The study was conducted at the University Hospital of Heidelberg with pregnant women and young mothers, as well as health care experts [22]. Study participants were recruited between November 2021 and March 2022. We used purposive sampling to include all perspectives necessary for the conception of an app-based perinatal guidance program. Overall, we recruited 9 prospective users, among whom 5 users were pregnant and 4 users had infants, and 13 experts from all areas of perinatal services (Table 1). Eligibility criteria for users were older than 18 years of age and fluency in German. To be eligible for participation, service providers had to be involved in the care of pregnant women or young families. We conducted interviews until information saturation was reached.

Semistructured interviews with a mean length of 32.45 (SD 9.54) minutes were held by 3 trained investigators following a previously established interview guide with primarily open-ended questions. At the end of the semistructured interviews, we added a general survey of the participants’ perspective on digital health with primarily closed-ended questions, using a scaling system (Multimedia Appendix 1). We performed systematic text condensation on the responses to the questions, which is a descriptive method concentrating on people’s experiences rather than the underlying meaning [23]. Through meaning units, we established a coding scheme to form predominant themes in accordance with our research questions. Researcher triangulation was used to increase reliability. Specific quotes were translated into English to underline the main perspectives. The answers to the digital health survey were assessed through descriptive statistics.

The study aimed to explore the perceived status quo of perinatal services and investigate whether there was a demand for a digital navigator, and also determine preuse acceptance of the planned mHealth intervention study [24]. Second, we wanted to give our prospective users and collaborators a voice within the conception phase of the app. Data were analyzed descriptively.

The study was approved by the ethical committee of the University of Heidelberg (S-344/2022). Informed consent was gathered prior to the interviews. Participants gave oral and written permission to record the interviews and perform data analyzation. They were later transcribed verbatim. The data were anonymized. Participants did not receive any compensation.

Through our analysis, we established the following main themes: health care and psychosocial services, and preuse acceptance of an app-based intervention (Figure 1). We listed the most important meaning units for preuse acceptance by comparing the views of our prospective users and experts.

At the end of the interview, we asked our participants some general questions about their opinions concerning digital health in Germany (Multimedia Appendix 1). They indicated that the state of digital health in Germany is at least mediocre. However, experts still had a higher opinion than our prospective users, where one even gave a zero, which was outside the given range of 1‐10. When asked about the need for more digital interlinkage between women and services, both sides estimated that the need is fairly high. Here, opinions did not differ between experts and users (Figure 2). We asked whether not only interlinking providers and users but also providers with providers might be beneficial. All the respondents thought that creating a digital network for service providers would improve access for women. A total of 13 out of 19 respondents thought it would also ameliorate the quality of services, while 6 respondents thought it would not have any effect on the quality. When we asked our service providers specifically, 82% indicated it would enhance their efficiency (Multimedia Appendix 3).

This study showed that most women already access information about perinatal services online and have a high willingness to take advantage of general perinatal services, in particular. Barriers consist mainly of a lack of knowledge, time and affordability constraints, and a certain degree of distrust in the qualification and effectiveness of the services. On the other hand, most experts stated that the services they offered are in high demand, and both pregnant women and young mothers reflected this in their interviews. This outcome can be argued in light of the sociodemographic background of our study participants and the region of Heidelberg, where the annual household average income is approximately €24,400 (approximately US $27,469), which is among the highest in Germany [25]. Our multicenter approach to the RCT, involving centers from low-income areas such as Berlin Tempelhof and more rural areas such as Jena, will provide a more representative study population. The next question we asked is whether the demand is high relative to what is being offered and the capacity of services, or whether services are saturated for other reasons, such as underfunding and understaffing. This fact was explicitly mentioned by some of our experts. While stating that their resources are limited, they also saw an urgent need to reach more families in need, suggesting that their services needed improved access points. This finding compares well with similar studies in Germany showing that there is, in fact, a need to improve access to perinatal services for hard-to-reach subgroups [14,26].

There is a significant amount of evidence pointing in the direction of mHealth for improving access to psychosocial treatments [27]. Furthermore, multiple studies showed that mHealth interventions had positive effects on a large range of psychosocial measurements, including self-management of health, acceptance of pregnancy, anxiety, depressive symptoms, perceived stress, mental well-being, coping, and self-efficiency. It also showed that mHealth interventions positively influenced social support from partners or health care providers. The greatest effect was observed in highly vulnerable pregnant women, leading to the conclusion that a perinatal navigator can effectively help vulnerable groups that we are missing right now [28-31]. In prior studies, interlinking women with service providers or enhancing self-help through mHealth interventions seemed to be the key concept. We took this a step further by asking whether it might be beneficial not only to interlink providers and users but also to connect providers with providers. All the respondents thought that access could be facilitated for women by creating a digital network for service providers. Most of the respondents thought it would also improve the quality of services. When we asked our service providers specifically, 82% indicated it would enhance their efficacy. Creating interdisciplinary networks within perinatal care is an ongoing aim for health care providers and has been shown to be beneficial, for example, in mental health settings [32,33]. So far, interprofessional networks have been based on personal meetings and consultations, and to our knowledge, a telemedical network has not yet been implemented within perinatal care. We submit that regional interdisciplinary networks can be created and implemented via a mobile navigator and will improve access to and uptake of perinatal services.

All of our study participants gave positive feedback and showed high preuse acceptance. Most pregnant and postpartum women have already used apps during their pregnancy. Promoting factors for app use from the user’s perspective were time-efficient self-education concerning evidence-based information, positive feedback mechanisms through symptom tracking, direct and easy contact opportunities to regional perinatal and psychosocial services, and networking possibilities. Providers estimated a destigmatization of risk factors, the low threshold for information, and for access to specific services, as well as the chance to better monitor high-risk pregnancy, as success factors for a perinatal app-based navigator. On the subject of perinatal and postpartum depression, a study from Varma et al [34] showed comparable results on acceptance and utility. Especially during the COVID-19 pandemic, we saw an increased interest in the subject of telemedical monitoring. Several studies showed that virtual visits and communication through telemedicine are highly accepted on both the patient and provider sides of health care [35-37]. Barriers to app use expressed by future users were mainly unawareness, data protection concerns, complexity of app use, hidden costs, or in-app advertisements, as well as the already high number of apps on the market. Providers added language barriers, low education profile of users, and mismatch of app design, denial of necessity, and psychological lethargy, as well as a general digital skepticism, to this list. Similar barriers to telehealth uptake, including level of education, telehealth literacy, and unawareness, were found in a multinational review by Kruse et al [38]. What differs from other studies is our family-centered approach in a multidisciplinary context, allowing multiple entry points, as well as a personalized solution for women and young families navigating through this phase.

There are several limitations to this study. The first and perhaps greatest limitation concerns our study participants’ socioeconomic status and level of education, which is only partly representative of the foreseen cohort of women with psychosocial risk factors from hard-to-reach socioeconomic niches. Furthermore, all participants were from the same geographic area, which might lead to results not being generalizable nationally. Nonetheless, tailoring the app to the needs of prospective users and health care providers should help the intervention to be more successful. Testing the mHealth intervention in a multicenter setting will help with representative data. Another limitation is the small sample size, which is characteristic of qualitative research methodology. To validate the data, we used researcher triangulation. Interviews were conducted by two investigators, and data interpretation was done in a team of three. By introducing a small survey with closed-ended questions, we were able to triangulate common notions on digital health.

This study demonstrated high acceptance of an app-based perinatal navigator both from the users’ perspective and the psychosocial and health care providers’ points of view. It also showed that creating better networks between users and providers, but also between providers and providers, will help improve access and quality of care. Feedback on requirements and content, as well as possible barriers, informed our concept and helped in creating all parts of the self-education guide. All information was curated by a team of health care professionals from different specialties, including midwives, gynecologists, psychologists, and pediatricians. The results from this study underscore the necessity for a multicenter RCT on the perinatal navigator.