Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study

Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0. 46) years; most were White (21/28, 75%) and Medicaid insured (26/28, 93%), with an annual household income of <US 30, 000 (16/28, 57%). The mean gestational age at enrollment was 22 weeks. Almost half (13/28, 46%) were taking medication for opioid use disorder (methadone or buprenorphine). Other substances used included tobacco (22/28, 79%), marijuana (20/28, 71%), illicit opioids (9/28, 32%), alcohol (6/28, 21%), and stimulants (4/28, 14%), including cocaine, amphetamines, and benzodiazepines (2/28, 7%). Most (19/28, 68%) reported previously using one or more prenatal apps and 11% (3/28) cited prenatal apps as their most frequently used source of pregnancy information. After approximately 4 weeks of app exposure, 71% (20/28) logged in at least weekly, 89% (25/28) were satisfied with the app, and 96% (27/28) reported that the app was a helpful source of support. In cognitive interviews, participants reported that app-based disclosure of substance use could be easier than disclosing in person due to reduced stigma. However, participants expressed concerns about not knowing who would have access to this information. Conclusions: Incorporating substance use supports into a pregnancy app was found to be acceptable among those using substances. Participants reported frequent baseline use of prenatal apps, showed a high level of engagement with the pregnancy app during the study, and demonstrated interest in expanding the substance use support elements of this app. Embedding substance use screening, information, and connection to care into a tool with wide-scale use during pregnancy has the potential to identify at-risk individuals who may otherwise not be identified during routine prenatal care. It also has the potential to connect individuals, who might otherwise be hesitant to disclose their substance use, to recovery or harm reduction resources.