Demographic differences in usage of an electronic health intervention for pregnant women

Introduction: The high prevalence of excessive gestational weight gain among US women (46%) and increasing access to the Internet indicate that an online intervention could contribute to obesity prevention. Methods: We developed an online health intervention for pregnant women 18-35 years old that utilizes a website and text/e-mail messages. Utilization of the pregnancy website and text/e-mail reminders was examined among a racially/ethnically diverse sample of higher and lower income pregnant women. Results: The sample reflects the study population: 53.7% lower income (<185% poverty line); 63% White, 25% African American/Black, 14% Latina; 54% normal BMI, 30% overweight BMI, 16% class 1 obese BMI. Among women in the study for a month or more (n=877), 77% used the website at least once. While there was a statistically significant difference (p < .001) between lower and higher income women in utilization of the website, it was not as great as anticipated: 70% versus 83%. 62% requested at least one reminder. Of those 545 subjects who requested reminders, 36% were text messages and 64% e-mail messages. Lower income women were significantly less likely to login, enter weights, and request reminders than higher income women. Viewing of articles was not significantly different. There were no differences across BMI category in website utilization or request of reminders, including weight entries. Discussion: Overall utilization of this online pregnancy intervention was above the average for online interventions reported in the literature, but disparities in Internet access and utilization remain a concern for expanding the reach of web-based interventions.