Improving preconception care for women with diabetes : development and feasibility study of a mobile application.

Abstract

Introduction Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can minimise risk of complications and improve outcomes, but current provision is inadequate. Mobile technology, particularly smartphone apps, could improve preconception care provision but research is lacking in this area. Aim The study aimed to critically appraise the literature with respect to PCC educational interventions and highlight limitations of current interventions, and to develop a Preconception and Diabetes Information (PADI) app for women with type 1 or 2 diabetes and explore the system’s feasibility and acceptability. Methods A systematic review of the literature and a 2-phase mixed methods study design, (1) development and (2) feasibility and acceptability, were used. The app was developed via a co-design approach with women with diabetes, healthcare professionals and an app development company. A 3-month pre- and post-intervention study assessed preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), user acceptability was also explored. Data collection methods included focus groups, semi-structured interviews and questionnaires. Results The systematic review showed that PCC educational interventions had a positive effect on patient and behavioural outcomes, however, PCC uptake was low and the use of eHealth for PCC of women with DM was still in its infancy. The 2-phase mixed methods study design indicated a high level of enthusiasm and interest towards a preconception care app that could overcome shortfalls in current preconception care service provision. Improvements were recorded in knowledge of pregnancy planning and pregnancy-related risks, perceived benefits and self-efficacy to seek preconception care, and patient activation measure, following the 3-month app usage. Participants found the PADI app acceptable (satisfaction rating was 72%), useful and informative. Usage was episodic and influenced by functionality (manual data input) and personal factors (pregnancy intention, time/memory and conflicting priorities) that participants felt could be overcome via personalisation, automation, improved interactivity and daily reminders. Conclusion This is the first study to explore the acceptability and feasibility of a preconception care app for women with diabetes. It has positive implications in terms of overcoming barriers to preconception care provision and uptake, and changing preconception behaviours. In order that the contribution of the PADI app can be fully realised, further evaluation is required.