Using Intervention Mapping to Codevelop Orchid, a Digital Tool for Reproductive Life Planning: Development and Feasibility Study.

Abstract

Background: Most people make no health or lifestyle changes before pregnancy, missing a key opportunity to improve outcomes. Consequently, nearly half of UK pregnancies are unplanned, disproportionately affecting underserved groups and widening health inequalities. Digital health interventions (DHIs) offer promise but require systematic, theory-driven development to ensure effectiveness and real-world applicability.

Objective: This study aimed to use Intervention Mapping to codevelop and pilot Orchid, a novel DHI designed to support people of reproductive age to understand their pregnancy preferences and develop a reproductive life plan (RLP).

Methods: We used Intervention Mapping steps 1-4 to guide the systematic, theory-informed codevelopment of Orchid. A multidisciplinary planning group and codevelopment group of 21 members of the public contributed throughout. At step 1, previous research and a scoping review of existing RLPs informed the program goals and logic model of the problem. During step 2, we identified performance objectives and behavioral determinants to specify practical strategies for each target behavior. At step 3, we applied the Capability, Opportunity, Motivation-Behavior (COM-B) model and relevant behavior change techniques to guide intervention design. Finally, at step 4, Orchid was co-designed as a website and mobile app providing users with a pregnancy preference group and prediction of pregnancy, a dynamic RLP, tailored evidence-based information, and optional goal-setting features to support behavior change. Orchid was piloted between January and May 2025 to explore its feasibility and acceptability in health care settings. Interviews with users, nonusers, and health care professionals were conducted and quantitative data from users were collected.

Results: These findings indicate that implementation was feasible, and health care professionals found it acceptable to recommend Orchid to patients, though noted barriers including time constraints and competing priorities. Overall, 153 people signed up to Orchid; 68% (72/106) of eligible users received a pregnancy preference group and 27% (32/119) of eligible users completed a full RLP. Users were positive about Orchid, appreciating its content and design, noting that Orchid contained a wealth of information about reproductive health presented in an easy-to-understand manner. They valued the autonomy, convenience, and privacy afforded by the digital format, and found it acceptable to be recommended Orchid within a health care setting. Orchid uptake was lower than anticipated, and use was limited; this was partly expected given the short pilot period, but feedback also suggested targeted recruitment and navigation improvements could enhance uptake and engagement.

Conclusions: Orchid is the first co-designed DHI to support reproductive health across the life course. Its systematic development, theoretical foundation, strong user involvement, and positive pilot testing position it as a promising, scalable innovation to support reproductive health, deliver credible information in accessible formats, and promote preventative, community-based care across the National Health Service.