Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis.

BACKGROUND: Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. OBJECTIVE: This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. METHODS: Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. RESULTS: Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. CONCLUSIONS: Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). TRIAL REGISTRATION: PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13643-019-0996-6.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective.

BACKGROUND: Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives' attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice. METHODS: This is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. RESULTS: Ten midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care. CONCLUSIONS: Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Protecting mental health in quarantine: Exploring lived experiences of healthcare in mandatory COVID-19 quarantine, New South Wales, Australia.

Objectives: In response to the COVID-19 pandemic, Australia implemented mandatory hotel quarantine for returned international travellers from March 2020-November 2021. Healthcare was rapidly transformed and scaled up to facilitate delivery of face-to-face and virtual healthcare within quarantine facilities. We sought to understand, from the patient perspective, what a virtual model of healthcare may need to be aware of to respond to, protect, and mitigate people's mental health within a 'public health protection' context of quarantine. Design: Qualitative study design using in-depth semi-structured interviews exploring experiences of the virtual model of healthcare in quarantine. Setting: Special Health Accommodation (SHA) quarantine facilities following Australian Federal and New South Wales (NSW) State quarantine policy, NSW, Australia. Participants: 25 returned international travellers aged 18 years or older of any COVID-19 status who quarantined within SHA between October 2020-March 2021. Results: Participants identified three broad areas of concern. Firstly, their potential to transmit COVID-19, that created anxiety for all participants. Secondly, the effects of losing personal freedoms in quarantine to protect the wider Australian community. Thirdly, many participants entered quarantine during intense biographical moments in their lives, compounding the stress of their experience. Participants felt lost within the 'faceless' quarantine administrative system they navigated prior to their actual arrival in Australia and during their mandated quarantine period. This cumulative experience compromised their expectations and experiences of person-centred care once in quarantine. Conclusions: Quarantine has been a critical public health measure for managing COVID-19 in Australia. The pandemic provides opportunities to learn from quarantine implementation. Participants struggled to separate healthcare provision from the broader quarantine systems and processes. Due to this confusion, blame was directed at healthcare providers for many, and in some cases all difficulties, including those encountered getting into and once within quarantine. Valuable lessons can be learnt from engaging with patients' perspectives to adapt and strengthen future quarantine to deliver responsive, person-centred healthcare.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective

Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies, who require improved access to such services. This tool has recently been implemented into routine antenatal care in two Sydney Maternity centres. To explore midwives' attitudes to the LMUP and their understanding of its application to their scope of practice following 12 months after it was introduced into the booking visit. A qualitative study using in-depth semi structured interviews with midwives from the two maternity care centres in Sydney, New South Wales, Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. Ten midwives from the two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and lack of structured referral pathways were identified barriers to the implementation of the LMUP in routine care. Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.