Activity tracking devices in pregnancy: Understanding the participant experience in a longitudinal birth cohort

Abstract

Background:

Improving understanding of physical activity (PA) during pregnancy can inform future interventions and support the delivery of high-quality prenatal care.

Objectives:

Within the longitudinal birth cohort Research Enterprise to Advance Children’s Health (REACH), the sub-study REACH-Fitbit sought to understand the prenatal experiences of utilizing an activity monitoring device and best practices for receiving PA information.

Design:

REACH recruits gravid patients ⩾18 years old receiving prenatal care and planning to deliver at predefined hospitals. REACH-Fitbit participants had to be <20 weeks gestation with access to a Bluetooth-enabled device. Recruitment (self-selection) for focus groups occurred from completed REACH-Fitbit participants (e.g., delivered their baby).

Methods:

A semi-structured moderator guide was utilized to capture feedback on experiences, adherence to protocols, resources, and best practices for measuring PA during pregnancy. Two groups of six participants participated virtually, which included conversations about the overall participant experience, compliance with protocols, and opportunities for knowledge dissemination about PA.

Results:

The majority of focus group participants identified as Black, were between 20 and 29 years of age, and had positive feelings about the Fitbit, finding it usable and functional. Participants felt protocol compliance was facilitated by text message reminders and research team support, while barriers included Fitbit application problems, busy schedules, and forgetting. Participants preferred to receive PA information from a trusted healthcare source (e.g., doctor, nurse, or other healthcare provider), though most participants (57%) did not receive PA information during prenatal care. Participants were interested in learning about the safety, type, and amount of prenatal PA in which to engage.

Conclusion:

Findings presented here can support compliance in future studies or PA interventions utilizing similar technology. Incentives for compliance with study protocols and enhanced communication with the research team can improve participant engagement. Future work will address the need to communicate the interests of pregnant persons to clinical care teams, specifically, improvements to how providers share information on PA.

Plain language summary

Tracking physical activity during pregnancy: Understanding the participant experience

Measuring physical activity during pregnancy can give researchers and medical providers an understanding of how physical activity might affect a person’s health pre- and post- natally. A subset of participants in an ongoing study, which follows participants from early pregnancy through their child’s first few years of life, were asked to wear a Fitbit device during their pregnancy as part of a sub-study called REACH-Fitbit. This device was used to monitor behaviors such as physical activity and sleep. Once the participant delivered their baby, their Fitbit data was no longer tracked by the research team, and their participation in this sub-study was considered complete. Feedback from completed participants on their experience wearing the Fitbit as well as their preferences for how they would like to have received physical activity information during pregnancy were gathered via two focus group discussions. These discussions revealed that participant experiences with the Fitbit device were mostly positive, and that their participation in the sub-study was facilitated by the research team providing reminders and support. Barriers to their full participation included problems with the Fitbit application, busy schedules, and forgetfulness. When it came to preferences for learning about physical activity during pregnancy, participants indicated that they want to discuss this information with a trusted healthcare team member, and that they would be most interested in learning about the safety, type, and amount of physical activity to engage in during pregnancy. Overall, ways to improve engagement in the sub-study were identified, and future work will focus on communicating the interests of pregnant persons to healthcare team members.

Keywords

Fitbit physical activity focus groups prenatal care

Introduction

During pregnancy, women undergo numerous biological, hormonal, and psychological changes to accommodate the growing fetus.¹ Pregnancy is a unique timepoint to emphasize healthy behaviors to improve overall health and reduce the risk of pregnancy complications.² Physical activity (PA) is an example of a safe and healthy behavior to engage in during pregnancy and is recommended by the American College of Obstetricians and Gynecologists.^3,4 PA has numerous positive health outcomes for both the mother and her unborn child, including a reduced risk of excessive weight gain, gestational diabetes mellitus,^5
–13 preeclampsia, Cesarean section delivery,⁵ and preterm birth.^5
–13 PA is any bodily movement that is produced by the contraction of skeletal muscle and which substantially increases energy expenditure.¹⁴ The recommended guidelines for PA during pregnancy are at least 150 min of moderate-intensity aerobic activity a week.³ Women who were physically active before pregnancy can continue at their activity level (unless recommended otherwise by their healthcare provider), and those looking to develop PA behaviors are advised to increase activity in increments of 5 min a day until they can remain active for 30 min a day.³ Qualitatively, the present study is situated to understand the best practices for incorporating the longitudinal use of activity tracking devices (ATDs) to measure prenatal PA.

Although positive health benefits for pregnant women have been suggested, many findings are based on self-administered PA questionnaires.¹⁵ Little information is available about the quality of PA questionnaires during pregnancy. Criticisms for the current PA assessment approach include: lacking appropriate standards in data collection¹⁶ and overestimating levels of PA (compared to objective measures),^10,17 thus attenuating the quality of evidence. ATDs offer an opportunity to measure PA and appraise maternal daily energy expenditure and provide high-quality evidence for obstetric outcomes. ATDs (e.g., Fitbit; Fitbit Inc, San Francisco, CA, USA), use sensors for accelerometry and photoplethysmography to detect heart rate via changes in light absorbance through thin tissues.¹⁸ ATDs appear more accurate than self-reported measures among pregnant populations.^19
–21 Among the pregnant population, ATDs are valid²¹ and feasible^20,21; however, most investigations objectively measuring prenatal PA have been conducted in cross-sectional studies (e.g., only wearing ATDs for 7-day periods) and in the few United States studies, only some included diverse women in terms of race, ethnicity, and socioeconomic status.^21
–23 In addition, previous work using research-grade ATDs came up against barriers of the device being “bulky” and not visually appealing, which was related to reduced levels of compliance.²⁴ This field is rapidly advancing, requiring ongoing updates on the latest devices, emerging challenges, and future developments.

To understand the usability of ATDs in representative pregnancy research studies, particularly with relatively new devices like the Fitbit Charge 4 and 5 used in the present study, the collection of patient feedback is highly warranted.

Despite the evident importance of PA during pregnancy, pregnant women often report a lack of knowledge concerning the safety of exercising during pregnancy and desire information related to how to exercise during pregnancy safely and effectively.^25
–27 Most women indicate that their healthcare providers have the most influence on their beliefs regarding PA during pregnancy²⁸; however, 30%–75% of women self-report not having received advice on PA during prenatal care.^29
–34 Moreover, racial disparities in access to information about prenatal PA exist.³⁵

The goal of the present study was to understand the best ways to incorporate the longitudinal use of ATDs using a sub-study called Research Enterprise to Advance Children’s Health (REACH)-Fitbit, into an ongoing ethnically, racially, and sociodemographically diverse birth cohort, REACH, as well as to gather and report on participant feedback for other researchers who similarly may want to measure PA during pregnancy. Evidence suggests that patient/participant experience feedback improves patient adherence and compliance with research study protocols.^36,37 In addition, patient experience feedback informs healthcare systems and providers with insight to better meet the needs of their patient population.^37
–39 Participants who completed the REACH-Fitbit study were asked to participate in a focus group aimed to gain feedback to improve participant experience, adherence, and compliance to study protocols. Moreover, the preferences, attitudes, and knowledge of PA in pregnancy were also assessed to gain insight into the understanding of PA during pregnancy.

Materials and methods

Ethics approval and consent to participate

The Institutional Review Board of Henry Ford Health granted ethical approval for this study (#16140-01). All participants provided informed consent prior to participation via an electronic consent form. All study procedures were carried out in accordance with relevant guidelines and regulations. The researchers and staff have experience working with vulnerable populations, and all considerations were given as required by our IRB Board.

Study design

REACH is an ongoing longitudinal birth cohort study, with a goal of recruiting 3000 pregnant women seeking prenatal care at Henry Ford Health. Participants are being recruited from the Detroit Metropolitan area, with the broad goal of understanding outcomes such as preterm birth and childhood asthma and allergy. Currently, participation in REACH can last from pregnancy through the child’s first few years of life. REACH study participants must be 18 years of age, and as an observational study, participants are not excluded based on medical or obstetric history, unless they or their healthcare provider choose to discontinue their participation. Henry Ford Health is a 501(c)(3) organization serving a diverse community wherein 8.7% of residents are uninsured and 58.6% have public health insurance,⁴⁰ 22.6% have no car,⁴¹ 87% are non-White, and 31% of persons are living below the poverty.⁴² REACH-Fitbit aims to recruit 500 REACH participants early in pregnancy (before 20 weeks of gestation who must have access to a Bluetooth-enabled device with the goal of using an ATD (i.e., Fitbit Charge 4 or 5) to objectively understand changes in PA, heart rate, and sleep in a sociodemographically diverse population, as well as how these factors impact obstetric outcomes (e.g., perinatal mental health, gestational diabetes, and preeclampsia). Fitbit devices are purchased from Google (Fitbit Inc.) for this study through the Fitbit Enterprise for Researchers, and Fitbit Inc. has reviewed and approved our research application. Compliance with the REACH-Fitbit study protocol is measured using intraday heart rate: a measure of heart rate is generated every 15 min. Compliance is defined as wearing the device (having heart rate data) for more than 10 h/day. An overall compliance rating percentage is calculated by the count of compliant days in the study divided by the count of total days enrolled in the study. The study reported here sought to garner qualitative participant feedback from completed REACH-Fitbit participants (i.e., delivered their baby) via focus groups. Recruitment for REACH-Fitbit began in February 2022 and is ongoing. This manuscript is based on completed participants from sub-cohort inception through January 2023.

At the time of recruitment, all 56 participants who had completed REACH-Fitbit (e.g., delivered their baby) were approached via email to participate in the focus groups. Interested and eligible focus group participants provided informed consent via REDCap (Vanderbilt University, Nashville, TN, USA).^43,44 Aligned with Braun and Clarke’s view on data saturation,⁴⁵ this was not our main goal of sample size selection, rather, achievement of our study goals (gathering feedback and ideas for the study, wherein no new themes emerged) and ensuring that diverse perspectives were captured was our aim.

REACH-Fitbit participant experience

After being recruited and consented to REACH-Fitbit, a study team member meets with the participant to discuss the sub-study procedures. Participants are provided with a folder to take home, which includes a welcome message, a study timeline, and Fitbit device instructions. These handouts are to help the participant learn more about what data is being collected, why the data is being collected, and ways to assist the participant in using the device. Then the study team hands off the device, assists the participant in creating a Fitbit account, downloading the mobile application that connects via Bluetooth, and obtaining the participant’s explicit consent to access and use their Fitbit data. During the appointment, it is expressed that, as an observational study, the study team members are not asking the participant to make any changes to their lifestyle. Rather, participants are asked to go about their day-to-day activities as they normally would. Thus, the study team does not give participants explicit PA guidelines to follow or changes to make during their pregnancy. Expectations of participation include wearing the device 24/7, except to charge, and syncing the device regularly via the mobile application. Along the way, participants are provided with support by study team members, reminders and check-ins via text message, email, and telephone call, a paper resource with troubleshooting advice, and e-resources covering topics related to the device features and capabilities.

Data generation: focus groups

A semi-structured moderator guide⁴⁶ was developed and utilized in two virtual focus groups, which were conducted via Webex (Cisco Systems, Inc., San Jose, CA, USA). The guide was developed by authors AR and SS, who each have extensive training in qualitative research, and though not pilot tested with participants because of limited resources (e.g., funding) and the study’s focus on exploring general themes rather than testing specific hypotheses, it was reviewed extensively by the study team (researchers are each women, represent multiple racial and ethnic backgrounds and varying experiences with pregnancy). AR, who holds a master’s degree in public health, was selected to facilitate the focus groups due to her experience in women’s health and interest in quantitative data collection methods. AR is a skilled moderator utilizing active listening and neutral facilitation as quality control measures while ensuring all participants have a chance to contribute to the discussion. SS, the sub-study Principal Investigator, leveraged her doctoral training in kinesiology and her knowledge of the project goals and topic area to guide item construction. The moderator guide was composed of five sections. In the first section, facilitator AR and a notetaker from the study team introduced themselves and provided background about the sub-study. In the second section, the goal of soliciting patient perspectives and feedback was described. Defining clear objectives acts as a quality control measure for focus groups. The third section was an icebreaker, wherein participants introduced themselves and shared their new baby’s age and their favorite Fitbit feature. In the fourth section, key questions regarding sub-study experiences, adherence to sub-study protocols, sub-study resources, and prenatal opportunities related to PA were asked. Questions were open-ended to encourage detailed responses and rich discussion, and balanced to include both positive and negative aspects of the topic to avoid bias. The final section involved a wrap-up by way of the facilitator summarizing the main points of discussion and providing an opportunity for participants to ask any outstanding questions or share remaining feedback. Following the discussion, participants were compensated $25 for their time. Compensating research participants, although there are conflicting findings⁴⁷; can result in undue inducement and social desirability biases; this is more likely when the amount of payment offered to participants is very large. The compensation amount of $25 is modest and reflects the time commitment and inconvenience involved in the study. The notetaker sent and discussed field notes with the facilitator AR after all participants had exited the session. No repeat interviews were conducted, and transcripts were not returned to participants for comments or correction.

Data analysis

Transcripts, auto-generated by Webex, were cleaned by a study analyst using the original audio file for validation (DC). Focused coding was completed in NVivo 14 by one coder (AR) utilizing a structured codebook to guide the data analysis. This aligns with Braun and Clarke’s stance on the use of one coder and the assumptions underpinning “accurate” coding.⁴⁸ Once data were coded, a thematic analysis⁴⁹ was conducted wherein themes corresponding to the study goals and moderator guide were identified. As it was not included in the study protocol, participants did not provide feedback on the findings.

Overall, Fitbit compliance rating percentage calculations were extracted for each participant, as having diversity in compliance with study protocols could provide context for what individual participants were sharing.

Study quality

The consolidated criteria for reporting qualitative research (Supplemental File [COREQ]) guidelines were followed in the preparation of this manuscript to ensure all processes and findings were shared in a transparent and comprehensive manner.⁵⁰ A well-designed moderator guide, skilled moderator, and appropriate settings and logistics (e.g., comfortable space and properly recorded) provide key quality control measures for focus groups. In addition, the coder took reflective notes throughout the coding process, with the purpose of reassessing her impressions and reactions (i.e., triangulation and another quality control measure) and preventing preexisting assumptions from influencing the analysis.

Results

Non-probability volunteer (self-selection), purposive sampling was used. All completed REACH-Fitbit participants (N = 56) were contacted via email in January of 2023 with information about the focus group study. Recruitment remained open for 3 weeks, and during this time, potential participants received up to two reminder emails. A total of 17 (30%) individuals consented to participate in the focus groups. Not all who consented actually participated in a focus group (29% did not attend). Reasons for attrition included participants’ schedule changes, or they forgot. Ultimately, 12 individuals (n = 6 per group) participated across 2 focus groups in February 2023, which lasted an average of 40 min. The majority of participants identified as Black, between 20 and 29 years of age, and the average study compliance of focus group participants was 64%, with a range of 4.6%–99.3% (Table 1).

Table 1.

Participant demographics.

Participant identifier	Age range (years)	Compliance (%)	Parity
P1	40+	18.02	2
P2	20–29	4.62	1
P3	20–29	26.14	1
P4	20–29	65.56	1
P5	20–29	87.82	3
P6	30–39	96.34	1
P7	30–39	90.65	3
P8	20–29	99.30	1
P9	30–39	66.39	3
P10	30–39	99.22	2
P11	20–29	39.02	1
P12	20–29	71.24	4

The overall compliance rating percentage is calculated by the count of compliant days in the study divided by the count of total days enrolled in the study.

The four themes presented below are: Experience Using the Fitbit Device and Application, Study-related Resources, Compliance with Study Protocols, and Patient-Provider Communication. Illustrative quotes supporting each theme are provided.

Experience using the Fitbit device and application

Participants shared their perspectives on the usability and features of the Fitbit.

Usability

Though the device itself was regarded as “straightforward” and “simple” to use, the associated Fitbit application, which participants access via their smartphone to sync their activity data, was less intuitive. A minority of participants regarded the application itself as unreliable (“It’ll sync in for one day then the next day, it won’t go in”—P4), and a participant suggested that this was burdensome: “It only got frustrating because I would like click on the app and I don’t know if it was like the connection from my phone itself, but sometimes it would sync quick, and sometimes it’ll seem like it’s taking forever and I’m like, I got other stuff I got to do.” —P8.

Functionality

The device itself appealed to participants: “My sister has a Fitbit, and my best friend has a Fitbit, so they were telling me little things to do. . .it’s really cool.”—P1. Participants expressed enjoyment of device features such as the step count, the alarms, the battery life, reminders to breathe, and the size and color of the device itself. Some stated that they preferred the Fitbit device to Apple Watches, which they had worn previously.

Study-related resources

Participants were asked to think back on their engagement with study resources, which included a paper-copy “Troubleshooting Your Device” document, infographics sent via email, and access to study team members via telephone call, email, text, and in-person conversations.

Paper and e-resources

Largely, participants agreed that they did not read the paper resource provided, though some clarified that this was due to them having no need for troubleshooting information: “I feel like I would have read it had I had an issue, but it was pretty smooth using [the Fitbit].”—P5. The e-resources, infographics containing information pertaining to different Fitbit features, such as heart rate and sleep measures, were read by some participants and considered helpful. One participant elaborated, “I was excited getting the Fitbit, so I definitely read it. . .I was having a lot of hard days too, so it was kind of a highlight for me.”—P3. A participant who did not interact with these infographics explained: “I had a Fitbit before, so I was aware of how they worked and everything. So, I don’t know if I paid attention to that part, but I’m sure it might be helpful for someone who had not had a Fitbit before.”—P10.

Study team

Interactions with the research staff were regarded positively. Participants cited the way that study team members made the device set-up simple and efficient and regarded the staff as problem-solvers: “Any time I had a problem, I would just call, and they would fix the problem. They always checked in to make sure everything was okay.”—P7. Reminders to complete sub-study activities, sent from the research staff to the participants, were appreciated.

Compliance with study protocols

As consistently wearing the Fitbit and completing frequent data uploads was required of participants, they shared the factors that facilitated and prevented them from having high compliance with wearing and syncing the Fitbit device.

Facilitators

Overwhelmingly, receiving text message reminders to sync data was the most common facilitator of compliance. Similarly, participants shared that support from research staff was crucial to their successful completion of participant expectations. The other facilitating factor shared was the receipt of REACH incentives such as baby items and monetary gifts: “Well, the little gifts definitely helped. The little gifts we received kept me going.”—P12.

Barriers

One barrier mentioned was related to previously mentioned usability issues with the application, wherein sometimes participants did not know that their data upload was unsuccessful. Multiple users cited “pregnancy brain,” and simply not remembering to put the device back on after charging it, forgetting to charge the device (resulting in the device dying instead of tracking data), or forgetting to upload their data each day. Others had busy schedules with careers and other children, which led them to forget. One referenced simply not liking wearing the device so often, though their compliance remained high: “Because I didn’t like wearing. . .I found it really annoying like wearing it in bed and in the shower.”—P6.

Participant-generated ideas for study compliance

Participants were interested in sharing strategies that aided their compliance, as well as ideas that they had for others. These included (1) Participants creating reminders for themselves on their cell phones; (2) having compliance “goals,” generated by the study team, to keep them consistent; and (3) the study team offering additional incentives such as gifts or gift cards. Participants were especially interested in receiving new watch bands or items for their new baby.

Patient-provider communication

Since the study team also wants to understand and characterize PA for pregnant women broadly, the focus groups sought insight into patient-provider communication about PA.

PA information

Participants described inconsistent dissemination of PA information throughout their prenatal care. The majority of participants (57%) endorsed that they did not receive any PA information during their prenatal medical visits, but all participants (100%) endorsed that this information was important to them. Regarding what type of information interested the women specifically, the most common areas were the safety of PA, the type of PA, and amount of PA. For example, one participant shared her concern about the amount of PA, “You have to exercise, right? You have to move around for the baby’s health as well. How much is too much or how much is too little?”—P5. One participant cited being unsure about how her health conditions (i.e., having preeclampsia) may affect how she should adhere to typical PA recommendations for pregnant women.

Dissemination opportunities

Regarding how participants would like PA information shared with them, many participants shared that they would have liked to have a conversation with their doctor during a prenatal care appointment. Many mentioned that they often felt rushed during the prenatal care appointments, which they viewed as the reason why these conversations did not take place. Participants were open to anyone on the medical team sharing this information, not just their doctor, illustratively: “It doesn’t matter who shares it, I mean, everyone is helping us and telling us different stuff and its very helpful because everybody knows different stuff. They all been in the field to see what is going on, so information from anyone from like a part of the doctor field, it can be helpful from any one of them.”—P7. Some participants recommended paperwork that they could peruse on their own time: “How they give paperwork at your appointment and stuff, like that. I think it may be a pamphlet or something like that, that just describes what is safe and what isn’t safe.”—P3. One participant, however, shared that she does not typically read paperwork, so this strategy alone might not reach her. One participant specified preferring a combination of both in-person conversation and paperwork to take home: “Personally, I think that when you’re pregnant, you may forget. You’re tired, you know, you’re just pregnant. Lord knows what may happen. So, I think that maybe getting both would be really good because then you’ll have the document and you could be like, oh I don’t remember the exercise the doctor told me. Then you can just go right to the paper and look at it instead of just not doing it in general.”—P8.

Discussion

Leveraging participant experience feedback, the present study provides insight into the best ways to incorporate the longitudinal use of ATDs into sociodemographically diverse birth cohort studies. Focus groups were used to explore sub-study experiences, adherence to sub-study protocols, and sub-study resources, as well as preferences, attitudes, and knowledge of PA in pregnancy. From these focus groups, completed REACH-Fitbit participants have provided feedback, which has been grouped into four themes: Experience using the Fitbit Device, Study-related Resources, Compliance with Study Protocols, and Patient-Provider Communication. Overall, findings suggest that support from the study team was associated with compliance, while the busyness of life and being a mom/being pregnant were barriers to compliance. Of note, even participants with low compliance enjoyed having and using the device. Many participants desired to learn more from trusted sources about PA during pregnancy. Importantly, themes may interrelate or impact each other. For example, usability issues with the app might negatively affect compliance, and study team interactions may positively affect compliance. As there is a paucity of longitudinally collected, objectively measured PA data during pregnancy, especially in diverse pregnant persons, it is critical to incorporate participant feedback into the sub-study design to maximize adherence and compliance.

The feedback provided by REACH-Fitbit participants, reported here, has directly impacted changes to the REACH-Fitbit sub-study design moving forward. To improve sub-study experience and compliance with sub-study protocols, participant-generated ideas have been incorporated into the REACH-Fitbit study protocol. These include improvements related to the initial appointment at which participants are given their device, communication touchpoints, and additional incentives, each of which is described in more detail below.

Participants reported having trouble consistently remembering to upload their data and that usability issues with the device sometimes prevented well-intentioned efforts to complete this task. Moving forward, at the time of Fitbit deployment, participants are encouraged by study staff to create reminders for themselves on their cell phones (e.g., calendar apps) or alarms on the device itself to sync their devices consistently. The study folder given at the time of deployment has been made more concise with clear, pertinent information that fits on a single sheet of paper, and with better instructions highlighting elements of the device that are most important to the participant.

Weekly communication now occurs with participants to provide insight into the previous week’s compliance. Tailored text messages based on compliance are generated by the study team. Telephone calls are made to those participants appearing to not wear the device (no data). This communication is treated like a wellness check—not accusatory, but as an act of quality checking our data records with the participant and engaging in troubleshooting if necessary. To further increase engagement, the return of results (e.g., participant newsletters sharing data like how much sleep sub-study participants average per night) are now being provided via a bi-weekly bulletin that is sent via text. A growing body of literature shows that returning aggregate study results to participants promotes transparency, makes participants feel valued and respected, and even may be considered an ethical obligation.^51,52 In one study, receiving aggregate results was associated with increased willingness to participate in research in a diverse population.⁵³

As participants mentioned that they enjoyed receiving additional incentives such as gifts or gift cards, REACH-Fitbit has initiated a monthly raffle for a gift card valued up to $100. Participants can earn weekly entries into the raffle by being compliant in the sub-study (10 h/day 4 out of 7 days/week), a strategy utilized in various longitudinal studies.^54,55

Just as a provider’s recommendations can influence engagement in PA, barriers and misconceptions about PA can also influence a woman’s decision to engage in PA during pregnancy. Some common barriers to PA among pregnant women are concerns about safety, pregnancy discomforts, the lack of knowledge, lack of recreational facility access, fatigue, shortness of breath, low motivation, and more.⁵⁶ These barriers were echoed during the focus group in which participants from the REACH-Fitbit study gave feedback based on their experiences in the sub-study. This feedback, coupled with the fact that many participants did not learn about PA during their prenatal visits, clarifies that the present information is relevant to prenatal care providers and must be presented to them to prioritize patients’ needs and interests.

Strengths and limitations

Strengths of the current study include a representative sample with varying levels of sub-study compliance and incorporation of the participant’s voice into the ongoing sub-study. An additional strength is the novelty of the Fitbit Charge 4 and 5 devices to measure PA in pregnancy. A notable limitation is the small sample size, which may limit the generalizability of the findings and the potential for data saturation. Although researchers have argued the subjective nature of sample size in qualitative research,⁵⁷ examining ATD utilization and patient-provider communications surrounding PA information provided prenatally among other pregnant persons, in a larger sample size, is warranted. As mentioned previously, the moderator guide was not pilot tested and relied on the stated expertise of the researchers. Pilot testing can help ensure the effectiveness of the guide and should be considered in future studies to further refine the data collection process. Additionally, it is possible that selection bias occurred, as the majority of the focus group participants had REACH-Fitbit compliance levels of over 60%. Finally, no member-checking occurred, a potential limitation, though it has been posited that this process may be an additional burden on already overburdened populations, such as the sample reported here,⁵⁸ future studies may seek to include member-checking as a way to strengthen confirmability.

Conclusions

Incorporating the participant voice into an ongoing research project has the potential to improve engagement and compliance and enhance the participant experience. PA is of interest to pregnant women, and there is a need for pregnant women to receive PA information during the prenatal period. Future work will address the need to communicate the interests of pregnant women to clinical care teams, specifically improvements to how providers share PA information with this population (e.g., using tailored approaches⁵⁹). Moreover, the findings presented here can support the study design for other researchers who plan on measuring prenatal PA.

Supplemental Material

sj-docx-1-whe-10.1177_17455057251344388 – Supplemental material for Activity tracking devices in pregnancy: Understanding the participant experience in a longitudinal birth cohort

Supplemental material, sj-docx-1-whe-10.1177_17455057251344388 for Activity tracking devices in pregnancy: Understanding the participant experience in a longitudinal birth cohort by Ashley Redding, Dionne Coates, Andrea E. Cassidy-Bushrow, Jennifer K. Straughen and Sara Santarossa in Women’s Health

Footnotes

Acknowledgements

The study team would like to acknowledge Ms. Dana Murphy and Ms. Jean Lava, Public Health Sciences, Henry Ford Health, for conducting recruitment for the focus groups and for Ms. Lava participating in the sessions as a notetaker.

ORCID iDs

Ashley Redding

Jennifer K. Straughen

Sara Santarossa

Ethical considerations

The Institutional Review Board of Henry Ford Health granted ethical approval for this study (#16140-01). All study procedures were carried out in accordance with relevant guidelines and regulations. The researchers and staff have experience working with vulnerable populations and all considerations were given as required by our IRB Board.

Consent to participate

All participants provided informed consent prior to participation via an electronic consent form.

Consent for publication

Not applicable.

Author contributions

Ashley Redding: Conceptualization; Methodology; Data curation; Formal analysis; Project administration; Writing – original draft; Writing – review & editing.

Dionne Coates: Project administration; Data curation; Writing – review & editing.

Andrea E. Cassidy-Bushrow: Conceptualization; Writing – review & editing; Funding acquisition.

Jennifer K. Straughen: Conceptualization; Writing – review & editing; Funding acquisition.

Sara Santarossa: Supervision; Conceptualization; Writing – original draft; Writing – review & editing; Methodology; Funding acquisition.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by: NIAID 5P01AI089473, pilot funds from the Center for Research in Reproduction and Lifelong Health, fund for Henry Ford Hospital, and HFH Mentored Scientist Award.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data used and analyzed in the present study are available from the corresponding author on reasonable request.

Supplemental material

Supplemental material for this article is available online.

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