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Citation

Hayman M, Alfrey K, Cannon S, Alley S, Rebar AL, Williams S, Short CE, Altazan A, Comardelle N, Currie S, Denton C, Harrison CL, Lamerton T, Mena GP & Moran L (2021) Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis. JMIR mHealth and uHealth, 9 (4), Art. No.: e23649. https://doi.org/10.2196/23649

Abstract
Background: Physical activity during pregnancy is associated with a variety of health benefits for the mother and her child. Despite the many health benefits of physical activity during pregnancy, few women participate in regular physical activity during pregnancy. ehealth platforms, such as the internet and mobile applications (apps), are now altering how women access information about their pregnancy and have become an important information source for pregnant women. Whilst the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilisation of behaviour change techniques. This is despite research suggesting the inclusion of behaviour change techniques in ehealth interventions can play an important role in improving, supporting and maintain healthy behaviours, including physical activity. Objective: To review physical activity apps designed for pregnant women with a focus on app content, quality and features, and the presence and efficacy of Behaviour Change Techniques (BCTs). Methods: A systematic search in the Australian AppStore and GooglePlay stores using search terms relating to exercise and pregnancy. App features and quality was assessed using the 19-item Mobile Application Rating Scale (MARS) and a taxonomy of BCTs was used to determine presence of BCTs (26 items). BCTs previously demonstrating efficacy in behaviour change during pregnancy were also identified from a review of the literature. Results: Nineteen exercise apps were deemed eligible for this review and accessed via GooglePlay (n=13) or AppStore (n=6). MARS Overall Quality scores showed moderate app quality (m=3.5, SD=0.52). Functionality was the highest scoring MARS domain (m=4.2, SD=0.5), followed by Aesthetics (m=3.7, SD=0.6) and Information Quality (m=3.16, SD=0.42). Engagement (m=3.01, SD=0.9), Subjective App Quality (m=2.54, SD=0.64) and Likelihood for Behavioural Impact (m=2.5, SD=0.6) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (m=4.74, SD=2.51, range=2–10), with provide instructions (95%) and provide information on consequences (89%) being the most common BCTs. Eleven apps included BCTs that previously demonstrated efficacy for behaviour change during pregnancy, the most common of these being provide opportunities for social comparison (n=8) and prompt self-monitoring of behaviour (n=7). Conclusions: Apps to improve exercise in pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with the prevalence of BCTs previously demonstrating efficacy in promoting and/or supporting physical activity during pregnancy scarce. Thus, it is unlikely that apps reviewed in this study will effectively promote and/or support the exercise behaviours among pregnant women. Clinical Trial: Not required.

Keywords
pregnancy; exercise; physical activity; mobile health (mHealth); applications; MARS; behavior change techniques; mobile phone

Notes
Additional co-authors: Michelle Mottola; Taniya S Nagpal; Lisa Vincze; Stephanie Schoeppe

Journal
JMIR mHealth and uHealth: Volume 9, Issue 4

• Published version