Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial.

BACKGROUND: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. OBJECTIVE: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. METHODS: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). RESULTS: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01). CONCLUSIONS: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. TRIAL REGISTRATION: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.

Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey.

BACKGROUND: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle- and pregnancy-tracking mobile apps are promising tools for improving women's awareness of and attitudes toward their reproductive health; however, there is little information about subscribers' perceptions of app functionality and its impact on their knowledge and health. OBJECTIVE: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. METHODS: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. RESULTS: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98%) and pregnancy (698/824, 84.7%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant (χ21=4.2, P=.04; χ21=52.3, P<.001, respectively) and pregnancy tracking (χ21=19.3, P<.001; χ21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy (χ21=4.2; P=.04) and to learn more about their body (χ21=10.8; P=.001) and sexual health (χ21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health (χ21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. CONCLUSIONS: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale.

Menstrual cycle-associated symptoms and workplace productivity in US employees: A cross-sectional survey of users of the Flo mobile phone app.

Objective: Mood and physical symptoms related to the menstrual cycle affect women's productivity at work, often leading to absenteeism. However, employer-led initiatives to tackle these issues are lacking. Digital health interventions focused on women's health (such as the Flo app) could help fill this gap. Methods: 1867 users of the Flo app participated in a survey exploring the impact of their menstrual cycle on their workplace productivity and the role of Flo in mitigating some of the identified issues. Results: The majority reported a moderate to severe impact of their cycle on workplace productivity, with 45.2% reporting absenteeism (5.8 days on average in the previous 12 months). 48.4% reported not receiving any support from their manager and 94.6% said they were not provided with any specific benefit for issues related to their menstrual cycle, with 75.6% declaring wanting them. Users stated that the Flo app helped them with the management of menstrual cycle symptoms (68.7%), preparedness and bodily awareness (88.7%), openness with others (52.5%), and feeling supported (77.6%). Users who reported the most positive impact of the Flo app were 18-25% less likely to report an impact of their menstrual cycle on their productivity and 12-18% less likely to take days off work for issues related to their cycle. Conclusions: Apps such as Flo could equip individuals with tools to better cope with issues related to their menstrual cycle and facilitate discussions around menstrual health in the workplace.

A global and local perspective of interruption frequency in a visual search task.

We investigated the impact of frequency of interruptions in a simulated medical visual search task. Participants (N = 150) performed the visual search task during which they were interrupted by a number-classification task in 25, 50, or 75% of all trials, respectively, reflecting the frequency conditions (i.e., low, mid, high). Target presence (i.e., present vs. absent) and interruption (i.e., uninterrupted vs. interrupted) were varied within-subjects, and interruption frequency was varied between-subjects. Globally, on a frequency condition level, participants in the low frequency condition had longer mean response times (RT) for the primary visual search task than in the high condition, but there were no other performance differences between the three frequency conditions. Locally, on the level of specific interruption effects, accuracy decreased directly after interruptions for target present but not for target absent trials. Furthermore, interruptions caused significant interruption costs, reflected in slower overall RTs in interrupted than in uninterrupted trials. The combined findings show that especially for critical visual search tasks as in the medical field, interruptions-regardless of frequency-should be avoided.

Effects of complexity and similarity of an interruption task on resilience toward interruptions in a procedural task with sequential constraints.

The goal of the present study was to examine effects of complexity and similarity of an interruption task on postinterruption performance in an 8-step procedural task with sequential constraints. In Experiment 1, the primary task was interrupted between different steps with 1 of 4 versions of n-back task, which differed in complexity (simple, complex) and similarity in processing codes (verbal, spatial) to the primary task. After the interruption, participants (N = 44) had to resume the primary task as quickly as possible with the next correct step, that is, the 1 following the step after which the interruption occurred. Postinterruption performance in terms of resumption times, sequence errors and nonsequence errors was assessed. Results of Experiment 1 revealed longer resumption times and more sequence errors after complex interruptions compared to the simple ones. However, effects of processing-code similarity were less clear. For assessing the effects of similarity in processing codes again in Experiment 2, participants (N = 41) performed the same primary task and were interrupted with a verbal or a spatial classification task. The results revealed no significant effect of processing code on the postinterruption performance. Moreover, a posthoc analysis revealed that 1-back (sequential) interruption led to longer resumption times compared to the classification (nonsequential) interruption. Overall, our results revealed strong and consistent detrimental effects of interruption complexity on the postinterruption performance and no effect of similarity in processing codes. Finally, we provide preliminary evidence that similarity in sequential structure between the tasks can influence the resilience toward interruptions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of a Mnemonic Acronym on Learning and Performing a Procedural Task and Its Resilience Toward Interruptions.

The present study examines the potential impact of a mnemonic acronym on the learning, the execution, the resilience toward interruptions, and the mental representation of an eight-step procedural task with sequential constraints. 65 participants were required to learn a sequential task, including eight different steps which had to be carried out in a predefined sequence. 33 participants were provided with the acronym "WORTKLAU" as a mnemonic to support the learning and execution of the task and the other 32 participants had to learn and execute the task without such support. Each letter of the acronym coded one step of the task, involving a binary decision about a certain property of the complex stimulus. In 60 out of 72 trials of the task, participants were interrupted between different steps, and had to perform a 2-back interruption task for 6 or 30 s, after which they had to resume the procedural task as quickly as possible at the correct step. Learning times, performance in uninterrupted trials, and post-interruption performance measures were analyzed. Results of Experiment 1 suggest that the mnemonic acronym enhanced learning of the task sequence, and provide some evidence for a hierarchical mental representation of the task, resulting in faster resumption times at certain steps of the procedure after an interruption. In Experiment 2 the internal structure of the acronym was even emphasized by a hyphen at the borders of the two words included in the acronym (WORT-KLAU). This improved the resilience toward interruptions at the border step of the procedure significantly. Our results provide evidence for beneficial effects of mnemonic acronym particularly for the learning of a sequential procedural task. In addition, they suggest that the structure of mnemonic acronym directly impacts the mental representation of a task. Finally, they show that mnemonic acronyms could be used to improve the resilience toward detrimental effect of interruptions, at least at certain task steps of a procedural task.