以理論為基礎的應用程式於過重及肥胖孕婦在管理妊娠體重增加的可接受性──混合研究法

Acceptability of a theory-based app to manage gestational weight gain for overweight and obese pregnant women- A mixed-methods study

緒論：過重與肥胖婦女於懷孕期間體重增加過多，不僅對孕婦及胎兒的健康上有風險，甚至在產後也會涎生體重滯留及長期的肥胖問題。雖然目前有許多以孕婦為對象的應用程式，但在台灣仍缺乏以整合理論及臨床的證據，採嚴謹的研究方法，且以過重及肥胖婦女進行懷孕期間體重管理的應用程式。本研究目的乃以社會認知理論為基礎開發的應用程式，以協助過重及肥胖孕婦進行體重管理，並瞭解該應用程式對過重及肥胖孕婦的可接受性、可行性及初步成效。方法：本研究乃運用混合研究法。量性研究的部份採前後測實驗設計，並輔以問卷調查的方式收集資料。質性研究則採訪談方式來評估實驗介入的初步成效(自我效能及孕期體重管理)及對應用程式介入的可接受度。量性資料分析運用SPSS軟體20.0版本，質性資料則使用主題分析方式。結果：研究對象在自我效能的整體分數、飲食及運動層面皆較後測高於前測，但未呈顯著差異(p > .05)。所有的研究對象(100%)的體重皆有達到理想的孕期體重增加量。藉由使用該應用程式，研究對象可以設定目標、自我監測、自我評值及自我調整來增進孕期體重管理的自我效能。應用程式乃以使用者為中心的功能設計，及個別性的簡訊服務以增加研究對象在孕期體重管理的黏著性。結論：以理論為基礎的應用程式顯示對過重及肥胖孕婦在體重管理的潛在成效及使用的高度可接受性。未來可運用應用程式來協助健康照護人員共同照護過重及肥胖孕婦，增進健康行為，以預防孕期體重增加過多。

Introduction: Overweight and obese women’s excessive gestational weight gain presents a health risk for both mothers and fetuses, resulting in postpartum weight retention and long-term obesity. Despite the abundance of existing applications for pregnant women, there is a lack of methodological guidelines for integrating theory and clinical evidence to assist Taiwanese overweight and obese women in managing their gestational weight gain (GWG). This study aims to develop an mHealth application based on social-cognitive theory and assess its acceptability, focusing on the enhanced self-efficacy. Additionally, it seeks to investigate the prelimliary effects of this app on GWG management in overweight and obese women during pregnancy. Methods: Using a mixed-method approach, a pretest/posttest experimental design employing questionnaires and qualitative interviews was used to assess the preliminary effects (self-efficacy and managing gestational weight gain) and acceptability of the interventions. The quantitative data analyses were performed using SPSS for Windows, version 20.0, and the qualitative data were thematically analyzed. Results: Compared to the pretest scores, participants exhibited increased posttest scores in categories of overall-, diet-, and exercise-efficacy, as well as increased step counts. However, these improvements were not statistically significant (p > .05) even though all participants subsequently achieved optimal GWG (100%). By utilizing this app, they could set goals, self-monitoring, self-evaluation, and self-regulation to promote self-efficacy in managing gestational weight gain: the user-centered feature and short message service to adhere to gestational weight gain management. Conclusion: This theory-based app showed potential efficacy for weight management and was accepted by individuals in the overweight and obese subgroup. Its potential usefulness for healthcare professionals to assist overweight and obese pregnant women in preventing excessive gestational weight gain by promoting healthy behavior.