A Technology-based Pregnancy Health and Wellness Intervention: The Two Happy Hearts Case Study during the COVID-19 Pandemic (Preprint)

BACKGROUND The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts (THH) intervention is a personalized mind-body program, coached by community health workers (CHWs), that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. OBJECTIVE The study objectives were to 1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and 2) explore the user’s engagement with the THH intervention prototype, as well as understand her experiences with the THH intervention prototype components. METHODS We recruited a 29-year-old woman, at 33 weeks gestation with a singleton pregnancy, and no medical complications or physical activity restrictions. She reported some college education and was identified as low income. The participant engaged in the THH intervention prototype from her third trimester until delivery. The Oura ring was used to continuously monitor objective physical and emotional states, such as heart rate, heart rate variability, sleep, and physical activity. In addition, the participant reported physical and emotional health using the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, State Trait Anxiety Inventory, as well as the app-based 24-hour recall surveys and Ecological Momentary Assessment. Objective data from the Oura ring and subjective self-reported data on physical and emotional health were described. Furthermore, the participant’s engagement in the THH intervention prototype was recorded using both the smart ring and THH mobile phone app, and her experiences collected via survey. Descriptive statistics and Pearson correlations were conducted. RESULTS Decreased resting heart rate was significantly and negatively correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: i) positive emotions and RMSSD (r=0.54., P<.001), ii) sleep quality and sleep score (r=0.52, P<.001), and iii) physical activity and step-count (r=0.23, P=.097). In addition, deep sleep appeared to increase as light and REM sleep decreased. The psychological measures of stress, depression, and anxiety decreased from baseline to post-intervention. Furthermore, the participant had a high completion rate of the THH intervention prototype components and shared several positive experiences, such as increased self-efficacy and an uncomplicated delivery. CONCLUSIONS The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.