Digital Maternal Support Tool Implementation

Acceptability of App

20 questions tailored from the Unified Theory of Acceptance of Use of Technology (UTAUT) asked at 3 study timepoints: 10 days, 4 weeks, and 8 weeks. 11 of the 20 questions are repeated across timepoints that assess the smartphone app (e.g., "The amount of information in \[the app\] is what I need" or "Overall, I like \[the app\]"). The remaining 9 are specific to distinct features of the app that are made available to the user at specific timepoints (e.g., "I like the way the healing check-in looks and feels"; "I like the way the \[2-month\] baby milestones look and feel"). Answers are measured on a 5-point Likert scale, ranging from (1)strongly disagree to (5) strongly agree (5), unless reverse-coded. Means and standard deviations will be calculated for each item, with higher responses indicating higher levels of acceptability.

Feasibility of App Use

Feasibility will be measured using rate of engagement. Engagement will be evaluated by the number of study weeks that users uniquely access the smartphone app.

Knowledge - postpartum symptoms

From a list of 14 postpartum symptoms, participants will be asked to classify the symptom with the appropriate response: monitor at home, call your provider, or call 911/seek emergency care. Baseline knowledge will be measured at enrollment based on the number correct out of 14, with follow-up measurements taken at 10 days, 4 weeks, and 8 weeks.

Attitudes - positive parenting

From a list of 10 statements focused on parenting practices, participants will rate the statements from strongly disagree (1) to strongly agree (5). Example statements include, "Skin-to-skin contact improves baby health and development," "Babies need strict routines" (reverse coded), and "Infants should be fed when they show hunger cues." These responses are summed, with higher scores indicating stronger endorsement of positive parenting. These measurements are taken as a baseline measurement at enrollment, and then again at 10 days, 4 weeks, and 8 weeks.

Health services utilization

Well-visit (maternal) and check-up (infants) attendance are surveyed on day 10, week 4, and week 8 (e.g., "Has your baby (or twins) had their first well visit with their pediatrician yet?" or "Have you attended a postpartum check-up?"). Non-routine healthcare utilization is surveyed at week 4 and week 8 (e.g., "In the last 4 weeks, did your baby (or twins) have a visit at an emergency department?"or "In the last 8 weeks, did you call, message or schedule a visit with your Obstetrician or Primary Care Provider for a reason other than a postpartum check-up?"). Distributions for each response will be used for analysis.