Co-creation of a mobile health program (MumCare) for preventing maternal cardiovascular disease after pregnancy complications

OBJECTIVE: Epidemiological studies show an increased risk for premature maternal cardiovascular disease in women after pregnancy complications, like preeclampsia, gestational hypertension and gestational diabetes mellitus. Our goal was to create a novel “digital companion” for women with such pregnancy complications, in the format of a mobile health-assisted user- centered follow-up software application (app). METHODS: A cardiovascular postpartum follow-up program was developed as a digital companion, including a new mobile application (app), which is based on Norwegian obstetric and international guidelines. The MumCare app was developed through a co-creation process that included users, stakeholders, and clinical experts. Five qualitative interviews and 10 qualitative co-creative user testing interviews were conducted throughout the development stages to improve the perceived usefulness of the companion. The objective of the present study was to analyze the iterative co-creation process including users, stakeholders and clinical experts. RESULTS: Phase 1 involved developing the companion within an interdisciplinary expert group through an iterative process in close dialogue with users. Explorative user interviews in Phase 2 (n = 5) supported the translation of guidelines into a structured app format, visualized as MumCare sketches for design, functionality and user communication. During Phase 3, the app sketches were revised in collaboration with users, in application interviews (n = 7). During Phase 4, the programmed prototype was refined through feedback from pilot users (n = 3). The user groups highlighted several app benefits, including a follow-up system of personal modifiable risk factors, a user-friendly system for tracking blood pressure over time, with individualized feedback and prompts. The use of non-ambiguous language and symbols was appreciated among users, who also contributed new content items to the app. CONCLUSION: User-centered co-creation improved several important features during the companion development process. The MumCare app is being tested in a prospective randomized controlled clinical trial that started in June 2024. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov reg., identifier NCT05835596.