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Supporting at-risk mothers across perinatal period: a randomized controlled trial' (SMART): A development study

Lubna Shah¹, Joelle Yan Xin Chua¹, Aayisha Aayisha¹

¹Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

|May 28, 2026

Abstract

Background:

Mothers at high risk for developing depression due to psychosocial vulnerabilities that need to be supported in the perinatal period. A theory-based, user-centered mobile health application-based perinatal intervention can potentially improve at-risk mothers' maternal and infant outcomes.

Aim:

To describe the development of SMART, a mobile health application-based perinatal intervention designed to support at-risk mothers across the perinatal period.

Methods:

The SMART intervention was developed using a combined information systems research framework and design thinking approach. The development process included identification of user needs, intervention design, prototype development, integration of theory, treatment fidelity planning, and user acceptance testing. User acceptance testing was conducted with 21 perinatal women using a SMART-specific questionnaire and the user version of the Mobile Application Rating Scale.

Results:

The development process resulted in a mobile health intervention comprising educational content, an activity hub, peer support chat, discussion forum, gratitude journal, helplines, and useful links, push notifications, and personalisation features. User acceptance testing indicated favourable ratings for app quality, information quality, usability, and perceived impact. Participant feedback informed refinements to the intervention, including improvements to content presentation, search/filter functions, pregnancy-related resources, and the user-guide video. Interdisciplinary collaboration and treatment fidelity planning supported the systematic development of the intervention.

Conclusion:

This study described the key processes in developing a mobile health application-based perinatal intervention. Researchers can learn from the insights gained to plan future multidisciplinary, technology-based perinatal interventions.

Trial Registration:

The SMART study was registered on clinicaltrials.gov (Registration ID: NCT06363019) on 04 September 2024.

Keywords:

Depression Development Mobile application Mothers Perinatal Telehealth

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