In conversation with: Dr. Beth Holder, Lecturer in Maternal and Fetal Health
Working within the Institute of Reproductive Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London.
What is the MatImms app?
The MatImms app is a free educational smartphone app, which is aimed primarily at pregnant women. The objective of the app is to provide reliable information about vaccinations in pregnancy. This includes background on the immune system and how vaccines work, as well as what vaccines are available and how women can get them. We also included a calendar function, where women can put a vaccine reminder into their phone.
How did the app come about?
In 2013, I was part of a research project at Imperial, also called MatImms. This study was headed up by Professor Beate Kampmann, a consultant paediatrician and Professor in Infection and Immunity. The study involved looking into the uptake of vaccines by pregnant women, and the potential barriers or encouraging factors that feed into that uptake. Through this study we found that awareness of maternal vaccines was quite low at this time, and many women didn’t understand what vaccines were available and how they worked. Although Public Health England and the NHS had been really good at introducing protective vaccines into maternity care, not enough was being done to inform and educate parents-to-be.
Knowing that there is a high level of smartphone ownership and app use amongst pregnant women, we decided to make the MatImms app to try and help fill this gap in peoples’ knowledge. Beate was successful at getting some additional funding from the NIHR Imperial Biomedical Research Centre, and the journey began!
You say that women were unaware of maternal vaccines, can you tell us a bit about what these are and why we need them?
The term ‘maternal vaccines’ just means vaccines given during pregnancy. Some people call them ‘pregnancy vaccines’.
For several years now, flu vaccination has been recommended in pregnancy because pregnant women can get very severe flu disease, which can result in hospitalisation and risk of death for both her and her baby. More recently, vaccination against whooping cough has also been introduced. The reasons behind the maternal whooping vaccine are a little different. The aim of this vaccine is to help protect babies in the first few weeks of life, by boosting the levels of protective immunity passed from mother to baby during pregnancy. The UK, and many other countries, has seen a large increase in whooping cough infections in recent years, particularly in very young infants who are most vulnerable to severe complications. Sadly 14 babies died of whooping cough in 2012 – this was the catalyst for introducing the maternal whooping cough vaccine in the UK.
The vaccine has been shown to be very effective, and safe. Now, we need to focus on making sure that pregnant women are aware of, and informed about, the benefits of this vaccine.
Tell us a bit more about yourself and the team
Professor Beate Kampmann heads up the team. I am a biologist, and previously worked 100% on the laboratory side of the MatImms research project but have become increasingly involved in the patient-facing aspects of MatImms. We were joined by research midwifes, notably Beverly Donaldson and Anna Bosanquet, and more recently by Helen Skirrow, a public health doctor. The research midwives and Helen did all the work speaking to pregnant women and finding out their views of maternal vaccination. Although not direct members of the MatImms team, we have also worked closely with the vaccination midwives in the hospital who are doing a fantastic job at improving vaccination rates. They have been helping us to monitor the uptake of maternal vaccines since being introduced into our antenatal clinics. They have also been great advocates of the MatImms app and have been advertising it for us in the hospital.
Who are the stakeholders in the app and how did you involve them?
When we initially developed the app, we viewed pregnant women as the stakeholders in the app. We developed all the content of the app ourselves, and then we did some usability testing with pregnant women.
After getting feedback from these women, we later realised that we should have involved them much earlier in the research cycle. We were able to make changes to the content, based on their feedback. However, it was too late to change the structure of the app, without repaying the app developers. Some women would have preferred to have the app structured more flexibly, rather than the linear ‘journey’ structure that we created. This is something we definitely learnt from during this process. If we did it again, I think we would have done some testing using a ‘mocked-up’ version of the app, rather than the finished product. Making an app is very different from making a website!
Did you identify any other stakeholders in the app?
Yes, we did! But unfortunately, this was a little later in the process; another example of how we learnt during our journey. Some of this learning came from feedback from colleagues and our usability testing. The rest came from attending the CRISH course at Imperial College. Here we started to think more laterally about the stakeholders, and as a result identified a lot more: expectant fathers/partners, the family of pregnant women, friends, midwives, doctors, GPs, public health professionals, organisations like the Royal College for Midwives… the list became very long!
If we started this process again, I think we would all agree that we would spend more time at the very beginning of the project identifying all the potential stakeholders and thinking about how we could involve them at all stages of the research cycle. For example, we could have also done a focus group with expectant fathers, or with pregnant womens’ mothers/mother-in-laws. These people play a big supportive role in decision-making during pregnancy. In addition, many organisations wanted to be involved in the actual development of the app in order to give official endorsement. On the flip side of this, we would need to consider if we’d actually want endorsement if that limited our flexibility and ability to make changes to the app in the future.
So, what would your take home advice be for those developing a smartphone app?
I would suggest the following approach:
- At the beginning, identify ALL the stakeholders. It may be many more than you first realise! Decide who is your target market.
- Think about whether you can make an app that serves everyone’s needs, or perhaps an app with different sections for different people.
- Map out the app on pieces of paper or on your own computer. Use this to get feedback from your target group right from the beginning.
- Once you have decided on a basic ‘structure’ for the app, try and mock this up in some way. We did this in PowerPoint. Then do usability testing using this mock-up.
- Think about whether you want to seek endorsement from any organisations (such as the NHS, charities, or professional bodies). They will want to review the app and make comments. Decide if this is compatible with your plans for now, and the future.
- Finally, get the app developed! Ideally with the option to do interim testing.
- Test with the target audience again, before release!
- Perform periodic assessment and testing.