What do hospital-based health professionals need and expect from an mHealth app to support the first 1000 days of life? Results from a cross sectional study

{"Background": "The first 1000 days of life\u2014from conception to age two\u2014are critical for maternal, newborn, and child health (MNCH) and influence lifelong health trajectories. Pregnant women and new mothers increasingly use digital media for health information, a trend accelerated by the COVID-19 pandemic. Despite numerous mHealth apps targeting this period, most fail to meet end-user needs, particularly regarding content validity, functionality, and technical features. Many apps also neglect the continuum from pregnancy through postpartum. This study aimed to explore the needs and expectations of hospital-based health professionals (secondary users) for a hypothetical mHealth app to support the first 1000 days of life, with the goal of informing a participatory co-design process.", "Methods": "From November 2021 to March 2022, a cross-sectional survey was conducted at the 136-bed Institute for Maternal and Child Health\u2014IRCCS 'Burlo Garofolo' in Trieste, Italy. All health professionals involved in maternal and child care (physicians, medical residents, midwives, nurses, support staff) were invited to participate. The 83-item questionnaire covered six domains: pregnancy care and counselling (26 items), postnatal care and counselling for mother and child (13 items), reminders and push notifications (4 items), notes and records (13 items), social support (4 items), and app technical features (23 items). Items were rated on a 5-point Likert scale (0=not important at all to 4=absolutely essential). Four additional questions assessed sources of patient information, expected improvements from the app, settings for information exchange, and barriers to communication. Sociodemographic data (professional profile, working area, years of experience) were collected. After excluding one item due to a typing error, 64 missing values (0.5%) were imputed using multivariate imputation via chained equations. Ward hierarchical clustering classified respondents by response patterns. Data were analyzed in R using dplyr, ggplot2, Hmisc, mice, and pvclust packages.", "Key Results": "145 questionnaires were collected. Participants included 33 physicians (23%), 43 medical residents (30%), 30 midwives (21%), 24 nurses (16%), and 15 support staff (10%). Working areas were obstetrics/gynecology (82, 57%), pediatrics (48, 33%), and nursery/neonatology (15, 10%). Most had >5 years experience (77, 53%). Health professionals reported that patients most frequently used social media (120, 83%), communities of practice (102, 70%), and live communities (96, 66%) as information sources. Expected improvements from the app included improved communication with patients (100, 69%) and better patient preparation (88, 61%), while fewer expected reduced time spent informing patients (51, 35%). Major barriers to information sharing were fake news (123, 85%), language difficulties (100, 69%), and low patient education (57, 39%). The highest-rated content items were general information about pregnancy health (very important/absolutely essential for 133, 92%; mean 3.54) and information about infections during pregnancy (132, 91%; mean 3.56). The lowest-rated items included integration with social networks (not important/little importance for 73, 50%; mean 1.51), ability to schedule appointments (68, 47%; mean 3.09), and recording routine activities (64, 44%; mean 1.73). Cluster analysis identified three groups: medium demanding (92/145, 63.4%), high demanding (30/145, 20.7%), and low demanding (23/145, 15.9%). The high demanding cluster rated all domains highly, while the low demanding cluster expressed skepticism, particularly about reminders, notes/records, and social support. Support staff were overrepresented in the high demanding cluster (53% of support staff), while medical residents predominated in medium (35%) and low (29%) clusters. Differences by professional profile (p=0.02) and working area (p=0.02) were statistically significant; no professionals from nursery/neonatology were in the low demanding cluster.", "Clinical Implications": "This study demonstrates that hospital-based health professionals generally recognize the value of an mHealth app for the first 1000 days of life, with strong endorsement for evidence-based content on pregnancy health and infection prevention. The discrepancy between health professionals' perception that patients primarily use social media and prior findings that patients prefer certified sources suggests a knowledge gap that an institutional app could address. The finding that most professionals (63.4%) fell into a medium-demanding cluster indicates readiness for telehealth integration, though skepticism about social features and tracking functionalities highlights the need for careful design. The app should prioritize free access, multilingual support, intuitive navigation, and appointment booking capabilities. The varying enthusiasm across professional roles\u2014with support staff most positive and medical residents more skeptical\u2014suggests that implementation strategies must address role-specific concerns about workload and workflow integration. These findings provide actionable guidance for co-designing mHealth solutions that can improve patient-professional communication and health literacy during this critical developmental window."}