Table 3 Characteristics of papers and mobile applications reported in included papers

Watson et al. (2017) [16]

Study assessing the reliability of risk prediction scores incorporating in the app. Comparison of the QUIPP predicted risk within 7 days to the actual delivery rates. Also investigated the impact of using the QUIPP app relative to a treat-all strategy at 24–29 + 6 weeks (as per NICE Preterm Labour guideline 2015).

UK. 355 women with threatened preterm labour between 2010 and 2015.

Preterm birth

Yes

No

No

No

Risk of preterm delivery in symptomatic women calculated using risk factors and test results.

Dunsmuir et al. (2014) [17]

Describes development of app and results of usability study. This paper describes the development process, including challenges and solutions, of the PIERS on the Move (POTM) is a low cost, easy-to-use, mobile health (mHealth) application for accurately predicting the risk of adverse outcomes associated with pre-eclampsia in pregnant women.

Cape Town, South Africa. 202 women had been assessed with the POTM application. A total of 37 nurses and midwives evaluated the user interface through three usability studies. November 2011 to January 2013.

Pre-eclampsia

Yes

Yes

No

No

App calculated a risk score using clinical findings (including measurements by pulse oximeter connected to a smartphone). Based on the risk score, the application provided recommendations on treatment, referral, and reassessment.

Jeon et al. (2016) [18]

Describes development of app and results of evaluation study. Paper reports the development and evaluation of four mobile applications that provide tailored nursing recommendations for metabolic syndrome management in pregnancy. Evaluation included the algorithm proficiency and efficiency, user interface, usability, and effectiveness. Usability evaluated using different tools for each condition.

Setting and time period not explicit (corresponding author based in Korea). Paper reports “evaluations by experts and users.” But does not specify any detail or numbers involved.

Metabolic syndrome in pregnancy, including, obesity, diabetes, hypertension, and hyperlipidaemia.

Yes

No

No

No

Authors report: “Mobile applications provide tailored nursing recommendations for metabolic syndrome management, e.g. “when a patient intakes more calories than needed, the alert function can alert the patient by sending a message based on the daily calorie intake that the diary function has helped the patient to track. p. 512” No further detail or examples reported.

Jonas et al. (2016) [19]

Describes development of app and results of evaluation study. Paper describes the development and evaluation of a smartphone-based imaging and automated analytical tool which incorporates the Congo Red Dot (CRD) test. This test assesses the presence of misfolded proteins in urine, and shows promise as a diagnostic and prognostic tool for preeclampsia. Stage 1: evaluation of a preliminary version of image processing software tool using stored images. Stage 2: testing improvements in real-time on newly prepared standardized CRD arrays and analysed the results for agreement. Stage 3: Analysis of test results across four operators, including untrained personnel (n = 1) who did not receive any instruction or prior knowledge of the system.

Setting and time period not explicit. Corresponding author based in Germany. No patient participants.

Pre-eclampsia

Yes

No

No

Yes

Smartphone application guides the user through seven easy steps that can be used by non-specialized personnel, through test image acquisition to interpretation of result.

Lim et al. (2015) [20]

Describes development of app and results of 2 usability and feasibility studies. Paper reports findings of study assessing the usability and feasibility of PIERS on the Move, an App for pre-eclampsia triage, with mid-level health workers, for iteratively refining the system. Two usability studies were performed with the potential end-users. Each step in the development process used the findings of the previous, thus improving on the design and features available in the app.

Usability study 1: evaluation by advanced midwifery students at Tygerberg Hospital (Cape Town, South Africa), (n = 15). Usability study 2: evaluation of the next iteration by maternal nursing staff at Frere Maternity Hospital (East London, South Africa), (n = 22).

November 2012 to December 2013.

Pre-eclampsia

Yes

Yes

No

Yes

“Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. The app combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter.”

Mackillop et al. (2014) [21]

Describes development of app and results of evaluation study. Paper describes development of a prototype software application for the management of women with or at high risk of Gestational Diabetes. A custom website was built for clinician review of the data transmitted by the smartphone. After system refinement, further evaluation was undertaken for usability and reliability in a 48-patient service development project.

UK. Seven women participated in the first testing phase and 50 of the 104 women approached volunteered to test the system in the service development phase.

Gestational Diabetes

Yes

Yes

Yes

Yes

Authors state that the: “Functional objectives included the ability to: 1. Allow women to accurately and easily record blood glucose measurements, which are then automatically uploaded to a website. 2. Allow health care professionals to access these measurements remotely and respond quickly to them, thus potentially improving glycaemic control without the need for more intensive face-to-face contact. 3. Allow 2-way communication between women and health care professionals. 4. Promote user participation (empowerment) of pregnant women in their medical management.”

Marko et al. (2016) [22]

Prospective observational study assessing feasibility, efficacy and satisfaction. Paper reports findings of a prospective observational pilot study to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction. Patient satisfaction was measured using a 12-question survey that was completed by participants after 20 weeks of platform usage.

Department of Obstetrics & Gynecology at the George Washington University Hospital, USA. n = 8 women with low risk pregnancy in the first trimester. July 2014 to January 2015.

Weight and blood pressure monitoring in pregnancy

Yes

Yes

Yes

Yes

Mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider.

Peleg et al. (2017) [23]

Mixed methods study of compliance, satisfaction and quality of life.

The MobiGuide project aimed to establish a user-friendly, patient-centred mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records.

The objective of this paper was to evaluate whether the initial deployment of the MobiGuide system, for two different clinical domains - atrial fibrillation (AF) and gestational diabetes (GDM) - had achieved three main outcomes: (a) high patients’ and care providers’ compliance to clinical-guideline based monitoring reminders and recommendations, (b) high patients and care providers’ satisfaction, and (c) increased patients’ quality of life.

Italy and Spain. The study involved ten AF patients from IRCCS Foundation “Salvatore Maugeri”, Pavia, Italy and twenty GDM patients from Parc Tauli Sabadell University Hospital, Sabadell, Spain. As a control group for GDM, researchers referred to data from a historical group of 247 patients, similar in characteristics, who had been followed up during 2010–2013 at the same GDM clinic. April to December 2015.

Gestational diabetes

Yes

Yes

Yes

Yes

Authors report: “MobiGuide is a remote chronic-patient management system that has five main objectives: (1) Increasing patient safety and quality of care through provision of personalized ubiquitous decision-support to the patients. (2) Semantic data integration into a personal health records. (3) Creation of a generic architecture that supports interoperation with a variety of portable sensors, and different hospital electronic health records. (4) Distribution of the decision support system (DSS), between a mobile DSS that runs on the patient’s smart phone and a backend DSS that is accessible via the Internet by the patients’ care providers. (5) Performance of intelligent data analysis, to discover clinical data patterns in individual patients, thus providing additional decision-support.” In the GDM domain, blood glucose monitor and sphygmo-manometer were connected to the patient’s smart phone by Bluetooth.

Stroux et al. (2016) [24]

Mixed methods study of feasibility and acceptability. Paper describes findings of a mixed methods feasibility study to evaluate a smart phone based system designed to identify fetal compromise. The feasibility assessment was designed to evaluate whether frontline healthcare workers could operate the study equipment (1D foetal Doppler, pulse oximeter and recording application) and record signals successfully using a smart phone. The study also set out to assess user need and to assess the acceptability by both healthcare provider and patient.

Guatemala. n = 22 pregnant women.

Written feedback was provided by 6 members of staff.

Fetal compromise

Yes

Yes

Yes

Yes

A smartphone-based system including peripheral sensors, pulse oximeter and handheld Doppler for the identification of foetal compromise. Designed for use by illiterate birth attendants, the system uses pictograms, audio guidance, local and cloud processing, SMS alerts and voice calling.

Tsai et al. (2014) [25]

Paper describes findings of a feasibility study aimed at determining the extent to which community health workers could be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant women were recruited independently in two cross-sectional studies and assessed for antenatal depression.

Khayelitsha, South Africa. May 2009 to September 2010 (n = 1144) and May 2010 to February 2011. (n = 361).

Antenatal depression

Yes

Yes

No

No

In both studies, the Xhosa version of the EPDS-10 was administered using survey software programmed into a mobile phone.

von Dadelszen et al. (2015) [26]

Paper describing observations noted during development of app. This paper describes observations noted during development of the PIERS (Pre-eclampsia Integrated Estimate of RiSk) models that identify pregnant women with pre-eclampsia who are most likely to develop life-threatening complications, and suggests recommendations for development of mHealth in perinatal care.

The authors had developed and validated two outcome prediction models, the PIERS (full and mini). Both models have accurate ability to identify women at low risk of developing imminent complications.

For use in low and middle income countries. 2011.

Pre-eclampsia and other potentially life threatening conditions.

Yes

Yes

Yes

Yes

Authors state: “The PIERS on the Move (POM) smart phone app integrates miniPIERS and clinical decision algorithms to support community health care professionals (cHCPs) as they provide prenatal care, diagnose pre-eclampsia, and initiate lifesaving therapies in the woman’s home prior to urgent transfer to an effective facility. The researchers have also developed a modified blood pressure device (Microlife 3AS1–2; Microlife, Widnau, Switzerland) specifically for use in low- and middle-income countries (LMICs), which fulfils WHO requirements for suitability for use in low-resource settings. A traffic light early warning system has been incorporated into the device, to alert users to abnormalities in blood pressure and pulse, using these developed shock index thresholds along with well-recognized thresholds to indicate hypertension in pregnancy.”

Battle et al. (2015) [27]

Mixed methods evaluation of program using app.

Report of findings from a mixed methods study qualitative and quantitative data evaluation the “mHealth for Safer Deliveries” program - an integrated mobile health intervention on maternal care utilization. The program was designed to address each of the “three delays” to receiving skilled care at delivery: (1) the decision to seek care; (2) reaching skilled care; and (3) the provision of adequate care once at the health facility.

Zanzibar, Africa. January 2013 to December 2014. Qualitative interviews -September-October 2014 in all districts using semi-structured interviews (women, n = 27; community health workers, n = 25; health facility workers, n = 12). Quantitative data were collected January 2013 and December 2014 (n = 13,231).

To encourage facility birth

Yes

Yes

Yes

No

The program supported community health workers trained to use a phone with a user-friendly decision-support application. This enabled them to: 1. Counsel the mother and family on healthy behaviours and recognizing danger signs; 2. Record permissions from husband and family members agreeing to a facility-based delivery; 3. Screen women (and their babies) for complications from pregnancy up to a week after delivery and refer them as needed to the health facility; 4. Use mobile banking to pay for transportation to the health facility when the woman is referred, paying for transport without ever touching cash; 5. Use text or voice communication to notify a health facility that a woman is in transit.

Vélez et al. (2014) [28]

Mixed methods study evaluating a program using app. The Millennium Villages Project (MVP) was an integrated rural development program to achieve the Millennium Development Goals (MDGs) in low-income rural Africa by 2015. The Millennium Village Health System (MVHS) was a major component of the project, whose core strategy was to ensure universal access to services free of charge at the point of care, with a continuum of services from the household to the clinic and the referral hospital. This paper describes a descriptive usability study composed of 3 phases to evaluate an mClinic prototype: 1) hybrid lab-live software evaluation of mClinic to identify usability issues; 2) completion of a usability questionnaire; and 3) interviews that included low-fidelity prototyping of new functionality proposed by midwives.

Bonsaaso, Ghana. All midwives working in the cluster of MVP (n = 7). May 2011.

Access to maternity care.

Yes

Yes

Yes

No

A mobile health (mHealth) application, known as mClinic, captures data for managing patient care, program evaluation and monitoring, decision making, and management, and allows midwives to access the MVG-Net.