Persuasive Technology in a mHealth application for Pelvic Floor Muscle Training among pregnant women (Preprint)

BACKGROUND Urinary incontinence common among pregnant women with first-line management is pelvic floor muscle training (PFMT). To develop a mHealth app in self-management of UI is by designing a unique PFMT app for pregnant women. The development should be based on the behavioural change theory and should be able to persuasive towards them. Persuasive strategies are essential to attract the patients' attention or targeted population to adhere to the app. The Behaviour Change Wheel Framework (BCW) provides a systematic approach with methodology replicable which consists of nineteen frameworks that may be able to focus on the appropriate intervention. OBJECTIVE This study is to identify the mHealth applications for PFMT published in peer-reviewed journals, describe the principles of persuasion used for each app, and suggest a mHealth application’s design based on the COM-B theoretical framework. METHODS A systematic literature review approach was performed to find the eligible articles. This literature search aimed to answer three main research questions: 1) What are the mHealth apps for PFMT available in the databases? 2) What are the persuasive strategies used in their studies? and 3) What is the successful outcome of PFMT adherence with the selected persuasive strategies used? The databases that we searched were MEDLINE, CINAHL, Web of Science, and Scopus database using PRISMA flowchart. The search keywords were as follows: (“pelvic floor muscle training” OR “pelvic floor muscle exercise” OR “Kegel exercise”) AND (“women” OR “pregnant women” OR “pregnancy” OR “postpartum”) AND (“digital health” OR “mHealth” OR “mobile health” OR “mobile application” OR “smartphone” OR “mobile app” OR “smartphone app”). Full-text articles were further assessed and discussed by the two reviewers, and the consensus was achieved through discussion with the third reviewer. RESULTS The search found 169 records screened for titles and abstracts, 53 full texts were reviewed, and 11 articles met with the selection criteria and were included in the review. A total of 3546 PFMT mHealth app users with a mean age range from 29.3 to 54 years old. 9 mHealth apps were designed for PFMT with 4 out of 9 may have used the authority strategies to improve PFMT adherence. 1 out of 9 used operant conditioning as the behaviour change theory. These apps reported favourable PFMT adherence outcomes. CONCLUSIONS Persuasive technology with BCW framework will enable healthcare providers to approach the target behaviour holistically and develop the intervention comprehensively in general practice. The future mHealth app will enable pregnant women to adhere to the PFMT and adopt this as new behaviour even after the postnatal period.