Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study

Abstract

Background: Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study.

Objective: The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy.

Methods: A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective.

Results: A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated "above average" in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes.

Conclusions: Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects.

Keywords: PHR; app; application; applications; apps; attitude; attitudes; data sharing; develop; development; digital; electronic; electronic maternity record; experience; experiences; feature; features; health record; health records; information behavior; information behaviour; information seeking; log; logbook; mHealth; maternal; maternity; maternity log; maternity logbook; maternity record; mobile health; online search; opinion; opinions; paper hand-held record; perception; perceptions; personal health record; perspective; perspectives; pregnancy; pregnancy app; pregnancy record; pregnant; privacy; searching; smartphone; smartphones; usability; wearable; wearables.

Figure 1.. Example screenshots of the developed app. (A) “Start,” (B) “My tasks,” (C) “Mapi questionnaire,” (D) “Installation guide,” (E) “My measurements,” (F) “Main menu,” (G) “Ultrasound section,” and (H) “Information” sections. The app is intended for a German audience and was thus developed in German. A retrospectively translated English version of these screenshots is provided in Multimedia Appendix 1.

Figure 2.. Task completion times for each task. See Table 1 for details on the individual tasks. GOMS (goal, operators, methods, and selection rules) modeling using Cogulator was performed to estimate reference times. No times were measured for explorative tasks (tasks 3, 5, 7, 9).

Figure 3.. User Experience Questionnaire (UEQ) results. The app was rated as “above average” in most areas. The UEQ scales range from −3 to +3. The graphic was derived from the official UEQ evaluation benchmark tool, which crops ranges to improve readability.