The Effect of a Mobile App (eMOM) on Self-Discovery and Psychological Factors in Persons With Gestational Diabetes: Mixed Methods Study.

Background: Gestational diabetes is a type of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life. The rising prevalence of gestational diabetes mellitus (GDM) highlights the need for more comprehensive treatment strategies, with a particular emphasis on supporting maternal self-management. We showed recently that a mobile app, eMOM, where glucose, nutrition, and physical activity are combined within a single app, significantly improves multiple clinical outcomes among persons with gestational diabetes.

Objective: This study aims to explore the effects of the eMOM on maternal self-discovery and learning, autonomous motivation to manage GDM, and psychological well-being. Additionally, we examine the correlation between improved maternal clinical outcomes and change in autonomous motivation. We also assess the acceptance and usability of the eMOM app.

Methods: Building upon the original randomized controlled trial (RCT), in which the intervention arm used a mobile app (eMOM), we conducted a mixed methods study that included an investigation of eMOM log files, semistructured interviews on self-discovery, and an examination of questionnaires assessing motivation (Treatment Self-Regulation Questionnaire and Perceived Competence Scale), depression (Edinburgh Postnatal Depression Scale), technology use and acceptance (Unified Theory of Acceptance of Use of Technology questionnaire), and usability (modified Software Usability Measurement Inventory). Additionally, we monitored participants' stress levels using wearable electrocardiographic devices (FirstBeat Bodyguard 2). A total of 148 individuals participated in the original RCTs, with 76 in the intervention arm and 72 in the control arm. From the intervention arm, 18 participants were randomly selected for interviews in this study.

Results: Results show that the use rate of eMOM was high, and novel visualization supported self-discovery in persons with GDM. Most participants (17/18, 94%) indicated that the eMOM app helped to find the associations between their daily activities and glucose levels. Especially having nutrition visualized together with glucose was highly appreciated. Participants also reported learning about the associations between physical activity and glucose levels. No differences were observed between the intervention and control arms in autonomous motivation, depression, or stress. Furthermore, there were no correlations between improved clinical outcomes and changes in motivation. Accessibility and usability ratings were consistently high throughout the intervention.

Conclusions: The eMOM mobile app combining data from continuous glucose monitor, food diary, and physical activity tracker supports maternal self-discovery related to GDM without contributing to depression or adding extra stress. This encourages the use of such mobile apps in maternity care. Notably, motivational factors did not correlate with the positive outcomes observed in our prior RCT, suggesting that self-discovery has a greater impact on clinical results.

Trial registration: ClinicalTrials.gov NCT04714762; https://www.clinicaltrials.gov/study/NCT04714762.