This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.
For women with pre-existing and gestational diabetes mellitus, pregnancy involves specialized and intensive medical care to improve maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. Barriers to face-to-face care during the COVID-19 pandemic have signaled the need for high-quality, patient-centered virtual health care modalities, such as mobile health (mHealth).
The objective of the proposed scoping review is to identify the patient-reported benefits and limitations of mHealth technology among women with diabetes in pregnancy. We also aim to determine how the women’s experiences align with the best practice standards for patient-centered communication.
Arksey and O’Malley’s framework for conducting scoping reviews with refinements by Levac et al will be used to guide the conduct of this scoping review. Relevant studies will be identified through comprehensive database searches of MEDLINE, Embase, Emcare, and PsycINFO. Following database searches, studies will be screened for eligibility at the title, abstract, and full-text level by two independent reviewers, with the inclusion of a third reviewer if required to reach consensus. Data charting of included studies will be conducted by one reviewer using a standardized data extraction form and verified independently by a second reviewer. Synthesis of results will be guided by Thomas and Harden’s “Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.”
As of August 2020, we have carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies.
With the results of this review, we hope to describe the patient-reported benefits and limitations of mHealth technology for women with diabetes in pregnancy. Furthermore, we aim to determine how women’s experiences align with the best practice standards for patient-centered communication. Ultimately, our review can provide valuable information for guideline developers, policy makers, and clinicians related to mobile technologies to support virtual care delivery for women with diabetes in pregnancy.
PRR1-10.2196/29727
Diabetes is estimated to affect 20.4 million births or 15.8% of pregnancies worldwide [
For women with both gestational and pre-existing diabetes, there is a strong inverse relationship between maternal glycemic control and adverse pregnancy outcomes [
As the evidence indicates that improved glycemic control during pregnancy optimizes perinatal outcomes, expectant mothers with diabetes receive intensive and specialized care to achieve this goal. During pregnancy, women with diabetes attend approximately 15 face-to-face visits with health care providers [
The COVID-19 pandemic has created a barrier to the frequent face-to-face appointments that characterize the medical management of diabetes in pregnancy, highlighting the need for virtual health care. Innovative approaches to virtual health care, such as mobile health (mHealth) technology that facilitates patient-provider communication, offer a promising option to support maternal and fetal well-being. Among nonpregnant adults with diabetes, mHealth interventions are associated with statistically significant and clinically important improvements in glycemic control [
COVID-19 pandemic–induced limitations that impede face-to-face patient-provider communication may compromise the specialized and intensive care that supports expectant mothers with diabetes in achieving glycemic targets and optimizing pregnancy outcomes. It is possible that mHealth interventions that facilitate patient-provider communication may break down barriers and contribute to optimal glycemic control and pregnancy outcomes. These technologies ought to meet best practice standards for patient-centered communication. Therefore, the objective of this scoping review is to map the literature regarding patient-reported benefits and limitations of mHealth technologies that facilitate patient-provider communication in the context of diabetes in pregnancy. We will also determine how the women’s experiences align with the best practice standards for patient-centered communication, as described by King and Hoppe [
This scoping review protocol was preregistered with Open Science Framework (OSF) on March 25, 2021. Arksey and O’Malley’s framework for conducting scoping reviews [
The research question is twofold: (1) Among women with diabetes in pregnancy, what are the patient-reported benefits and limitations of mHealth technology? (2) How do the women’s experiences align with the best practice standards for patient-centered communication?
Relevant studies will be identified by search strategies developed by health science librarians. First, we will search MEDLINE, Embase, Emcare, and PsycINFO for qualitative studies. Secondly, we will search for quantitative literature in MEDLINE, Embase, and Emcare. The reference lists of relevant studies will also be reviewed to identify additional eligible studies.
Following database searches, duplicates will be removed in EndNote and the remaining studies will be transferred to DistillerSR for the title and abstract screening and full-text review. Studies eligible for inclusion are primary studies that report benefits and limitations of mHealth technology used to support or facilitate virtual care for pregnant patients with gestational or pre-existing diabetes. Title and abstract screening will determine whether the study is about mHealth technology in pregnant women with gestational or pre-existing diabetes. The full-text review will determine whether the study elicits patient-reported benefits and/or limitations of mHealth technology. Title and abstract screening and full-text review will be conducted independently by two reviewers (KS and QRW). Any discrepancies will be resolved through discussion or by the inclusion of a third reviewer (DS).
Data charting will be completed using a standardized data extraction tool. This tool will first be piloted to ensure accuracy and efficiency during the data charting process. Extracted data will include study characteristics, participant characteristics, and details regarding the described mHealth technologies. All text labelled “results” or “findings” in the included studies will also be extracted. Finally, relevant data will be extracted to determine how the women’s experiences align with King and Hoppe’s best practice standards for patient-centered communication [
The approach to data synthesis will be adapted from Thomas and Harden’s “Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews” [
As of August 2020, we have completed the qualitative search strategy. We carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies.
For women with diabetes, pregnancy is a critical period that requires intensive and specialized medical management to optimize perinatal outcomes. Among nonpregnant adults with diabetes, mHealth interventions have been shown to improve glycemic control [
Qualitative search strategy for Ovid MEDLINE, Embase, Emcare, and PsycINFO.
mobile health
Open Science Framework
Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews
KS and HT are supported through graduate scholarships. DS acknowledges her Heather M. Arthur Population Health Research Institute/Hamilton Health Sciences Chair in Inter-Professional Health Research.
KS drafted the manuscript. KS, QRW, HTM, DFL, and DS contributed to the design of the review protocol. All authors approved the final manuscript.
None declared.