Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study

Aida Jaffar, Sherina Mohd-Sidik, Chai Nien Foo, Novia Admodisastro, Sobihatun Nur Abdul Salam, Noor Diana Ismail, Aida Jaffar, Sherina Mohd-Sidik, Chai Nien Foo, Novia Admodisastro, Sobihatun Nur Abdul Salam, Noor Diana Ismail

Abstract

Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy.

Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women.

Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app.

Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use.

Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.

Keywords: Acceptability; Digital intervention; Pelvic Floor Muscle Training; Pregnancy; Urinary incontinence; Usability; User-centered design; mHealth Development and Evaluation Framework; mHealth app.

Conflict of interest statement

Conflicts of Interest: None declared.

©Aida Jaffar, Sherina Mohd-Sidik, Chai Nien Foo, Novia Admodisastro, Sobihatun Nur Abdul Salam, Noor Diana Ismail. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 03.02.2022.

Figures

Figure 1
Figure 1
Intervention mapping framework of the KEPT app development. APEASE: affordability, practicability, effectiveness and cost-effectiveness, acceptability, side-effects and safety, equity; KEPT: Kegel Exercise Pregnancy Training; RE-AIM: reach, effectiveness, adoption, implementation, maintenance; UI: urinary incontinence.
Figure 2
Figure 2
KEPT app development and evaluation framework. KEPT: Kegel Exercise Pregnancy Training.
Figure 3
Figure 3
Low-fidelity design of the KEPT app (six user interfaces). KEPT: Kegel Exercise Pregnancy Training.
Figure 4
Figure 4
Low-fidelity design of the KEPT app (four user interfaces). KEPT: Kegel Exercise Pregnancy Training.
Figure 5
Figure 5
High-fidelity prototype design. KEPT: Kegel Exercise Pregnancy Training.
Figure 6
Figure 6
Prototype KEPT app version 1.0. KEPT: Kegel Exercise Pregnancy Training.

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