PMID- 37556197 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230826 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 12 DP - 2023 Aug 9 TI - Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App-Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study. PG - e45293 LID - 10.2196/45293 [doi] LID - e45293 AB - BACKGROUND: Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app-based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation. OBJECTIVE: Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster. METHODS: The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster's feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the "mHealth App Usability Questionnaire" and additional interviews or questionnaires. RESULTS: Results are expected to be published by December 2023. CONCLUSIONS: Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster's feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45293. CI - (c)Sharissa M Smith, Babette Bais, Hafez Ismaili M'hamdi, Maartje H N Schermer, Regine P M Steegers-Theunissen. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.08.2023. FAU - Smith, Sharissa M AU - Smith SM AUID- ORCID: 0000-0002-5085-4755 AD - Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands. FAU - Bais, Babette AU - Bais B AUID- ORCID: 0000-0003-3579-6670 AD - Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands. FAU - Ismaili M'hamdi, Hafez AU - Ismaili M'hamdi H AUID- ORCID: 0000-0002-5559-2694 AD - Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands. FAU - Schermer, Maartje H N AU - Schermer MHN AUID- ORCID: 0000-0003-4283-9659 AD - Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands. FAU - Steegers-Theunissen, Regine P M AU - Steegers-Theunissen RPM AUID- ORCID: 0000-0002-4353-5756 AD - Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands. LA - eng PT - Journal Article DEP - 20230809 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC10448288 OTO - NOTNLM OT - ethics OT - health inequality OT - lifestyle OT - mHealth OT - mental stressor OT - mobile health OT - mobile phone OT - periconception OT - preconception care OT - pregnancy OT - socioeconomic status COIS- Conflicts of Interest: RPMS-T is an initiator and developer of the mobile health app Smarter Pregnancy. The funder had no role in the design of the study, writing of the manuscript, or decision to publish the protocol. EDAT- 2023/08/09 12:55 MHDA- 2023/08/09 12:56 PMCR- 2023/08/09 CRDT- 2023/08/09 11:54 PHST- 2022/12/23 00:00 [received] PHST- 2023/05/03 00:00 [accepted] PHST- 2023/04/22 00:00 [revised] PHST- 2023/08/09 12:56 [medline] PHST- 2023/08/09 12:55 [pubmed] PHST- 2023/08/09 11:54 [entrez] PHST- 2023/08/09 00:00 [pmc-release] AID - v12i1e45293 [pii] AID - 10.2196/45293 [doi] PST - epublish SO - JMIR Res Protoc. 2023 Aug 9;12:e45293. doi: 10.2196/45293.