Mobile health applications for postnatal care: Review and analysis of functionalities and technical features

Lamyae Sardi; Ali Idri; Leanne M Redman; Hassan Alami; Rachid Bezad; José Luis Fernández-Alemán

doi:10.1016/j.cmpb.2019.105114

. Author manuscript; available in PMC: 2022 Apr 29.

Published in final edited form as: Comput Methods Programs Biomed. 2019 Oct 16;184:105114. doi: 10.1016/j.cmpb.2019.105114

Mobile health applications for postnatal care: Review and analysis of functionalities and technical features

Lamyae Sardi ^a,^*, Ali Idri ^a,^b, Leanne M Redman ^c, Hassan Alami ^d,^e, Rachid Bezad ^d,^e, José Luis Fernández-Alemán ^f

PMCID: PMC9052424 NIHMSID: NIHMS1787583 PMID: 31655305

Abstract

Background:

Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy.

Methods:

A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps

Results:

A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care.

Conclusions:

The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps

Keywords: Postnatal care, Apps, Mobile health, Functionality

1. Introduction

The postnatal (or postpartum) period is the most critical, yet the most neglected phase in the lives of mothers and newborn infants. Beginning immediately after childbirth, the postnatal period usually extends for about six weeks as the mother’s body returns to its pre-pregnant state. Yet, some evidence indicates that the postnatal period is a continuity of three distinct phases of which the third one lasts up to six months following delivery [1]. The postnatal period marks an important transition in the lives of parents as it brings about major changes in parental roles, responsibilities, and identities. During this period, parents are supposed to make physical, psychological and social re-adjustments to restore balance in their lives [2].

While most expecting mothers focus on potential risks involved during pregnancy and up to delivery, a few closely consider the risks afterward. In fact, the postnatal period poses substantial health risks for both mothers and newborn infants and is the period when most maternal and infant mortalities and morbidities occur. According to recent estimates by the World Health Organization, upwards of 303,000 women died as a result of pregnancy and child birth-related complications and approximately 2.7 million newborn babies died after birth in 2015 [3]. Given that maternal health and newborn health are closely linked, interventions targeting maternal care can likely also improve fetal and neonatal health [4]. Providentially, most maternal and infant mortalities are preventable and healthcare solutions to handle and avoid complications are well-known [5]. In this regard, it is particularly important that all births are attended by skilled health personnel and that all women have access to the appropriate level of care before, during and after pregnancy and childbirth. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health.

Postnatal care (PNC) is the care given to the mother and her newborn infant immediately after the birth and during the postnatal period. Although for most women and newborn infants, the postnatal period is uncomplicated and manageable, effective and adequate care during this period needs to address any deviation from expected recovery after birth and to appropriately intervene in a timely fashion [6]. Nevertheless, PNC services tend to be poorly covered when compared with other reproductive health care services. The inadequacy and the underutilization of PNC services likely emanate from several factors ranging from poor education and poverty to limited access to healthcare facilities [7]. The void in PNC can also be attributable to differing priorities and perceptions of maternal and infant needs among healthcare providers, new mothers and their families which is also likely influenced by regional and cultural practices [8].

Information and Communication Technologies (ICT) have proven to be a powerful prospect in promoting the fields of health care and allowing patient empowerment and disease management [9]. ICT have been efficiently used by patients and health care providers to facilitate communication, manage patient history and handle medical transcriptions, among others [10]. Mobile technology appears to be promising in improving access and efficiency in health care delivery [11]. Mobile health (mHealth) has great potential in addressing disruptive issues in healthcare, given the ubiquity of mobile devices around the world and the unique aspects of mobile technology including its high reach, cost-effectiveness, and relative simplicity to use. The arrival of internet and smartphones has indeed revolutionized mobile health technology. Smartphones are considered powerful devices that typically combine the conventional features of a mobile phone with sophisticated processing and computing capabilities enabling users to access and run a myriad of mobile applications, commonly called ‘apps’ [12]. The mobile health (mHealth) app market has been expanding steadily over the last few years with the adoption of new technologies and new workflows that are transforming healthcare [13]. With respect to the PNC, there is an increasing proliferation of apps bringing up new opportunities to improve maternal and infant health care services [14,15].

The main purpose of the present study is to review and analyze features and functionalities of the pool of apps for postnatal care that are currently available in the two most widely used smartphones applications stores: Apple app store and Google Android play store. In the realm of reproductive healthcare, previous studies have scrutinized the functionalities of the available mobile Personal Health Records (mPHRs) for pregnancy monitoring for iOS and Android platforms [16] and those of mobile applications for postpartum depression [17]. To the best of our knowledge, this is the first study that has been conducted to thoroughly analyze the features and functionalities of mobile applications targeting postnatal care.

The remainder of the present paper is structured as follows: Section 2 outlines the research questions and describes the methodology used to search for, select and analyze the functionalities of postnatal care apps. Section 3 answers the research questions and discusses the findings. Section 4 explores the limitations and the threats to validity of the present study. Section 5 draws some concluding remarks and gives a summary of future work.

2. Method

The search for postnatal care apps was addressed through the use of systematic literature review (SLR) methodology [18] that ensures the accuracy and completeness of the search and retrieval process. Prior to performing the search for candidate postnatal care apps, a protocol which outlines the different steps constituting the SLR process developed, was designed in accordance with a set of guidelines delineated by the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) [19] statement. The PRISMA guidance is said to improve the quality reporting in systematic reviews and provide substantial transparency in the selection process. The review of postnatal care apps was completed through the following steps: (1) framing the research questions, (2) defining search strategy, (3) identifying eligibility criteria for the selection process, (4) determining elements for analysis and (5) formulating assessment questions. Each of these steps was accomplished by two authors (L.S and A.I) independently. Any disagreements and discrepancies were discussed until consensus was reached.

2.1. Framing the research questions (RQs)

To rigorously yield the purpose of the review, a set of five research questions was identified by the authors (Table 1). These research questions were informed by the scientific literature related to the postnatal care for mother or/and newborns [6,20–22] and a preliminary analysis of available postnatal care apps.

Table 1.

Research questions.

Research Question (RQ)	Rationale
RQ1. Which are the common types of the postnatal care apps selected?	Determine the classification of the apps selected in terms of their purpose.
RQ2. Which are the predominant characteristics of postnatal care apps?	Identify the common functionalities and features among the postnatal care apps.
RQ3. To what extent do the postnatal care apps comply with the items analyzed?	Examine the comprehensiveness of the apps selected in terms of functionalities and features.
RQ4. Are user ratings proportionally linked to the apps’ characteristics?	Investigate the relationship between users’ perception of the quality of the apps selected and the relevance of the functional content of these apps.

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2.2. Defining search strategy

The leading app stores namely, Google Play store and Apple app store [23] were considered to perform the search for candidate postnatal care apps. The PICO criteria (Population, intervention, Comparison and Outcome) [24] were used to define a search string that ensures the maximum coverage. The Population considered was that of new mothers and their newborns. The Intervention consisted of free and paid apps which are intended to be used during the postnatal period. Given that the primary focus of the present study was not comparative and did not seek to find evidence about the existing postnatal care apps, the Comparison criterion was disregarded. With respect to the last criterion, all the aspects and outcomes of postnatal care apps were of interest in the present study, of which managing the postnatal period and promoting maternal and infant care were the mostly considered.

The following terms: ‘Postnatal’ OR ‘Postpartum’ OR ‘After childbirth’ OR ‘newborn’ OR ‘(Postnatal OR Postpartum OR newborn) AND care’ were therefore identified and were primarily applied to the title and description of the apps using the search tools in both app stores. The search process took place in January 2019.

2.3. Identifying eligibility criteria for the selection process

To identify the candidate postnatal care apps and discard the disqualifying ones, a set of eligibility criteria was defined. Apps fulfilling all the inclusion criteria (IC) were included in the present study. These criteria are the following: IC1. Free or paid apps obtained using the pre-defined search terms and available in the reviewed app stores. The paid version of a given app was only considered if it presents additional features of functionalities when compared to the free version. IC2. Apps pertaining to categories related to health namely, Health & Fitness or Medical. Given that the newborn care is inherently encompassed in the postnatal care, parenting category was also considered for apps in the Google play store. IC3. Apps that are mainly focused on any aspect related to PNC for the mother and/or the newborn. Further exclusion criteria (EC) were applied to the apps identified throughout the selection process to eliminate: EC1. Duplicates. This exclusion criterion aims to discard duplicates either within the same app store and apps available for both platforms under the same name and have identical content. EC2. Apps that are not designed with an English interface, EC3. Apps that were lastly updated before the 1st January 2018. This criterion is intended to keep solely the apps that release regular updates that include relevant bug fixes and features. EC4. Apps that cannot be installed or accessed to. This criterion excludes all apps presenting any kind of bug or error during or after installation that prevent authors from conducting an appropriate analysis of content.

2.4. Determining elements for analysis

Scientific literature and postnatal care apps available in the app store were reviewed to identify the main components for the evaluation of features and functionalities of the postnatal care apps selected. Two components were determined: (1) app characteristics comprising the common features of any app; and (2) data items including the fundamental functionalities and features to be included in a postnatal care app at a functional and a technical level.

2.4.1. App characteristics

The app characteristics that should be retrieved from the app store for each app selected include: the full name, the operating system (Android or iOS), cost (free, paid, in-app purchases), the app link in the app store or app website (if available), date of the latest update, user ratings, number of raters and country of origin of app developer.

2.4.2. Data items

A thematic template was designed containing the data that should be extracted in regard to the functional content of the postnatal care apps selected. This template was piloted using a small sample of published papers, standards and guidelines related to PNC as shown in Table 2; agreement was reached about six blocks for a comprehensive postnatal care app among the first three authors.

Table 2.

Relevant sources of information for each block of items.

Data items	Relevant sources of information
Postnatal care for mothers and newborn infants	Recommendations and guidelines on postnatal care [6,20] Studies about maternal health during the postpartum period [17,25–30]
Postnatal counselling	Counselling guides for maternal and newborn health care [31–34]
Reminders and push notifications	Studies tackling the use of reminders in mobile apps for maternal health medication adherence [36,37]
Notes and records	A study analyzing functionalities of personal health records for prenatal care [16]
Social support	Studies endorsing the importance of social support in improving maternal well-being during the postpartum period [38,39]
App technical features	Studies about security and privacy concerns in mobile health applications [40–42] Internationalization requirements catalog for health applications [43] Studies evaluating mobile health applications’ compliance with usability guidelines and standards [44–46] Reusable usability requirements repository for mobile health applications [47]

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Postnatal care for mothers and newborn infants.

Services providing postnatal care are supposed to incorporate all the essential elements required for the health of the mother and of her newborn infant in an integrated fashion. This category of data includes information related to the postpartum care and the newborn care. The terms ‘postpartum’ and ‘postnatal’ are often used interchangeably [17,25] but sometimes the former refers to the issues pertaining to the mother while the latter refers to those pertaining to the baby. To aid clarity and avoid confusion, the term ‘postnatal’ was adopted to refer to the care after childbirth for both mothers and babies [20]. The core pillar of a healthy postnatal period is to tackle all aspects of mental and physical health and wellbeing of the mother and the newborn infant.

A typical postpartum care plan provided to new mothers includes tips and advice with regard to the recovery from childbirth as well as to inform of the danger signs and life-threatening conditions in the postnatal period such as hemorrhage, infections and pre-eclampsia [6]. The provision of useful information related to the physiological and metabolic changes that take place during the postnatal period is also of a great importance. New mothers should be aware of the way the body reverts to the non-pregnant state to ensure optimum health-management [26]. To cope with pain associated with these changes, mothers tend to use prescribed medications, adapt some comfort measures or do physical exercises. Physical activity during the postnatal period is proven to not only improve the health and wellbeing of the new mothers but also helps in strengthening the woman’s body reducing the risk of developing lifestyle-related diseases such as obesity and cardiovascular diseases [27]. Besides physiological adjustments, the postnatal period brings about other social and emotional changes that render new mothers vulnerable to a range of mental and behavioral disorders such as baby blues, postpartum depression and puerperal psychosis [25]. Amid the postnatal period, many women experience feelings of sadness, anxiety and depressed mood, especially, in the few days following the childbirth. While many mothers suffer from brief to a mild bout of maternal blues, others suffer from long-lasting and severe depression. If not treated, these mental disorders may carry significant lifetime consequences for mother themselves and for their newborns [17]. Appropriate screening and treatment are subsequently paramount [28]. A myriad of coping strategies should be introduced to new mothers during the postnatal period to lessen the severity of depression. Yet, these strategies should not interfere with their cultural and religious preferences [29].

With regards to newborn infant care, the provision of a complete parenting guide to new mothers is necessary to avoid neonatal morbidities during the postnatal period. This has to include recommendations and advices on how to care for the baby in the first few days and throughout the postnatal period. It is important to provide new mother with practical tips on umbilical cord care, hygiene, and routine practices such as changing diapers, baby holding, feeding, burping and swaddling [20]. Moreover, new mothers should be taught essential instructions to detect and handle suspected and manifest neonatal complications [30].

Postnatal Counselling.

Throughout the postnatal period, new mothers should be counselled on various topics including nutrition, hygiene, family planning and infant feeding [31]. To provide positive and successful counselling which engender a considerable support for the new mothers, it is always important to put into practice the following skills: listening; learning; building confidence and giving support [32]. It is recommended to perform counselling session before and after childbirth during the postnatal visits. Cards are often used by counsellors and health specialists to cover all the essential postnatal topics [31,32]. Since PNC is usually considered as the weakest health program among all reproductive and infant health programs [8,20], postnatal counselling sessions are unlikely to take place. By taking advantage of mobile technologies, new mothers can be counselled on the postnatal health issues to maintain their health and that of their newborns. After delivery, new mothers should increase their food intake to cover the energy cost of breastfeeding and for her to recover her normal energy and health. Counselling on maternal nutrition includes advices and recommendations on adopting a balanced and varied healthy food and drink plenty of clean water [33]. Moreover, new mothers should be provided with recommendations about infant feeding and should be encouraged to exclusively breastfeed their newborns up to six months after birth [34]. Besides nutrition and breastfeeding, attention should be drawn to maternal hygiene. New mothers should be counselled on how to take care of their personal hygiene (e.g. Perineal and breast hygiene) to prevent infections [35]. Sexuality is perhaps one of the important elements to be addressed during the postnatal period. Therefore, counselling should cover the resumption of sexual intercourse along with the postpartum family planning. New mothers should be taught about the appropriate contraceptive methods to use to avoid unwanted pregnancies. Research suggests waiting at least 24 months before attempting the next pregnancy to reduce the risk of maternal and infant complications [33].

Reminders and push notifications.

Most of new mothers become busy and frustrated during the postnatal period owing to the multiple needs underlying motherhood. Consequently, they become less attentive to their postnatal check-ups, their newborns’ pediatric visits and vaccinations appointments. In this respect, reminders based on a pre-scheduled events can considerably improve medical appointment attendance [36]. Given that a number of drugs and medicines can be prescribed for both the mother and the newborn during the postnatal period, push notification reminders can play a great role in improving medical adherence and uptake [37].

Notes and records.

Similarly to pregnant women [16], new mothers can record major milestones of their postpartum period and their newborns’ development. As regards to newborns, it is important and practical to record routine activities (e.g. diapers changes, bottle feeding and sleeping patterns), the medical care received (vaccination shots, medications) and to keep track of the developmental milestones by entering measurements such as height and weight of the newborn. This can objectively indicate accelerated or delayed newborn growth. New mothers can make use of diary and recording features to take control of some of vital settings in their wellbeing, such as weight and sleep. Recording weight regularly can help the mother remain alerted and effectively manage their postnatal weight so as to avoid obesity [48]. Likewise, keeping a sleep diary on hand is important in evaluating sleeping patterns in order to detect and diagnosis some discomforts such as fatigue, insomnia and anxiety [49].

Social support.

To buffer the fluctuations associated with the postnatal period, new mothers need a large social and emotional support. In addition to providing social support, social media offer another venue for social learning and behaviour acquisition through observation, interaction and encouragement [38]. Sharing experiences with others can be of great help in addressing certain issues about motherhood and raising kids. Social support proved to reduce levels of postanal stress and panic [39] as well as improving the overall health and quality of life [38].

App technical features.

Convenient, secure and easy-to-use mHealth apps have the potential to increase adherence and engagement with the health system as a whole [40]. Security and privacy are considered as the most challenging risks encountered when developing mHealth solutions [41]. Health-related apps, in particular, are dedicated for tracking, recording and managing personal health information (PHI) of users. PHI is extremely sensitive and needs to be highly protected through robust security and confidentiality mechanisms such as encryption and authentication methods. In fact, unauthorized access to health information is a serious threat to privacy and security. Moreover, for users of mHealth apps, the existence of a privacy policy is an important baseline standard to know why, where, and how personal details and PHI will be collected, used, shared and protected [42]. Another app feature worth mentioning is internationalization (i18n). The i18n is the process of designing a software product that is able to adapt to different languages, regions and cultures. Health-related programs and practical guides are often elaborated to respond to all people’s needs regardless their cultural environment. Thus, i18n is a relevant aspect that renders mHealth solutions valuable for a wider number of users [43]. The usability, for its part, is identified as one of the decisive factors in building efficient and intuitive apps [44]. It relates to the ease with which users can complete their tasks in a specified context of use [45]. Task structure and interaction style should be optimal to minimize usability flaws [47]. Besides, usability aspects have a great impact on improving users’ interaction with the apps, and ultimately, enhancing the overall user experience [46].

2.5. Formulating assessment questions

To extract relevant data for an optimal analysis of the functional content of the postnatal care apps selected, a set of Yes/No questions was developed (Table A.1 in Appendix A). The developed questionnaire was drawn on the predefined data items and was validated by a gynecologist and pediatrist who are both highly acquainted with mobile technologies. The data obtained using the questionnaire were employed in answering the research questions. Each app was assessed separately for all the questions. The scoring was performed as follows: Yes (Y) = 1 point, the app offers the feature described in the question. No (N) = 0 points, the app does not offer the feature described in the question.

3. Results and discussion

This section presents and discusses the principal findings of the assessment conducted in the present study. Characteristics, functionalities and technical features of postnatal care apps were retrieved and evaluated using a questionnaire of 37 items. The findings are sorted and grouped by research question.

3.1. Selection process

The selection process of postnatal care apps and the resulting number of apps after applying the inclusion and exclusion criteria is shown in Fig. A.1 (Appendix A). The app repository search identified 1596 free and paid apps, of which 45% (n = 719) were excluded for not pertaining to the categories defined in the present study. After reviewing the in-store description and screenshots of the 877 remaining apps, only 73 apps were retained for further eligibility assessment. Ten apps were excluded after installation and full review of their contents. Apps designed for Android were downloaded in an OPPO A37fw while iOS dedicated apps were downloaded in an iPhone 6 Plus. Among the 63 apps reviewed, 15 apps were available in both repositories and duplicates were therefore excluded. These apps were counted as one since they provided similar functionalities. However, some differences with regard to the visual design and layout of cross-platform apps were observed. For instance, the menu of BabyTime app was displayed in the top and the bottom of the screen in the iOS version while it was fixed as a three-bar menu icon in the top left of the screen in the Android version. The multi-platform publishing is currently considered a norm in mHealth app market [50], which justifies the number of cross-platform apps selected in the present study.

A total of 48 apps were selected for analysis of functional content, of which 25 apps were found in the Google Play Store, 8 apps originated from the Apple App Store and 15 apps were available for both platforms. The disparity across the Android and iOS platforms in terms of the number of postnatal care apps is mainly due to the advantages of the Android platform in terms of the global reach of the market and the simple guidelines and system reviews of the Google play store.

3.2. General app characteristics

The overall characteristics of the apps selected are presented in Table A.2 (Appendix A). Among these, 25 apps were focused on the Health & Fitness category, 9 apps were considered medical and parenting apps accounted for 7. The 7 remaining apps were found in different categories across Android and iOS platforms: (1) Baby tracker - feeding, sleep and diaper app was found in parenting category in Android platform and in Health & Fitness in iOS platform; (2) Six apps (e.g. Baby+, Glow Baby Newborn Tracker App) were found in the parenting category for the Android platform and were considered medical in iOS platform. Among the apps selected, 26 apps were free, 7 apps were paid, and 15 apps offered additional features for purchase. With regard to the country of origin, 22 apps originated from the United States while the remaining apps were developed in various countries including Netherlands, United Kingdom, India, Canada, Egypt, Germany. This confirms the growing interest in developing mobile solutions for the management of the postnatal period across the globe.

3.3. Analysis of functional content

The results obtained from the assessment questionnaire are presented in Appendix B which describe the answers for each app and question. The total score percentage for each app evaluated which illustrates the assessment of its functional content in addition to the total percentage of each question referring to the number of apps fulfilling this question can also be depicted in Appendix B. For better analysis and interpretation, Figs. 1, 2 illustrate these results. Fig. 1 presents the scores obtained by the 48 postnatal care apps for each of the six blocks of assessment questions while Fig. 2 displays the number of apps fulfilling each of the 37 assessment questions.

Fig. 1. — Classification score of the 48 postnatal care apps.

Fig. 2. — Number of apps fulfilling each of the assessment questions.

Based on these results, the maximum score (22 points) was obtained by three apps; Baby+, you + baby and baby & me, while Postnatal pilates by reform app obtained the lowest score (3 points). With regards to the assessment questions, the highest score (83%) was reached by the informal writing style question (A34), followed by the intuitive navigation patterns question (A37) which attained a score of 79%. Moreover, the presence of a privacy policy question (A30) achieved a score of 63% and the specification of the newborn’s birthday (PN1) was included in 58% of the postnatal care apps. The question related to the ability to create a sleep diary (N25) attained the lowest score (0%).

Prior to answering the research questions, it is worth mentioning that given the complexity of the postnatal period and the various elements it gathers, the postnatal care apps selected in the present study are likely to yield relatively low scores with regard to the features they implement.

1. Which are the common types of the postnatal care apps selected?

Facilitated by the technological advances, the range of mobile health solutions being designed is constantly expanding. This fundamental shift in mHealth landscape resulted in informed decision-making, improved self-management and increased practice’s efficiency and effectiveness. Moreover, mHealth apps have proven to enhance access to basic levels of healthcare and save time for both patients and healthcare providers [13]. There is a particularly broad array of mHealth applications that serve different purposes such as providing a clinical diagnosis, remote monitoring, self-management, in addition to promoting healthy living and raising healthcare education and awareness. Correspondingly, the postnatal care apps selected fall into three main categories (Fig. 3). Forty percent of apps exclusively included features to track, monitor and record different information of infant development such as routine activities (e.g. diapering, feeding and sleeping), medical history and anthropometric measurements, in addition to the postnatal weight of the mother as in Baby+ app. Along with WebMD Baby app, Baby+ provide valuable information related to the development milestones of the infant as a reference for growth tracking. Another prevalent category is the provision of information and tips related to the postnatal period. Accounting for 35% of the apps selected, information is generally displayed into categories related to a single postnatal aspect as postpartum haemorrhage (e.g. Bleeding after birth app), or multiple aspects encompassing the health-management of the mother and the infant, postnatal counselling (e.g. Essentia baby app) and providing parenting tips (e.g. Pregnancy, parenting advice & baby care tips app). Of the 17 informative apps, eight offered features of tracking and recording the newborn measurements, doctoral appointments and feeding as in Telfair baby and MH Motherhood apps. Lastly, a total of 12 apps were designed to encourage weight loss during the postnatal period through physical exercises, nutritional and diet recipes and recommendations (e.g. Burn fat after pregnancy - weight loss app). With the aim to hasten postpartum recovery and assist with muscle strength and toning, these apps offer a selection of postnatal workouts through videos as in After birth exercise app or step-by-step visual and audio instructions as in FitMama Lite 5 Minute Workouts app.

Fig. 3. — Classification of the postnatal care apps selected.

1. Which are the predominant functional characteristics of postnatal care apps?

To answer this research question, the results obtained through the assessment of the functional content of the apps selected were used. As shown in Appendix B, 58% of apps implemented the specification of the newborn’s birthday feature (PN1) which stands upon specifying the birthdate of the newborn. This characteristic was found in all apps specially dedicated to the newborn care management. Besides allowing to constantly track the age of the infant, this characteristic helps in providing straightforward developmental milestones as a function of the infant age as in Baby+ and Sprout apps. In these same apps, additional details were required such as the name and the gender of the infant. Another recurrently covered functionality is recording of infant anthropometric measurements (N23) including height, weight and head circumference. At birth, the evaluation of these parameters is performed to mark out fetal growth restriction among newborns [51]. Throughout the postnatal period, recording accurately these measurements is important in monitoring and tracking infant health and growth.

Thus, it may be observed that most of the postnatal care apps analyzed in the present study are limited to the management of the postnatal care of the newborn. Significant efforts are required to address the needs of mothers during the postnatal period. With regards to the technical features, two usability aspects were largely present in the postnatal care apps, namely informal writing style (A34) and intuitive navigation patterns (A37). Familiar writing style and intuitive layout accounted for 83% and 79% of the apps analyzed. Another prevalent feature (A30) which achieved a score of 63% was that of including a privacy policy that clearly and comprehensively discloses how the app collects, uses and shares information.

1. To what extent do the postnatal care apps comply with the items analyzed?

This research question approaches the main objective of the present study, which consists on measuring the compliance of the postnatal care apps with the functional characteristics analyzed. Using the assessment results (Appendix B), each block of data items was separately investigated.

Postnatal care for mothers and newborn infants.

The characteristics of postnatal care were addressed to a large extent (78%) in 9 apps that were predominantly informative. The provision of postnatal fitness recommendations and awareness on postpartum metabolic changes and complications were the features the most commonly disregarded among these apps as in Telfair baby and Pregnancy, parenting advice & baby care tips apps, respectively. The apps designed for postnatal fitness and weight loss (e.g. postnatal workouts app) yielded the lowest score in this category of characteristics (12%). Furthermore, only 6 out of 48 apps (e.g. guide to newborn care app) provide practical tips on the basic everyday care of the newborn such as bathing, feeding and soothing. Only 27% of apps addressed maternal mental health. Apps like WebMD Baby and Post pregnancy recovery help in acquiring knowledge about symptoms, signs and remedies of postpartum depression and associated anxieties. Besides, Moment Health was found to be the unique app to offer a clinically-approved screening tool for postnatal depression. By combining symptoms’ checking and tracking of emotional changes, this app is said to likely allow a rapid mental recovery. Ultimately, 15 apps provide users with important information on immunizations recommended to newborn infants. Breastfeeding Tracker Baby Log app offers the possibility to display the immunizations’ list according to the recommendations of 19 countries including United States, France and Brazil.