Title: Needs and preferences of women with prior severe preeclampsia regarding app-based
cardiovascular health promotion
Version: 1 Date: 19 Jul 2022
Reviewer's report:
Thank you for the opportunity to review this manuscript on the Needs and preferences of women
with prior severe preeclampsia regarding app-based cardiovascular health promotion. This is a
well-written manuscript that will contribute to the literature.
The style of writing is clear and the findings are interesting.
Introduction
The authors need to expand the introduction section.
How prevalent is pre-eclampsia and does this prevalence differ by age or other maternal
characteristics? What predisposes women to pre-eclampsia and how can this be minimised?
Are there similar interventions out there and how is yours different? What is your USP?
How many pregnancies are complicated by pre-eclampsia every year? What proportion of
women are affected? The reader needs to appreciate the severity of the problem in order to
appreciate the importance of the intervention.
Apps are universal and indeed have significant advantage over computers and web browsers but
the introduction does not emphasise the pervasiveness of apps nor does it mention the proportion
of women who use health apps.
Methods
The authors should make clear whether an upper age limit was applied to the study sample.
“Recruitment was considered complete after data saturation was reached, i.e., when authors LLK
and MvdB agreed that new themes were not expected to arise from the inclusion of additional
participants (32)” This statement is misleading as data saturation only applies to qualitative
studies and I believe the authors have conducted a quantitative survey. How did the authors
decide on the sample size?
It is always a good idea to involve patients and members of the public in research to some
degree. Was the research instrument pilot tested or were recruitment materials scrutinised by
others outside the research team?
The response rate to the survey is quite low, do the authors have an explanation why 119 were
invited but only 35 completed the survey?
I just wondered how useful it was grading the response of whether participants were interested
in partaking in app-based intervention on a seven point scale. I feel a yes/no option would have
sufficed. Could the authors shed some light on their decision?
Finding out the proportion of women in the study who use a health app would have been useful.
More information needed on how the survey was developed.
Results
How many respondents provided qualitative responses to each open-ended question?
Discussion
The 12 week intervention duration has been used in other studies, the authors need to identify the
benefits and limitations of this and whether 12 weeks is enough time to observe desirable effects.
The authors need to acknowledge that the sample size is quite small to be able to make valid
inferences and generalisations.
The authors also need to consider the possibility that the study sample (being highly educated)
may be more favourable towards using a mHealth app compared to other members of the
population.
The authors need to discuss the challenges of mHealth app uptake / usage and strategies for
minimising these challenges and improving usage as considerations for future studies. They
should also include how adherence could be monitored and ensured. They should also take into
account the availability of other health apps that already do some of the things the proposed
app would be doing.