Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis

Abstract

Background Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions This review identified several useful, evidence-based apps that support the prevention o...

A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP)

“…In July 2015, we developed a set of 52 search terms informed by 3 previous systematic reviews on adolescent sexual health by combining 4 age-targeted terms, “adolescent,” “teen,” “young adult,” and “youth,” with 13 pregnancy prevention terms: “pregnancy prevention,” “sex education,” “sexual negotiation,” “family planning,” “sexual health,” “reproductive health,” “abstinence,” “sexual communication,” “sexual decision making,” “sexuality,” “condom,” “contraception,” and “birth control” [12,16,17]. Each of these 52 terms was searched separately by both authors in the Apple App Store and the Android Google Play store, and the number of results per search term was documented.…”

“…Apps that were primarily fertility trackers, birth control reminders, or locators were excluded because they were evaluated thoroughly in a recent systematic review and have too narrow of a purpose to benefit from an evaluation that takes a holistic approach [12]. Apps that were available in both the Apple App Store and the Google Play store were removed from the Google Play group and only analyzed as Apple App Store apps to avoid duplication.…”

“…For our final research question about general SRH features and content, we organized the data into 2 subsections: one that included 7 SRH features relevant for all ages (Textbox 6) and one that focused on the provision of contraceptive information (Textbox 7). Both subsections were adapted from the SRH evaluation criteria developed in the earlier review [12]. …”

“…A recent review on apps for the prevention of unintended pregnancy in the general population found 218 apps that claimed to help prevent unintended pregnancy [12]. However, only 16 of these apps specifically targeted young adults, and the criteria used to evaluate these apps were developed for a broader population, without special consideration for adolescents [13].…”

“…While adoption of mERA will lead to greater transparency and consistency in reporting across the broader field of mHealth, there is a need to develop nuanced and evidence-based checklists for specific mHealth approaches, such as adolescent pregnancy prevention and the promotion of sexual and reproductive health through mobile channels. Recognizing this gap, we build on the methodology and findings of a previous review of mobile apps for pregnancy prevention and identify evidence-based best practices for adolescent and young adult pregnancy prevention from the literature to develop and implement a preliminary framework for mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) [12]. …”