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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 4  |  Page : 170-179

Knowledge, attitude, and willingness to use and pay for smartphone applications for physical activity among pregnant women


1 Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
2 Department of Health Professions, Manchester Metropolitan University, Manchester, UK
3 Department of Physiotherapy, University College Hospital, Ibadan, Nigeria
4 Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria

Date of Submission22-Jan-2020
Date of Decision14-Mar-2020
Date of Acceptance18-Mar-2020
Date of Web Publication13-Apr-2020

Correspondence Address:
Chidozie Emmanuel Mbada
Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/digm.digm_3_20

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  Abstract 


Background: A decline in physical activity (PA) during pregnancy, despite its benefits to the mother and fetus, invites concerns for innovative platforms for its implementation. This cross-sectional study assessed knowledge, attitude, and “willingness to use” and “willingness to pay” for smartphone applications (apps) for PA. Materials and Methods: A total of 196 consenting pregnant women participated in this study. Eligible respondents were pregnant women who were 18 years and older, on at least a second antenatal visit and uses a mobile phone. Three purposively selected antenatal care facilities were surveyed. A self-developed questionnaire pilot tested for face and content validity was used as the research tool. Results: The mean age of the respondents was 27.5 ± 3.42 years, and 52% of them were occasionally engaged in PA. The point prevalence for smartphone use for general purpose and the usability rate of smartphone app were 72.4% and 84.2%, respectively. The rates for willingness to use PA apps for pregnancy and willingness to pay for the apps were 64.3% and 63.8%, respectively. There was a significant association between the attitude of respondents toward smartphone apps use for PA and number of parity (χ2 = 7.119; P = 0.028). There was no significant association between knowledge of the use of smartphone apps for PA in pregnancy and each of the educational qualification (χ2 = 13.046; P = 0.523), income (χ2 = 11.086; P = 0.679), age (χ2 = 4.552; P = 0.804), gravidity status (χ2 = 5.302; P = 0.506), and number of parity (χ2 = 1.878; P = 0.758). Conclusion: Nigerian pregnant women have good knowledge, positive attitude, and willingness to use smartphone apps for PA in pregnancy. There was a significant association between the number of parity and each of the attitude and knowledge of the use of smartphone apps for PA.

Keywords: Attitude, knowledge, physical activities, pregnant women, smartphone, use, willingness


How to cite this article:
Mbada CE, Omole OO, Igwe CF, Olakorede DB, Fatoye CT, Akinwande OA, Sanuade CT, Odole AC, Fatoye F. Knowledge, attitude, and willingness to use and pay for smartphone applications for physical activity among pregnant women. Digit Med 2019;5:170-9

How to cite this URL:
Mbada CE, Omole OO, Igwe CF, Olakorede DB, Fatoye CT, Akinwande OA, Sanuade CT, Odole AC, Fatoye F. Knowledge, attitude, and willingness to use and pay for smartphone applications for physical activity among pregnant women. Digit Med [serial online] 2019 [cited 2020 May 26];5:170-9. Available from: http://www.digitmedicine.com/text.asp?2019/5/4/170/282374




  Introduction Top


Pregnancy is a precious but precarious period in the life course for women, as it is associated with considerable physiological and psychological changes, which, in turn, may promote sedentary behaviors and low levels of physical activity (PA).[1] Such reduced PA has been associated with adverse maternal and child outcomes including low birth weight, preterm birth weight, intrauterine growth restriction, and other chronic diseases such as cardiovascular diseases and diabetes mellitus.[2] In recognition of these consequences, the America College of Obstetrics and Gynaecology[3] has recommended that pregnant women initiate or continue an active lifestyle during pregnancy, as it is the cheapest, preventive, and therapeutic intervention in which the individual has some measure of direct control.

For many years, engagement in PA in pregnancy was thought to harm the fetus or promote adverse pregnancy outcomes such as preterm delivery, fetal growth restriction, or small-for-gestational-age infants.[3] However, current evidences indicate that PA in pregnancy have positive effects on the mother and fetus including improved stress response in utero and reduced risk of childhood obesity.[4] Furthermore, maternal PA can improve cardiovascular function without adverse effects on fetal growth,[5] and fetuses of women who engage in PA demonstrate advanced gestational age related to a lower fetal heart rate.[5] However, apathy for PA in pregnancy is still common, as a substantial proportion of women stop exercising and decrease their general PA levels after they discover they are pregnant, while only a few begin participating in exercises or sporting activities during pregnancy.[6] One study submit that pregnant women worldwide often do not meet the PA recommendations, and only 15.8% of the pregnant women in the United States are engaged in PA during pregnancy at the recommended level.[7]

Mobile devices have been shown to be an effective tool for encouraging, increasing, and monitoring PA.[8] These devices may serve as a means to improve PA in pregnancy and, consequently, maternal and child outcomes. Tripp et al.[9] observed that there are more applications (apps) available to support pregnancy than for any other medical domain. Some of these apps have been successfully integrated into interventions that target diet, PA, and weight management.[10] Thus, apps can contribute to healthy lifestyle during pregnancy, as pregnancy is a critical teachable period in the lives of young women.[11] While the use of apps in pregnancy is becoming popular in most developed countries,[9] a number of factors, among which culture-related beliefs and dispositions are significant, seem to discourage pregnant women from engaging in this recommended health promotion and preventive strategy.[12] Although the delivery of PA through mobile phone-based interventions has substantial evidence to effectively increase participants' engagement in PA and lead to behavioral changes,[13] there is still paucity of evidence on their uptake in many developing countries, such as Nigeria, despite the increase in mobile phone penetration and usage in these countries.[14],[15] The objective of this study was to assess knowledge, attitude, and willingness to use and pay for smartphone apps for PA in pregnancy.


  Materials and Methods Top


This cross-sectional study recruited pregnant women receiving antenatal care in selected hospitals in Ile-Ife, Osun State, Nigeria. The antenatal care facilities were the Urban and Comprehensive Health Centre, Eleyele; Comprehensive Health Centre, Enuwa; and the Ife Hospital Unit of the Obafemi Awolowo Teaching Hospital Complex. Eligible respondents were pregnant women who were 18 years and older, on at least a second antenatal visit, and uses a mobile phone. The sample size for this study was determined using the following formula by Smith:[16]

n = (Z)2× p (1-p)/d2

where n = desired sample size, Z = 95% confidence level, it is 1.96, p = expected proportion in population, and d = absolute error or precision. Therefore, (1.96)2× 0.05 (1-0.05)/d2 yields a total of 196 respondents.

Procedure

A self-developed questionnaire tested for its face and content validity in a pilot study was used in this study. The four-section questionnaire sought information on (i) sociodemographic and obstetric information and PA levels, (ii) willingness to use smartphone apps for PA in pregnancy, (iii) knowledge on smartphone apps for PA, and (iv) attitude toward the use of smartphone apps for PA in pregnancy [Appendix]. The questionnaires were answered by the respondents through self-administration mode using the paper and pencil means. Ethical approval for this study was obtained from the Health Research and Ethics Committee of the Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria (IPHOAU/12/1128).

Data analysis

Descriptive statistics of percentages, mean, and standard deviation were used to summarize data. Inferential statistics of Chi-square were used to analyze the association between each of the knowledge, attitude, and willingness to use smartphone apps for PA and the respondents' characteristics. Alpha level was set at P < 0.05. Data analysis was performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp, Armonk, NY, USA).


  Results Top


The mean age of the respondents was 27.5 ± 3.42 years. The respondents were largely businesswomen (50.5%) with tertiary education qualification (79.1%) [Table 1]. About half of the respondents were occasionally engaged in PA (52%) [Table 2]. The obstetrics characteristics of the respondents are presented in [Table 3]. More than half (54.4%) of the respondents were multiparous. [Table 4] shows the results on the use of smartphone apps for general use and for pregnancy-related PA. The point prevalence of smartphone use was 72.2%. About half of the (45.4%) respondents had used a PA app for general purpose. The “willingness to use” and “willingness to pay” rates for PA apps specific for pregnancy were 63.8% and 64.3%, respectively. Concerns about privacy associated with Internet use were considered a barrier to willingness to use PA apps in pregnancy (42.3%). [Table 5] shows knowledge about smartphone apps. “Enhancing social connectivity” (72.4%) and “self-monitoring capacity” (72.4%) attributes of smartphone apps for PA in pregnancy were mostly rated by the respondents. According to [Table 6], it can be said that a majority of the respondents (82.2%) agree to use pregnancy smartphone PA apps.
Table 1: Sociodemographic data of the respondents (n=196)

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Table 2: Physical activity profile of the respondents (n=196)

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Table 3: Obstetrics characteristics of the respondents (n=196)

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Table 4: Smartphone use characteristics (n=196)

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Table 5: Knowledge characteristics of the respondents (n=196)

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Table 6: Willingness characteristics of the respondents (n=196)

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[Table 7] shows the result of Chi-square test of association between attitude toward the use of smartphone pregnancy PA apps and each of the sociodemographic and obstetric characteristics. The result shows that there was no statistically significant association between attitude toward the use of smartphone apps for PA and each of the education (χ2 = 5.478; P = 0.602), income (χ2 = 8.744; P = 0.272), age (χ2 = 1.024; P = 0.960), and gravidity status (χ2 = 1.920; P = 0.589). However, there was a significant association between attitude toward the use of smartphone pregnancy PA apps and parity (χ2 = 7.119; P = 0.028). Nearly 27% of the primiparous respondents had positive attitude toward the use of smartphone apps for PA. [Table 8] shows the correlation between knowledge about the use of smartphone apps for PA in pregnancy and each of the sociodemographic and obstetrics characteristics. There was no statistically significant correlation between the level of knowledge of use of smartphone apps for PA in pregnancy and educational qualification (χ2 = 13.046; P = 0.523), income (χ2 = 11.086; P = 0.679), age (χ2 = 4.552; P = 0.804), gravidity status (χ2 = 5.302; P = 0.506), and number of parity (χ2 = 1.878; P = 0.758).
Table 7: Levels and correlates of attitude to the use of smartphone apps for physical activity in pregnancy

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Table 8: Levels and correlates of knowledge of use of smartphone apps for physical activity in pregnancy

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  Discussion Top


This study was aimed to assess the knowledge, attitude, and “willingness to use” and “willingness to pay” for smartphone apps for PA in pregnancy, as well as to determine the sociodemographic (age, education, socioeconomic status, income, and occupation) and obstetrics (number of parity and gravidity status) characteristics that influence the knowledge, attitude, and use of smartphone apps in pregnancy. The mean age of the pregnant women in this study was 27.5 ± 3.42 years, and most of the women had a tertiary education qualification. Thus, the respondents were relatively young people. Being of this age range suggests that they should be knowledgeable and better informed about the use of internet facilities and use of smartphone apps. A previous study by Hearn et al.[17] found that young women are frequent users of smartphones and internet technology; they want short, quick answers to their pregnancy and child-rearing concerns and prefer information readily accessible on mobile devices.

In this study, there was a 52% prevalence of occasional engagement in PA among pregnant women. This study finding affirms an earlier submission that a large proportion of healthy pregnant women are not currently meeting up with the recommended PA benchmarks in pregnancy.[18] Literature indicates that most pregnant women do not practice any form of exercise and tend to decrease their level of PA, including household and occupational activities.[19] Studies report that <20% of pregnant women achieve PA recommendations and majority are completely inactive by the third trimester of pregnancy.[19] Even in those who self-reported being active prior to pregnancy, about half cease activity during pregnancy.[20] In an earlier study, in the same study setting, Mbada et al.[21] noted an apathy for PA and exercise among pregnant women.

From this study, it was noted that professionals' suggestions to engage in PA were needed by about half of the population, while more than 60% of the women do not require reminders to engage in PA. Literature suggests that engagement of professionals (such as physiotherapists, nurses, and doctors) is in some cases necessary in order to promote PA before, during, and after pregnancy.[22] Engagement of professionals in the conduct of PA in pregnancy may help reinforce confidence in the engagement of PA among these women. Furthermore, these professionals play vital roles which include evaluation and determination of suitability to engage in PA and type and intensity that is needed. For example, the American College of Obstetricians and Gynecologists,[23] in affirming the role of professionals, asserts that “obstetrician–gynaecologists and other obstetrics care providers should carefully evaluate women with medical or obstetrics complications before making recommendations on PA participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and in most cases, allowing ambulation should be considered.” While some studies confirm the importance of reminders in promoting PA engagement,[24] most of the pregnant women in this study submit that reminder may not be necessary for them to engage in PA.

The point prevalence of smartphone use (i.e., owning it and currently using it) among pregnant women in this study was 72.2%. An online report[25] stated that smartphone adoption is on the upswing in Nigeria, as the number of Nigeria's mobile subscribers has reached 150 million and the number of its internet users has climbed to 97.2 million at penetration rates of 81% and 53% for mobile subscribers and internet users respectively. The high penetration rate of smartphones among the pregnant women in this study may reflect the smartphone revolution that is currently sweeping through Nigeria. The usability rate of smartphones among pregnant women in this study was 82.4%. While there is a dearth of studies on smartphone use in pregnancy in Nigeria, there are some studies from other climes. The prevalence of smartphone use in pregnancy is high in those contexts; most of their studies explore nonusers instead. The prevalence of nonusers during pregnancy (6%) in a study by Papadopoulou et al.[26] was 9.8%, which is comparable with other studies such as by Vrijheid et al.[27] (11%)(Spanish study) and Guxens et al.[28] (6%) (Dutch study). Hence, nonuse of smartphone rate in this study was 17.6%, which is higher than the one observed in the aforementioned studies. The prevalence of use of smartphone apps for PA for general purpose among the pregnant women in this study was 45.4%. On the other hand, the prevalence of use of smartphone apps for PA, specifically for pregnancy in this study, was 31.1%.

The findings of this study revealed that more than half of the pregnant women (67.9%) had a positive attitude toward the use of pregnancy PA apps. This finding is comparable with a previous study on “Perceptions of Engagement Applications during Pregnancy” by Goetz et al.,[29] which reported a 60% positive attitude toward the growing e-Health movement. In addition, from this study, it was found that there was no significant association between attitude toward the use of smartphone apps for PA and each of the education and gravidity status. However, there was a significant association between attitude toward the use of smartphone apps for PA and parity. Furthermore, there was no significant association between the level of knowledge of the use of smartphone apps for PA in pregnancy and each of the educational qualification, income, age, gravidity status, and number of parity.

A high (64.3%) willingness to use PA apps specific for pregnancy was reported in this study, while willingness to pay for such app was also high (63.8%). This finding is similar to that of the study by Goetz et al.,[29] which reported that the usability requirements were high and the women stressed the need for a user-friendly interface in web-based applications and mobile apps. However, concerns about privacy (security of personal details) associated with internet use were considered a barrier in willingness to use PA apps in pregnancy. This finding is also comparable to that of the study by Goetz et al.,[29] which reported that various women expressed concerns about data security, especially in the field of mobile apps, because many free apps make private data easily accessible.

About half of the multiparous women had a positive attitude and were willing to use pregnancy PA apps. It is assumed that this perception is as a result of previous birth experiences they have had. It suggests that multiparous women desires to try new things, which makes them have a positive attitude and willingness to use pregnancy PA apps unlike nulliparous women who would be careful as they have not had any birth previously. Anecdotally, some of the pregnant women in this study may have filled the questionnaire out of apparent fatigue and tiredness. Filling out questionnaire lazily may significantly impact the level of correctness of what it measures. This observation is a potential limitation on the external validity of the findings of the study.


  Conclusion Top


Nigerian pregnant women have good knowledge, positive attitude, and willingness to use smartphone apps for PA in pregnancy. There was a significant association between attitude toward the use of smartphone apps for PA and number of parity.

Medical benefits

This study has a secondary benefit for policy and planning for PA in pregnancy using telerehabilitation platforms like the smartphone apps.

Physical activities

This study is not specific on the scope of PA in pregnancy. However, the study explores PA as defined by the WHO 2020 as any bodily movement produced by skeletal muscles that requires energy expenditure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Appendix Top



  QUESTIONNAIRE ON KNOWLEDGE, ATTITUDE, AND WILLINGNESS TO USE SMARTPHONE APPLICATIONS FOR PHYSICAL ACTIVITY IN PREGNANT WOMEN Top


You are invited to participate in this survey aimed to evaluate your knowledge, attitude, and willingness to use smartphone applications for physical activity (PA) in pregnancy. Your participation will be greatly appreciated as the outcome of the study may help to understand whether availability of mobile apps may help limit the challenges of inaccessibility to PA and exercise for prenatal and postnatal women. The survey tool will take approximately 15 min to complete. You are please requested to answer the questions as honestly as you can. The information obtained in this study will be kept strictly confidential and will be for academic purpose only. You are free to withdraw from this study at any time without sentiment.

To indicate your answer, please TICK the answer that comes closest to your opinion or write your answer in the space provided. Thank you for making out time to fill this questionnaire.


  SECTION A: SOCIODEMOGRAPHIC Top


1. What is your age as at last birthday?___________, Height __________ Weight ___________

2. What is your religion? Christianity [ ]

Islam [ ] Traditional religion [ ] Others [ ] specify___________

3. What is your occupation? Homemaker [ ] Trader [ ] Businesswoman [ ] Civil servant [ ] Student [ ] Others [ ] specify ________

4. What is your highest level of educational qualification? None [ ] Primary education [ ] Secondary education [ ] NCE [ ] OND [ ] HND[ ] Bsc [ ] Msc [ ] Phd [ ]

5. What is the range of your monthly income? Less than N 10, 000 [ ] N 10, 000 – N20, 000 [ ] N 20, 000 – N 50, 000 [ ] N 50, 000 – N100, 000 [ ] N 100, 000 – N150, 000 [ ] N 150, 000 – N 200, 000 [ ] Greater than N200,000 [ ]

6. What is your family setting? Polygamy [ ] Monogamy [ ] Single parenting [ ]

7. How many pregnancies have you had? ____________________

8. How many births have you had? _________________

9. How many children do you have? ____________________

Questions 10–13 is for mothers who have had previous birth experience

10. What is the mode of delivery of your last baby? Spontaneous vaginal delivery [ ] Cesarean

section [ ]

11. Where did you deliver your last baby? Hospital [] Home [] Others [] specify___________

12. Where did you get antenatal care in your pregnancy? Hospital [ ] Home [ ] Others [ ] specify______

13. When did you start receiving antenatal care in your pregnancy? <1 month [ ] 1–3 months [ ] 3–6 months [ ] 6–9 months [ ]

14. How long have you been attending antenatal clinic for your current pregnancy? <1 month [ ] 3–6 months [ ] 3–6 months [ ] 6–9 months [ ]

15. How often do you engage in physical activity? Never/seldom [ ] Occasionally [ ] 1–2 times/week [ ] 3–4 times/week [ ]

16. How long do you do you engage in physical activity each time?

<30 min [ ] 30–60 min [ ] >60 min [ ]

17. Do you need to be reminded by others to engage in physical activity? Yes [ ] No [ ] Not sure [ ]

18. Do you think your condition needs reasonable engagement in physical activity? Yes [ ] No [ ] Not sure [ ]

19. Do you think your condition needs physical activity engagement instruction? Yes [ ] No [ ] Not sure [ ]

20. Do you think you need the suggestions of professionals (physiotherapist, physician, fitness instructor, or nurse) in physical activity engagement?

21. Do you think you need to monitor your physical status (such as heart rate) when engaging in physical activity?

22. Please circle the number which reflects your physical activity performance in your pregnant state?

0. indicates “no activity” and 100 indicate “extreme activity.”



9. Which of the following factors may influence your use of a physical activity app?

  1. If functions do not meet needs (i.e., function is insufficient) Yes [ ] No [ ]
  2. If it is not easy to use (i.e., difficult to use) Yes [ ] No [ ]
  3. If there is an extra fee to use the app (i.e., extra cost) Yes [ ] No [ ]
  4. Concerns about personal information disclosure (i.e., security) Yes [ ] No [ ]
  5. Concerns about cost (if apps will require mobile data plan) Yes [ ] No [ ]








 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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