User engagement in relation to effectiveness of a digital lifestyle intervention (the HealthyMoms app) in pregnancy

Abstract

Although user engagement is generally considered important for the effectiveness of digital behavior change interventions, there is a lack of such data in pregnancy. The aim of this study was therefore to examine the associations of user engagement with the HealthyMoms app with gestational weight gain, diet quality and physical activity in pregnancy. The study involved secondary analyses of participant data from the intervention group (n = 134) in a randomized controlled trial to determine the effectiveness of a 6-month mHealth intervention (the HealthyMoms app) on gestational weight gain, diet quality and physical activity. In adjusted regression models, the total number of registrations from three self-monitoring features (i.e., for weight-, diet- and physical activity) was associated with lower gestational weight gain (β = - 0.18, P = 0.043) and improved diet quality (β = 0.17, P = 0.019). These findings were mainly attributable to the associations of physical activity registrations with lower gestational weight gain (β = - 0.20, P = 0.026) and improved diet quality (β = 0.20, P = 0.006). However, the number of app sessions and page views were not associated with any of the outcomes. Our results may motivate efforts to increase user engagement in digital lifestyle interventions in pregnancy. However, additional studies are needed to further elucidate the influence of different types of user engagement in digital pregnancy interventions on their effectiveness.Trial registration: ClinicalTrials.gov (NCT03298555); https://clinicaltrials.gov/ct2/show/NCT03298555 (date of registration: October 2, 2017; date of first enrolled participant: October 24, 2017).

Figure 1

Screenshots of the HealthyMoms app (translated from Swedish to English). Left panel: Homepage of the HealthyMoms app with access to the registrations of the self-monitoring features for weight-, diet- and physical activity; Middle panel: Example of the diet registration feature; Right panel: Example of feedback for physical activity registrations.

Figure 2

Number of registrations and app sessions per theme using box-and-whiskers plots. Registrations refers to the total number of registrations from the self-monitoring features for weight-, diet- and physical activity within the HealthyMoms app whereas an app session represents a single period of user interaction with the app. The box visualizes values for the first quartile, median and third quartile whereas the whiskers represent the first quartile minus 1.5 times the interquartile range and the third quartile plus 1.5 times the interquartile range. Each theme represents a two-week period.