Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores (Preprint)

Abstract

BACKGROUND Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. OBJECTIVE To identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. METHODS A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play, and the subject term pregnancy. The apps meeting the following criteria were chosen: i. pregnancy-related content; ii. free; iii. available in Spanish. They were excluded if: i. the app was classified as game/entertainment, and therefore had no educational or health aim; iii. they did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), the BCTs included using the taxonomy Behavior Change Techniques Taxonomy v.1 and its content. RESULTS A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IR=2,71-3.46) and 1.75 (IR=1.25-2.25) respectively. Regarding content, the median of topics included in the apps was 23 (IR=16050-23.50) being weight gain, nutrition, fetal development and physical activity the most common. The median number of BCTs was 12 (RI=0.50-3.50). Statistically significant correlations were observed between objective quality and content (0.634), subjective quality and content (0.641), objective quality and BCTs (0.672), subjective quality and BCT (0.623), and BCTs and content (0.563). CONCLUSIONS The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best quality score were those where a higher number of topics were addressed and included a larger quantity of BCT. While apps can potentially influence pregnant women’s behavior and contribute to pregnancy, a previous assessment of their content, quality, and behavior strategies is necessary in order to determine which apps could potentially be beneficial, and therefore, can be recommended.