Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review

Aida Jaffar, Chai-Eng Tan, Sherina Mohd-Sidik, Novia Admodisastro, Felicity Goodyear-Smith, Aida Jaffar, Chai-Eng Tan, Sherina Mohd-Sidik, Novia Admodisastro, Felicity Goodyear-Smith

Abstract

Background: Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation-Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps.

Objective: This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model.

Methods: A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias.

Results: Of the 169 records from the initial search, 10 (5.9%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The Tät, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as "competition" in its design. The Diário Saúde app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Diário Saúde, Tät, and Pen Yi Kang demonstrated improved PFMT adherence.

Conclusions: Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes.

Keywords: capability, opportunity, and motivation–behavior model; mHealth app; mobile phone; pelvic floor muscle training; persuasive technology; urinary incontinence.

Conflict of interest statement

Conflicts of Interest: None declared.

©Aida Jaffar, Chai-Eng Tan, Sherina Mohd-Sidik, Novia Admodisastro, Felicity Goodyear-Smith. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 22.03.2022.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

References

    1. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J. 2013 Jun;24(6):901–12. doi: 10.1007/s00192-013-2061-7.
    1. Moossdorff-Steinhauser HF, Berghmans BC, Spaanderman ME, Bols EM. Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis. Int Urogynecol J. 2021 Jul 22;32(7):1633–52. doi: 10.1007/s00192-020-04636-3. 10.1007/s00192-020-04636-3
    1. Arrue Gabilondo M, Ginto L, Zubikarai M, Galán C, Saro J, Diez-Itza I. Risk factors associated with stress urinary incontinence 12 years after first delivery. Int Urogynecol J. 2021 Jan;32(11):3061–3067. doi: 10.1007/s00192-020-04661-2.
    1. Salmon VE, Hay-Smith EJ, Jarvie R, Dean S, Terry R, Frawley H, Oborn E, Bayliss SE, Bick D, Davenport C, MacArthur C, Pearson M. Implementing pelvic floor muscle training in women's childbearing years: a critical interpretive synthesis of individual, professional, and service issues. Neurourol Urodyn. 2020 Feb;39(2):863–70. doi: 10.1002/nau.24256.
    1. Pintos-Díaz MZ, Alonso-Blanco C, Parás-Bravo P, Fernández-de-Las-Peñas C, Paz-Zulueta M, Fradejas-Sastre V, Palacios-Ceña D. Living with urinary incontinence: potential risks of women's health? A qualitative study on the perspectives of female patients seeking care for the first time in a specialized center. Int J Environ Res Public Health. 2019 Oct 08;16(19):3781. doi: 10.3390/ijerph16193781. ijerph16193781
    1. Jaffar A, Mohd-Sidik S, Manaf RA, Foo C, Gan Q, Saad H. Quality of life among pregnant women with urinary incontinence: a cross-sectional study in a Malaysian primary care clinic. PLoS One. 2021;16(4):e0250714. doi: 10.1371/journal.pone.0250714. PONE-D-20-35389
    1. Terry R, Jarvie R, Hay-Smith J, Salmon V, Pearson M, Boddy K, MacArthur C, Dean S. "Are you doing your pelvic floor?" An ethnographic exploration of the interaction between women and midwives about pelvic floor muscle exercises (PFME) during pregnancy. Midwifery. 2020 Apr;83(19):102647. doi: 10.1016/j.midw.2020.102647.S0266-6138(20)30021-8
    1. Woodley SJ, Hay-Smith EJ. Narrative review of pelvic floor muscle training for childbearing women-why, when, what, and how. Int Urogynecol J. 2021 Jul 05;32(7):1977–88. doi: 10.1007/s00192-021-04804-z.10.1007/s00192-021-04804-z
    1. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved Siv, Kernohan A, Hay-Smith EJ. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020 May 06;5:CD007471. doi: 10.1002/14651858.CD007471.pub4.
    1. National Institute for Health and Care Excellence (NICE) Pelvic Floor Dysfunction: Prevention and Non-surgical Management [NG210] London: National Institute for Health and Care Excellence (NICE); 2021.
    1. Lu J, Zhang H, Liu L, Jin W, Gao J, Min M, Fan Y. Meta-analysis of perinatal pelvic floor muscle training on urinary incontinence. West J Nurs Res. 2021 Jun 28;43(6):597–605. doi: 10.1177/0193945920960779.
    1. Jaffar A, Mohd-Sidik S, Nien FC, Fu GQ, Talib NH. Urinary incontinence and its association with pelvic floor muscle exercise among pregnant women attending a primary care clinic in Selangor, Malaysia. PLoS One. 2020 Jul 15;15(7):e0236140. doi: 10.1371/journal.pone.0236140. PONE-D-20-12159
    1. Grant A, Currie S. Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence. BMC Womens Health. 2020 Jan 17;20(1):9. doi: 10.1186/s12905-019-0878-z. 10.1186/s12905-019-0878-z
    1. Perera J, Kirthinanda DS, Wijeratne S, Wickramarachchi TK. Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence. BMC Womens Health. 2014 Jul 02;14:78. doi: 10.1186/1472-6874-14-78. 1472-6874-14-78
    1. van den Muijsenbergh ME, Lagro-Janssen TA. Urinary incontinence in Moroccan and Turkish women: a qualitative study on impact and preferences for treatment. Br J Gen Pract. 2006 Dec;56(533):945–9.
    1. Asklund I, Samuelsson E, Hamberg K, Umefjord G, Sjöström M. User experience of an app-based treatment for stress urinary incontinence: qualitative interview study. J Med Internet Res. 2019 Mar 14;21(3):e11296. doi: 10.2196/11296. v21i3e11296
    1. Barton AJ. The regulation of mobile health applications. BMC Med. 2012 May 08;10(1):46. doi: 10.1186/1741-7015-10-46. 1741-7015-10-46
    1. Pires IM, Marques G, Garcia NM, Flórez-Revuelta F, Ponciano V, Oniani S. A research on the classification and applicability of the mobile health applications. J Pers Med. 2020 Feb 27;10(1):11. doi: 10.3390/jpm10010011. jpm10010011
    1. Harjumaa M, Oinas-Kukkonen H. Persuasion Theories and IT Design. Berlin, Heidelberg: Springer; 2007. pp. 311–4.
    1. Fogg BJ. Persuasive Technology: Using Computers to Change What We ThinkDo. San Francisco, CA: Morgan Kaufmann; 2003.
    1. Oinas-Kukkonen H, Harjumaa M. A Systematic Framework for Designing and Evaluating Persuasive Systems. Berlin, Heidelberg: Springer; 2008. pp. 164–76.
    1. Shao X, Oinas-Kukkonen H. Thinking About Persuasive Technology from the Strategic Business Perspective: A Call for Research on Cost-Based Competitive Advantage. Switzerland: Springer; 2018. pp. 3–15.
    1. Orji R, Moffatt K. Persuasive technology for health and wellness: state-of-the-art and emerging trends. Health Informatics J. 2018 Mar;24(1):66–91. doi: 10.1177/1460458216650979. 1460458216650979
    1. Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009 Jul 16;4(1):40. doi: 10.1186/1748-5908-4-40. 1748-5908-4-40
    1. Li T, Chen X, Wang J, Chen L, Cai W. Mobile app-based intervention for pregnant women with stress urinary incontinence: protocol for a hybrid effectiveness-implementation trial. JMIR Res Protoc. 2021 Mar 10;10(3):e22771. doi: 10.2196/22771. v10i3e22771
    1. Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med. 2002 Jul;35(1):25–41. doi: 10.1006/pmed.2002.1028.S0091743502910285
    1. Richardson M, Khouja CL, Sutcliffe K, Thomas J. Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews. BMJ Open. 2019 Jun 22;9(6):e024950. doi: 10.1136/bmjopen-2018-024950. bmjopen-2018-024950
    1. McClurg D, Frawley H, Hay-Smith J, Dean S, Chen S, Chiarelli P, Mair F, Dumoulin C. Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS state-of-the-science seminar research paper i of iv. Neurourol Urodyn. 2015 Sep 21;34(7):606–14. doi: 10.1002/nau.22769.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011 Apr 23;6:42. doi: 10.1186/1748-5908-6-42. 1748-5908-6-42
    1. Danaher BG, Brendryen H, Seeley JR, Tyler MS, Woolley T. From black box to toolbox: outlining device functionality, engagement activities, and the pervasive information architecture of mHealth interventions. Internet Interv. 2015 Mar 01;2(1):91–101. doi: 10.1016/j.invent.2015.01.002. S2214-7829(15)00003-2
    1. Chapman D. Health-related databases. J Can Acad Child Adolesc Psychiatry. 2009 May;18(2):148–9.
    1. Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, New Jersey, United States: John Wiley & Sons; 2019.
    1. Kim SY, Park JE, Lee YJ, Seo H, Sheen S, Hahn S, Jang B, Son H. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol. 2013 Apr;66(4):408–14. doi: 10.1016/j.jclinepi.2012.09.016.S0895-4356(12)00322-8
    1. Araujo CC, Marques AD, Juliato CR. The adherence of home pelvic floor muscles training using a mobile device application for women with urinary incontinence: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2020 Nov 8;26(11):697–703. doi: 10.1097/SPV.0000000000000670.01436319-202011000-00009
    1. Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017 Jun 08;36(5):1369–76. doi: 10.1002/nau.23116. v19i5e154
    1. Dufour S, Fedorkow D, Kun J, Deng SX, Fang Q. Exploring the impact of a mobile health solution for postpartum pelvic floor muscle training: pilot randomized controlled feasibility study. JMIR Mhealth Uhealth. 2019 Jul 11;7(7):e12587. doi: 10.2196/12587. v7i7e12587
    1. Goode PS, Markland AD, Echt KV, Slay L, Barnacastle S, Hale G, Wright MK, Lane TR, Burgio KL. A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: Development and pilot evaluation of MyHealtheBladder. Neurourol Urodyn. 2020 Jan 27;39(1):432–9. doi: 10.1002/nau.24226.
    1. Han MN, Grisales T, Sridhar A. Evaluation of a mobile application for pelvic floor exercises. Telemed J E Health. 2019 Feb;25(2):160–4. doi: 10.1089/tmj.2017.0316.
    1. Hoffman V, Söderström L, Samuelsson E. Self-management of stress urinary incontinence via a mobile app: two-year follow-up of a randomized controlled trial. Acta Obstet Gynecol Scand. 2017 Oct;96(10):1180–7. doi: 10.1111/aogs.13192. doi: 10.1111/aogs.13192.
    1. Li J, Sun X, Wang C, Zhang Z, Xie Z. A mobile application penyikang applied in postpartum pelvic floor dysfunction: a cross-sectional study to analyze the factors influencing postpartum pelvic floor muscle strength and women's participation in treatment. Biomed Res Int. 2020;2020:4218371. doi: 10.1155/2020/4218371. doi: 10.1155/2020/4218371.
    1. Robson M. The Squeezy pelvic floor muscle exercise app: user satisfaction survey. J Pelvic Obstet Gynaecol Physiother. 2017;121:64–8.
    1. Sjöström M, Lindholm L, Samuelsson E. Mobile app for treatment of stress urinary incontinence: a cost-effectiveness analysis. J Med Internet Res. 2017 May 08;19(5):e154. doi: 10.2196/jmir.7383. v19i5e154
    1. Wang X, Xu X, Luo J, Chen Z, Feng S. Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: a randomized controlled trial. Int J Nurs Stud. 2020 Apr;104:103527. doi: 10.1016/j.ijnurstu.2020.103527.S0020-7489(20)30012-2
    1. Bunzli S, Gillham D, Esterman A. Physiotherapy-provided operant conditioning in the management of low back pain disability: a systematic review. Physiother Res Int. 2011 Mar;16(1):4–19. doi: 10.1002/pri.465.
    1. Hawkins RP, Kreuter M, Resnicow K, Fishbein M, Dijkstra A. Understanding tailoring in communicating about health. Health Educ Res. 2008 Jun;23(3):454–66. doi: 10.1093/her/cyn004. cyn004
    1. Wadensten T, Nyström E, Franzén K, Lindam A, Wasteson E, Samuelsson E. A mobile app for self-management of urgency and mixed urinary incontinence in women: randomized controlled trial. J Med Internet Res. 2021 Apr 05;23(4):e19439. doi: 10.2196/19439. v23i4e19439
    1. Rygh P, Asklund I, Samuelsson E. Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study. BMJ Open. 2021 Jan 04;11(1):e040819. doi: 10.1136/bmjopen-2020-040819. bmjopen-2020-040819
    1. Jaffar A, Mohd Sidik S, Foo CN, Muhammad NA, Abdul Manaf R, Fadhilah Ismail SI, Suhaili N. Protocol of a single-blind two-arm (Waitlist Control) parallel-group randomised controlled pilot feasibility study for mHealth app among incontinent pregnant women. Int J Environ Res Public Health. 2021 Apr 30;18(9):4792. doi: 10.3390/ijerph18094792. ijerph18094792

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi