Pregnancy mobile health applications: quality evaluation and a randomized clinical trial on maternal self-care knowledge and skills

Self-care is essential during pregnancy. However, pregnant women with low health literacy often lack adequate knowledge and skills. Despite the increasing availability of pregnancy mobile applications in Iran, a significant gap remains in systematic quality evaluation using validated instruments, and evidence of their effectiveness from randomized controlled trials is limited. This study assessed pregnancy self-care mobile applications in Iran and the effectiveness of the highest-rated application in improving maternal self-care knowledge and skills. This two-phase study was conducted in 2023–2024. In phase 1, five experts evaluated Iranian pregnancy self-care mobile applications using the Mobile App Rating Scale (MARS), and the highest-rated app (“MadarSho”) was selected. In phase 2, a parallel-group randomized controlled trial was conducted among 110 pregnant women recruited from three public health centers in Poldasht County, Iran. Participants were randomly assigned (1:1) to intervention ( n = 55) or control ( n = 55) groups. The intervention group was instructed to use the “MadarSho” application regularly for approximately 60–70 min per week, preferably in short daily sessions, alongside routine prenatal care for 12 weeks, while the control group received routine prenatal care only. Self-care knowledge and skills were assessed before and after the intervention using a valid and reliable researcher-developed questionnaire (Cronbach’s α = 0.96 for knowledge and 0.89 for skills). Data were analyzed using paired and independent t-tests, ANCOVA, and sensitivity analyses, with effect sizes calculated using Cohen’s d and partial η². The “MadarSho” application received the highest MARS score (overall 4.5). In the randomized controlled trial ( n = 110), the intervention group showed significantly greater improvements in self-care knowledge (83.91 ± 8.56 vs. 67.33 ± 9.44, p < 0.001, Cohen’s d = 1.84) and skills (22.78 ± 2.11 vs. 17.60 ± 2.92, p < 0.001, Cohen’s d = 2.03) compared to the control group. Within the intervention group, there were also large, significant increases in knowledge (from 56.36 ± 14.33 to 83.91 ± 8.56, p < 0.001, Cohen’s d = 2.08) and skills (from 14.56 ± 4.09 to 22.78 ± 2.11, p < 0.001, Cohen’s d = 1.96). The “MadarSho” application, when used as a complement to routine prenatal care, significantly improved pregnant women’s self-care knowledge and skills. However, given the sample size, study duration, and potential biases, further studies with larger and more diverse samples are warranted to confirm these findings and support broader implementation. Iranian Registry of Clinical Trials (IRCT): IRCT20230426057997N1. Registered on 2023-04-26.