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM)
Offering support, guidance, and strategies to reduce the risk of developing T2DM is recommended following a GDM diagnosis by the American Diabetes Association (ADA) and National Institute for Health Excellence (NICE) [1, 12]
Themes The following three key themes were generated: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to usability of the Baby Steps app
Summary
Gestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on managing modifiable risk factors such as weight, physical activity, and dietary patterns can help reduce long-term complications [8]. Such lifestyle interventions have shown to be safe and cost-effective for reducing T2DM risks among those with GDM and pre-diabetes [9]; these have implementation implications, as they can be difficult to sustain and scale-up [10, 11]. Digital technology provides easy on-demand access to information and social support which are needed by women with GDM who often have several timedemanding concerns [20] These technologies have shifted management strategies from traditional face-toface interventions toward interactive, self-directed, personalised, and cost-effective options; and, as a result, improved access to health care resources
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