Comparing Pregnant and Postpartum Client and Provider Feedback on a Digital Health Intervention for Substance Use...

Mobile health (mHealth) interventions can expand access to and engagement in lifesaving treatment for pregnant and postpartum people with a substance use disorder. Yet, many people with lived experience and substance use providers alike are often excluded from mHealth intervention development, limiting opportunities to provide feedback on critical design components such as usability, cultural relevance, and compatibility with real-world practice.

The study engaged pregnant and postpartum people and substance use providers in a formative evaluation to refine an mHealth intervention designed to support recovery.

Pregnant and postpartum participants (n=11) and providers working in recovery settings (n=13) across Missouri reviewed the same mHealth intervention. Participants completed a survey and semistructured qualitative questions on usability and compatibility after reviewing the same mHealth intervention. Survey responses and qualitative themes were compared across groups. Post hoc analyses examined differences between pregnant and postpartum participants who had used the app and those who had not (n=8) to identify barriers to participation.

Both participant groups reported similar themes related to the usability and compatibility of the mHealth intervention, including a need for simplified navigation and greater personalization of app content. The e-coaching feature and directory of recovery-focused resources were viewed as valuable by both groups. Uniquely, pregnant and postpartum participants emphasized the need for app content addressing craving management, emotional triggers, and parenting stress. These participants also requested more frequent communication with the e-coach than providers recommended. Nonapp users differed from app users by race, education, and household characteristics, underscoring structural barriers to engagement.

Engaging both pregnant and postpartum people and providers in formative evaluation reveals overlapping and distinct priorities for mHealth design. Findings highlight that user-informed development is essential for improving usability, engagement, and recovery outcomes, including reaching those least likely to engage with traditional or digital treatment supports.