A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

Abstract

Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.

Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.

Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data.

Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery.

Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

Keywords: ecological momentary assessment; heart rate; mHealth; physical activity; pregnancy; sleep; wearable electronic device.

Figure 1

Components of the Two Happy Hearts intervention prototype.

Figure 2

Average resting heart rate. HR: heart rate.

Figure 3

Average resting heart rate variability. RMSSD: root mean square of successive differences.

Figure 4

Self-reported positive emotions. EMA: ecological momentary assessment.

Figure 5

Self-reported negative emotions. EMA: ecological momentary assessment.

Figure 6

Self-reported quality of sleep.

Figure 7

Sleep score as measured by the Oura ring.

Figure 8

Stage of sleep (deep sleep).

Figure 9

Stage of sleep (light sleep).

Figure 10

Stage of sleep (rapid eye movement, or REM sleep).

Figure 11

Self-reported level of physical activity.

Figure 12

Step recordings as measured by the Oura ring.