Obstetrics & Gynecology · Medical Literature
User Experience of a Web-Based Mobile Health App Supporting Low-Income Pregnant Individuals With Diabetes: Mixed Methods Study.
Abstract
Diabetes mellitus management requires considerable patient self-efficacy, knowledge, and support for social determinants of health. These needs become particularly acute during pregnancy. Mobile health (mHealth) tools are a promising approach to enhance patient engagement with the health care system, education, and health promotion and may be particularly helpful during the period of rapid skills acquisition, which is a hallmark of experiencing diabetes during pregnancy. Therefore, we developed SweetMama, a web-based mHealth app designed to support and provide information to low-income pregnant individuals with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (T2DM). This study aimed to understand the user experiences of low-income pregnant people who were randomized to use SweetMama during a feasibility trial. This mixed methods secondary analysis of data from a feasibility randomized controlled trial (RCT) included participants randomized to SweetMama, an interactive, web-based mHealth app with multiple motivational and educational features that help reduce barriers to care, offer health education, and aim to improve diabetes self-care for low-income pregnant people. In the parent trial, English-speaking pregnant individuals with GDM or T2DM were randomized to use SweetMama during pregnancy or usual care. SweetMama users experienced an individualized curriculum from enrollment through 6 weeks postpartum. Upon exit, users completed 2 qualitative interviews (during the delivery hospitalization and at the postpartum visit) and surveys assessing standardized usability metrics. The surveys included the System Usability Scale (SUS), the Usefulness, Satisfaction, Ease of Use (USE) scale, and the mHealth App Usability Questionnaire (MAUQ) to assess usability. Qualitative data were analyzed using constant comparative techniques. Of 30 SweetMama users, 60% (n=18) had GDM, 83.3% (n=25) had publicly funded prenatal care, and the majority identified as non-Hispanic Black (n=17, 56.7%) or Hispanic (n=11, 36.7%). Scores on the SUS (median 85.0/100, IQR 70.0-88.8; ≥71% indicates acceptable or higher usability), USE (overall median 84.5/100, IQR 81.0-91.4), and MAUQ (median 84.1/100, IQR 79.0-91.3) indicated favorable usability assessments, particularly for the "ease of learning" domain. Qualitative interviews supported these findings: participants described the app as easy to navigate, well organized, and helpful for staying on track, citing features such as clear visual design, timely text reminders, and actionable tips. Users valued motivational elements and content specificity, while recommending increased customization and enhanced esthetics. In this user experience evaluation of a web-based mHealth app for low-income pregnant individuals with diabetes, participants found the tool to be user-friendly, visually appealing, informative, and motivating. Constructive feedback for application improvement for use in a future larger trial of clinical effectiveness was collected.
Clinical relevance
Diabetes in pregnancy—encompassing both GDM and T2DM—demands intensive patient self-management at a time when health literacy, social support, and access to care are frequently inadequate, especially among low-income populations. SweetMama addresses this gap by providing a web-based mHealth platform tailored to the intersecting vulnerabilities of socioeconomic disadvantage, racial/ethnic minority status, and pregnancy-specific diabetes self-care demands. As mHealth tools proliferate in obstetric care, rigorous user experience data from underrepresented populations are essential before scaling to effectiveness trials.
Key findings
1. Study population was markedly underserved: of 30 SweetMama users, 83.3% (n=25) had publicly funded prenatal care, 56.7% (n=17) identified as non-Hispanic Black, and 36.7% (n=11) as Hispanic—populations historically excluded from digital health research. 2. Sixty percent (n=18) of participants had GDM and 40% had T2DM, with app use spanning enrollment through 6 weeks postpartum, providing longitudinal usability data across a clinically dynamic period. 3. System Usability Scale (SUS) median score was 85.0/100 (IQR 70.0–88.8); a score ≥71 is the threshold for 'acceptable or higher' usability, indicating this tool met or exceeded acceptability benchmarks in this cohort. 4. Usefulness, Satisfaction, and Ease of Use (USE) scale yielded an overall median of 84.5/100 (IQR 81.0–91.4), and the mHealth App Usability Questionnaire (MAUQ) median was 84.1/100 (IQR 79.0–91.3), both reflecting consistently favorable multi-domain usability. 5. The 'ease of learning' domain was particularly highly rated across instruments, a clinically meaningful finding given the rapid skills-acquisition demands placed on patients newly diagnosed with or managing diabetes during pregnancy. 6. Qualitative interviews identified timely text reminders, clear visual design, and actionable self-care tips as key facilitators of engagement, while users recommended greater content customization and improved app aesthetics as priority areas for iterative development.
Practice implications
Clinicians and care teams managing low-income pregnant patients with GDM or T2DM should recognize that web-based mHealth tools like SweetMama can achieve high usability scores in populations that are typically considered digitally underserved, supporting their integration as adjuncts to standard prenatal diabetes education. Future implementation should prioritize apps that incorporate individualized curricula, motivational features, and text-based reminders, given these elements were most valued by users, and should extend engagement through the postpartum period given the continued diabetes risk after delivery. These findings support advancing SweetMama to a fully powered randomized effectiveness trial, with iterative improvements focused on personalization and aesthetic design to optimize engagement in racial/ethnic minority and publicly insured obstetric populations.