In this study, the application of the DECO-MOM app for environmental health of pregnant women increased environmental health behaviors in personal and community aspects, quality of life, and increased satisfaction with the app, while psychological health, such as quality of subjective health status, depression, and anxiety, did not show statistically significant changes. Therefore, study hypothesis 1 and 4 were supported, however, hypothesis 2 and 3 were not supported. The DECO-MOM application, by effectively enhancing personal and community environmental health behaviors, illustrated the viability of leveraging technology to disseminate critical health information and foster behavioral change at a personal and communal level. Furthermore, this study's findings on e-learning satisfaction provided insights applicable to health education contexts, including the elements critical to user satisfaction and engagement in digital learning environments.
The effectiveness of this study is attributed to the rPMT, which recognizes that pregnant women are vulnerable to climate change and environmental pollution and perceive real risks to their health [11]. Personal lifestyle and health behaviors to prevent micro dust triggered health behavior response efficacy, and community environmental health behaviors of reducing, engaging, recycling, and reusing stimulated self-efficacy to respond to climate change [11]. Climate change encompasses a broad spectrum of environmental alterations, including rising temperatures, increased exposure to pollutants, and the proliferation of vector-borne diseases, all of which pose significant health risks. For pregnant women, these environmental stressors can lead to adverse pregnancy outcomes, such as preterm birth, low birth weight, birth defects [24], and developmental issues in children [25]. The susceptibility of pregnant women to these environmental factors was attributed to physiological changes during pregnancy that can alter their response to heat, pollutants, and infectious agents. The intrauterine environment, crucial for fetal development, was sensitive to external environmental conditions, making it imperative to protect maternal health from the adverse effects of climate change [25].
The results of positive e-learning satisfaction reported by participants further validate the design and content delivery approach of the DECO-MOM program. This satisfaction is indicative of the program's ability to engage users effectively, a critical factor in the success of any health intervention [26]. This study showed that content satisfaction and communication satisfaction were effective, but interface satisfaction was not, suggesting that it is necessary to use more convenient and attractive technologies for users when developing environmental health apps. The positive reception of the app's content and communication suggests that user-centered design principles, which prioritize the needs and preferences of the target population, are essential in the development of effective mHealth interventions.
While previous studies in digital healthcare for pregnant women have shown benefits on depression [28], anxiety [28, 29], and subjective well-being [30], this study did not show significant psychological effects. The lack of effect on psychological health outcomes in this study could be attributed to the lack of social support during app use. Communication was noted as a key factor affecting the sustainability of mobile apps, so future research should incorporate this factor into the design and evaluation of tools [28]. Mental health experts ought to be strategically involved in mitigating the adverse effects of climate change by delivering essential psychological assistance and incorporating mental health aspects into the broader framework of climate resilience strategies [31]. The low levels of subjective well-being and happiness globally were linked to exposure to environmental factors during pregnancy [32]. Implementing mobile health interventions that focus on environmental health during pregnancy could enhance healthcare quality. Additionally, these interventions can encourage women to take a more active role in managing their own health, ultimately leading to empowered attitudes, healthier environmental health behaviors [32].
This study had several limitations. Firstly, this study was a small-sized experimental study of pregnant women in three Korean cities the generalizability of the study is limited. There was risk of selection bias of a quasi-experimental study due to difficulties in randomizing subjects as planned in the protocol. Secondly, this study did not consider health equity because it did not include digital literacy or migrant women, because the study only selected participants who could use digital devices and speak Korean. Thirdly, the researchers provided a mobile app and encouraged participation with social networking services, but were unable to provide individualized social support, which did not have a positive impact on mental health. Fourthly, we measured outcomes immediately after the 4-week app implementation, but did not follow up to measure the long-term impact of the app.
The DECO-MOM study, through its focus on leveraging a mobile application for prenatal environmental health education, offers several important implications for public health policy, and future research in the domain of environmental health and mHealth interventions. The DECO-MOM study underscore the critical need for incorporating environmental health solutions into public health strategies, especially those aimed at vulnerable populations like pregnant women. The study also indicates that discussing environmental health risks and mitigation strategies should be an integral part of prenatal care. The DECO-MOM study lays the groundwork for future research in key areas. There is a need for further studies to explore the long-term effects of prenatal environmental health interventions on maternal and neonatal outcomes. Such research could provide deeper insights into the potential for mHealth tools to contribute to reducing adverse birth outcomes associated with environmental exposures. In conclusion, the DECO-MOM study not only demonstrates the effectiveness of a mobile application in improving environmental health behaviors and e-learning satisfaction among pregnant women but also reflects the potential of digital health interventions in enhancing environmental health outcomes.
Trial status
Registered before recruiting.