Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2024

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Using Mobile Apps to Support Perinatal Mental Health and Overall Wellbeing

Danae Dinkel, PhD; Margaret R. Emerson DNP, APRN, PMHNP-BC; Biswadeep Dhar, PhD, MEd, MS; Carli Culjat, PhD, MBA, APRN, FNP-BC; Lisette T. Jacobson, PhD, MPA, MA, CBS - Child & Family Health SIG

In the United States, anxiety and depression impact up to 38% of perinatal women – defined hereafter as individuals who are pregnant and up to one year postpartum - with symptoms adversely affecting both women and their babies.1,2 Low engagement in healthy behaviors such as being physically active and eating fresh fruits and vegetables during this period further complicates matters and negatively impacts the health of women and their children.3 

Use of Mobile Apps in the Perinatal Period

Due to the challenges of the perinatal time period such as changing family dynamics including less time and often less sleep, easily accessible information to help mothers improve their mental health and overall wellbeing is needed.4 With 97% of 18-49 y/o adults owning a smartphone, mobile health (mHealth) apps are a logical tool to address this need.6 Research exploring digital interventions among perinatal women is increasing and indicates smartphones as a preferred source of health and behavior information.6,7

Lack of Available Apps Specific to This Time Period

A recent systematic review found a limited number of commercially available mental health apps designed for the perinatal population. Apps that were accessible had variable content, concerns related to privacy, and cost barriers.8

What is needed?

Due to the rising demand and interest in using mHealth apps among mothers, there is a need for additional studies and efforts that focus on helping perinatal women who experience challenges with their mental health and overall wellbeing via mHealth interventions. For those considering using mHealth apps in clinical care or culturally tailored interventions to help perinatal women, there are a few important factors to consider:

  • Ensure mother’s feedback is incorporated into the mHealth apps. Existing commercial apps and those used in research have limited documentation on how or if they worked with mothers to design the app or any of its content. Ensuring app developers have consulted or worked with mothers is an important first step when identifying or developing an app for this population. Therefore, we encourage individuals to conduct a formative study prior to the app’s implementation, along with a usability study post app development.
  • Understand the health literacy level of your population. Assuring alignment between health literacy levels of patients and app content is essential for successful implementation of these types of interventions.9
  • Identify health systems and clinicians that are open to mHealth app use. Ideally, mHealth apps are used to help supplement existing provider-patient relationships. While systemic level factors can make it challenging to incorporate mHealth apps into care, identifying health systems and leaders who are willing to take on these challenges is critical to successful implementation.
  • Examine the content available within the mHealth app. The type of interaction that occurs with apps will greatly impact sustained use as the average estimated retention rates for health-related mobile apps 30 days after download is 3.7%.10 Thus, it is important to understand your audience and the type of content they want as well as to ensure the content is appropriate and accurate. 

References:

  1. Forder PM, Rich J, Harris S, et al. Honesty and comfort levels in mothers when screened for perinatal depression and anxiety. Women Birth. 2020;33(2):e142-e150. doi: 10.1016/j.wombi.2019.04.001. Epub 2019 May 25. PMID: 31133524.
  2. Kendig S, Keats JP, Hoffman MC, et al. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Obstet Gynecol. 2017 Mar;129(3):422-430. doi: 10.1097/AOG.0000000000001902. 
  3. Urizar GG Jr, Murillo J, Miller K. Factors associated with prenatal health behaviors among low-income, ethnic minority women. Int J Environ Res Public Health. 2023;20(3):1695. doi: 10.3390/ijerph20031695. PMID: 36767060; PMCID: PMC9914291.
  4. Dennis CL, Chung‐Lee L. Postpartum depression help‐seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth. 2006;33(4): 323-31.
  5. Pew Research Center. Mobile Fact Sheet. January 31, 2024. Accessed September 2, 2024. www.pewresearch.org/internet/fact-sheet/mobile/
  6. Seo JM, Kim SJ, Na H, Kim JH, Lee H. Effectiveness of a mobile application for postpartum depression self-management: Evidence from a randomised controlled trial in South Korea. Healthcare (Basel). 2022;10(11):2185. doi: 10.3390/healthcare10112185. PMID: 36360528; PMCID: PMC9690421.
  7. Yew TW, Chi C, Chan SY, et al. A randomized controlled trial to evaluate the effects of a smartphone application-based lifestyle coaching program on gestational weight gain, glycemic control, and maternal and neonatal outcomes in women with gestational diabetes mellitus: The SMART-GDM Study. Diabetes Care. 2021;44(2):456-463. doi: 10.2337/dc20-1216. Epub 2020 Nov 12. PMID: 33184151; PMCID: PMC7818327.
  8. Emerson, M., Perret, S., Chinn, H. et al. A systematic review and exploration of smartphone app interventions for perinatal depression with case study. Curr Treat Options Psych. 2023;10:136–166. https://doi.org/10.1007/s40501-023-00301-w
  9. Emerson MR, Buckland S, Lawlor MA, et al. Addressing and evaluating health literacy in mHealth: a scoping review. Mhealth. 2022;8:33. doi: 10.21037/mhealth-22-11. PMID: 36338314; PMCID: PMC9634204.
  10. Longe T. Mobile app retention benchmarks by industries 2024. UXcam logo blog .com. March 27, 2024. Accessed September 25, 2024. https://uxcam.com/blog/mobile-app-retention-benchmarks/.