Co-creation of a mobile health program (MumCare) for preventing maternal cardiovascular disease after pregnancy complications

Objective Epidemiological studies show an increased risk for premature maternal cardiovascular disease in women after pregnancy complications, like preeclampsia, gestational hypertension and gestational diabetes mellitus. Our goal was to create a novel “digital companion” for women with such pregnancy complications, in the format of a mobile health-assisted user-centered follow-up software application (app). Methods A cardiovascular postpartum follow-up program was developed as a digital companion, including a new mobile application (app), which is based on Norwegian obstetric and international guidelines. The MumCare app was developed through a co-creation process that included users, stakeholders, and clinical experts. Five qualitative interviews and 10 qualitative co-creative user testing interviews were conducted throughout the development stages to improve the perceived usefulness of the companion. The objective of the present study was to analyze the iterative co-creation process including users, stakeholders and clinical experts. Results Phase 1 involved developing the companion within an interdisciplinary expert group through an iterative process in close dialogue with users. Explorative user interviews in Phase 2 ( n = 5) supported the translation of guidelines into a structured app format, visualized as MumCare sketches for design, functionality and user communication. During Phase 3, the app sketches were revised in collaboration with users, in application interviews ( n = 7). During Phase 4, the programmed prototype was refined through feedback from pilot users ( n = 3). The user groups highlighted several app benefits, including a follow-up system of personal modifiable risk factors, a user-friendly system for tracking blood pressure over time, with individualized feedback and prompts. The use of non-ambiguous language and symbols was appreciated among users, who also contributed new content items to the app. Conclusion User-centered co-creation improved several important features during the companion development process. The MumCare app is being tested in a prospective randomized controlled clinical trial that started in June 2024. Clinical trial registration Clinicaltrials.gov reg ., identifier NCT05835596.