Table 2.

Semi-Structured Interview and Focus Group Questions, Three Most Commonly Cited Higher and Lower Order Themes Per Question, Frequency of Responses, and Example Quotations

Question 1: “What forms of technology are you currently using during clinic to deliver health information, recommendations, or guidelines to your pregnant patient?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
No technology used	17 (94)	No online trackers, kiosk, website None No phone applications	“I don’t have enough knowledge about it [mobile phone applications] myself that I would recommend it.”
Public websites	13 (72)	ACOG iVillage National Library of Medicine American Medical Association American Dietetic Association Myplate.gov, NIDDK, CDC websites	“The only form of technology I usually use is actually the internet to point them towards websites that might have information.”
Smartphone applications	5 (28)	Weight Watchers Menstrual cycle tracker Calorie King Pregnancy wheel for gestational age Alarm for birth control reminders	“I have one of those smart phone apps that I use to calculate a…pregnancy wheel; I’ll use it to calculate their gestational age. That’s one of the free apps that I use.”
Question 2: “If resources were endless and we could develop the “ideal tool” for you to get your patients to engage in HE/PA behaviors to manage GWG, what would it be?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
Characteristics of the tool	10 (55)	Tool provides feedback Self-guided interactive touch screen Interesting tool to keep patients engaged Personalized to patient User-friendly, easy to access/navigate Tool should keep track of who is accessing it Tool can’t take too much of clinicians’ time Informational for patients Decrease “silly” questions clinicians are inundated with intermittent alerting Interactive Includes pictures	“It would be easy to navigate so that people don’t have to struggle with where to put information and where to get information and the linkages would then follow to other linkages.”
Smartphone or tablet	15 (83)	Smartphone app/toll Tablet/iPad Content delivered on phone or internet Pedometer app Multiple tools (i.e., smartphone applications, websites, kiosk)	“I would love to have an application on the phone. I think if they knew it came from somewhere local and our doctors knew it was something people were certified that were working on this, I think that would be good so that we could definitely recommend it, rather than just saying go to this website and not knowing if that site is really following the ACOG guidelines.”
Monitoring with the tool	12 (67)	Logging/tracking diet, activity, weight Help patients be more aware of behaviors Plot weight on a graph Tracking of fetal movement Provide positive reinforcement	“A tool where they could log information, like exercise logs and dietary logs.”
Question 3: “How often do you perceive you would use e-health technology to counsel women on HE and PA behaviors to manage GWG?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
Depending on need	12 (67)	Varies per patient Daily or weekly depending on number of calls getting Use more often with high risk women Can show that patients are actually using it Depends on motivation, need, weight gain, and any issues Use more often with overweight women Ff there are problems or issues Use with patients that are savvy with computers/technology Depends on patients coming into clinic	“I would probably use it a lot more for women who are overweight, or women who are more high risk initially.”
Frequently	7 (39)	Weekly Every pregnant patient should get it Daily depending on how many first visits occur Use with 60% of patients Use with all patients if the tool is easy to use and works All pregnant patients need counseling so if it’s reasonably practical, would use with all patients Use at every prenatal visit if concise and easy to use If effective, would use 100% of the time If it’s kiosk, iPad or e-tool – frequent because user can log on and use	“Again I think if it was an ideal tool you could use quickly or was concise or had a summary of whatever the issue or the things are, then I think you could use it at every prenatal visit.”
Intermittently	5 (50)	Would recommend it at their first prenatal visit and then intermittently follow-up Would bring up intermittently because women get weighed at each visit and don’t want women being hyperaware of what they’re eating and begin to restrict caloric intake Recommend it anytime they call in the first trimester and then intermittently	“And you know maybe intermittently throughout, you know, are you looking at that site? Have you been using it? What’s helpful, what’s not? You know maybe at 16 weeks, or 28 weeks, when we do a lot of our other counseling type stuff, I might ask about it then too.”
Question 4: “How would you determine which patients should receive e-health technology when counseling them on HE and PA behaviors to manage their GWG?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
Should be available to everyone	16 (89)	It should be made available to everybody It would be beneficial to all women but some women need the counseling more than others Should give it to everyone Helpful for everyone 100% because there isn’t a “which patient” Getting all patients at the nurse visit so that those who are gaining too much don’t feel targeted or more self-conscious In an ideal world, every patient would get it If it’s a website, then anyone can have access to it More beneficial to give it to everyone so they have information with them at home Would try to get everyone to use it	“I mean I think it is something that we should probably offer to everyone. There are probably people that I think need it – the information, the counseling, more than others but they don’t seem to care as much unfortunately. I think it would be beneficial to all women, I think there are some women that are very health conscious and are very interested in knowing how much they should gain, how much exercise they should be doing, and what to eat.”
Depending on prepregnancy BMI to target both underweight and overweight/obese women	9 (50)	Women with an elevated BMI Would probably focus on the extremes Underweight, undernourished patients, and overweight patients More concentration on those in the extremes than those in the middle Patients that begin pregnancy with a BMI over 30 Should be tailored to have a normal track and a high risk track	“Well I mean definitely the elevated BMIs because we all know they have pregnancy problems so if you could lower their problems.”
Patients with previous or current high GWG	8 (44)	Women who gain too much weight during the pregnancy Women who gained a lot of weight in the Past Would use with patients who are gaining too much weight, but most women know if they’re gaining too much weight and doctors dread being the one to say something to them Would target those gaining too much weight, specifically those having problems controlling blood sugar Reinforce with patients who are gaining too much weight	“And usually we would have a record of what their previous pregnancies were, if they had gained too much weight in a previous pregnancy.”
Question 5: “What do you perceive are the possible barriers that you or other OBGYN physicians may encounter with integrating e-health technology into the clinic?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
Time	14 (78)	No significant amount of time to explain things If it's going to take more time because physicians are already crunched for time OB patients only get 10–20 minutes If it's one more thing physicians have to talk about to patients in an already short time slot and it may take away from other important issues that need to be discussed	“It is going to be more time consuming, it’s going to be one additional thing that we have to talk to our patients about in an already short, 15 minute time slot. I also think about trying to work it into the conversation and not take away from other important issues we need to discuss with the patient.”
Facilitators to prevent there from being barriers	8 (44)	Needs to be user friendly, simple, and easy User friendly, no training is involved Incredibly reliable Patient driven Requires minimal key strokes or anything on part of the physician Very easy to use because if it is complicated and takes more than a couple clicks, it won't get integrated If insurance would cover the cost/technology/apps are free Could be engineered to be no more than a minute of additional time Linked to electronic medical records Easy literacy level Can’t be ineffective Needs to be well oiled, simple, and fast	“It’s got to be incredibly reliable. No down time. It has to require a minimal amount of key strokes or anything on my part. You know the major problem with EMR’s today is that physicians have become the world’s highest data paid entry clerks.”
Cost	11 (61)	If the technology costs money Would need to buy extra computers/equipment Cost is the biggest barrier from administration New technology that costs money that hasn’t been proven to work yet is a barrier Insurers may not pay for it	“And just the monetary or financial barriers to actually getting the kiosk or the program or that kind of thing.”
Question 6: “What do you perceive are the possible barriers that your prenatal patients may encounter with receiving healthcare information/counseling that is delivered with technology?”
Higher Order Theme	N (%) Theme In Responses	Lower Order Themes	Example Quotation
User acceptability	9 (50)	Literacy Patients misinterpret or get confused by information and incorrect information gets to the patients Level of comfort with technology Level of understanding of content Cultural issues – what they hear from their mother, grandmother, church members will trump over stuff they get from technology Getting so much information at appointment (first nurse visit) already – too much information to add technology Hard for patients to talk about nutrition or consider it when sick/nauseous in early pregnancy Weight is a sensitive issue	“And then also their literacy level and education level I think would be two of the patient barriers that I can just think of right off the bat.”
Patient engagement, interest, and motivation	12 67)	Language barrier Lack of care about health Engagement/interest/motivation of patient to use it Anxiety for patient Game like function to motivate patients to use it Lack of motivation to follow through and	“I don’t think it would be something that all our patients would be motivated to use; I mean some aren’t even motivated to come. And we have a pretty good population compared to most places.”
Access	13 (72)	Access to technology Most patients even on medical assistance have smartphones, but not all patients may have access or can afford computers or iPads Data plan would be needed if on a smartphone Maintenance of technology in the office – who updates it, fixes it if it isn’t working	“I think more and more are having access to it, but I still have patients when I ask them that say no, they don’t have a computer, or no they don’t have an iPhone, or an iPad, or whatever. I think it is getting better that more people do have access to it, but not everyone does.”

*Note. SSI/FG = Semi Structured Interview/Focus Groups; Higher Order themes that emerged in < 10% of the SSI/FG’s were excluded from the table. The first study author can be contacted to obtain the full results.