Design and impact of gamification, theory-driven frameworks, and human-centered design in mobile health applications...

Preconception care significantly improves maternal and child health but remains inconsistently implemented globally. Mobile health (mHealth) applications leveraging mobile technology are increasingly explored to deliver preconception interventions. The effectiveness of these apps may depend on their design, with strategies such as gamification, theory-driven frameworks, and human-centered design enhancing user engagement and behavioral outcomes. However, the application of these design strategies in preconception mHealth apps lacks systematic analysis. This systematic review protocol, adhering to PRISMA-P guidelines, aims to synthesize quantitative evidence on mHealth apps incorporating these design strategies. Studies from 2014-2024 evaluating such apps among reproductive-aged women will be identified through PubMed, Scopus, and Web of Science. Peer-reviewed quantitative studies, including randomized controlled trials, nonrandomized trials, and cohort studies, will be considered, while qualitative studies, reviews, and studies lacking empirical outcome data will be excluded. A comprehensive search strategy will combine key terms for preconception care and mobile health applications, with further evaluation of design-related and outcome-related terms during the title/abstract screening and full-text review stages. The review will categorize app design strategies and assess their effectiveness in improving preconception knowledge, awareness, behavioral intention, behavior change, engagement, usability, satisfaction, and adherence. Given the expected heterogeneity among the studies, a narrative synthesis following the Synthesis Without a Meta-analysis framework will be conducted, with subgroup analyses to explore design features and outcome variations. The findings will guide app developers, policymakers, and healthcare professionals while identifying gaps in the existing evidence base and highlighting areas for further research in digital reproductive health.