Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users' perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P = .04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care.
Bibliographical noteFunding Information:
The authors thank all the women and their families who, the authors hope, would have benefited positively and holistically by their active participation in this study. The authors are also thankful to all the staff of the antenatal clinics, labor ward, and postnatal wards, as well as the medical records office, who were very helpful in implementing all aspects of this study, and Ms ShreeAnn Simon, the ZIKApp study administrator. Similarly, the authors want to acknowledge and express gratitude to Francesca Viero, Giorgia Dalla Valle, Rachel Knowles, Peter Tanghe, Andrea Oletto, Thomas Byrne, Jacqueline McLean, and Trudy-Ann Blair-Wallace. This work was supported by the European Union's Horizon 2020 research and innovation program (734857; ZIKAction).
© Elisa Ruiz-Burga, Patricia Bruijning-Verhagen, Paulette Palmer, Annalisa Sandcroft, Georgina Fernandes, Marieke de Hoog, Lenroy Bryan, Russell Pierre, Heather Bailey, Carlo Giaquinto, Claire Thorne, Celia D C Christie, ZIKAction Consortium.
- digital health
- low- and middle-income countries
- maternal health
- mobile phone
- pregnancy complications
- pregnancy outcomes
- prenatal care